Healthcare Shorts: Predictive and Closing Gaps in Care

This post has been republished via RSS; it originally appeared at: New blog articles in Microsoft Tech Community.

Story Background


Proactive detection of any condition gives us the ability to take necessary interventions. Preventative care is vital in the healthcare industry as a whole. It helps to stem and forestall any potentially serious health problems.


Business Challenge 


Gaps in care refer to the difference between the care provided to patients and the recommended best practices in healthcare. Gaps can manifest in several ways: A patient in an at-risk age group fails to comply with recommended screenings or preventative care such as a mammogram, colonoscopy, or missed immunization. And it is not just important for the patients. It affects the bottom line of providers and payors too.


Business Outcomes 


Positive impact on HEDIS compliance measures [Healthcare Effectiveness Data and Information Set]. An 8% conversion rate across two gaps in care has the potential to deliver over $10M in incremental revenue on average. Improvement in patient’s lifespan and activity of daily living.


Solution Overview 


This model provides recommendations on the next best action to members, who have been identified as having gaps in their care, to educate and encourage them to take action. Calls made to the call center are addressed first and then opportunities are offered. Patient engagement that helps reduce gaps requires more than just knowing the patient’s medical history.

  • Nudge members to obtain appropriate preventative care
  • Once identified, it is important to work with members to close the care gaps.

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