A gap in care is an instance in which a patient has not received a healthcare service or intervention that they should have, based on established guidelines. HEDIS scores can suffer when patients do not consistently receive appropriate screenings, check-ups, treatments, vaccines, and other types of care. Thus, closing care gaps helps not only to improve HEDIS scores, but also to deliver care for patients.
Most importantly, closing care gaps – or preventing them from being created in the first place – can help patients to enjoy better health. For example, a care gap might be the result of a missed screening that could detect a disease early, when it is most treatable – or not receiving a recommended vaccine that could prevent an illness. Not only could closing these kinds of gaps have a positive impact on patient health, but it could save their health plan the costs of treating diseases (which are significantly higher than the costs of screenings and vaccines).
In other cases, closing a care gap can be a matter of effectively managing a chronic condition through monitoring and adherence to a treatment plan – helping prevent complications over time.
For health plans and other healthcare organizations, it’s also critical to close care gaps in order to improve HEDIS scores. When a health plan’s patients do not consistently receive appropriate healthcare interventions and services in line with HEDIS measures, the resulting care gaps can be detrimental to HEDIS scores. By preventing this from happening, a health plan can protect its reputation – helping it to receive a high Medicare Star Rating (if relevant) and performance-based financial bonuses, and to attract more members.
In short, closing care gaps can not only help patients stay safe and healthy, but also help health plans and other healthcare organizations ensure their financial sustainability.