Care Gap Closure Agent

The work it takes off your plate

Quality and value-based programs leave money and outcomes on the table when mammograms, A1c tests, colon screening, and chronic care visits remain overdue. Care managers cannot manually reconcile EHR, claims, and registry data for every attributed patient. Outreach is often generic and poorly timed, leading to low closure rates. The Care Gap Closure Agent continuously finds open gaps and orchestrates targeted outreach and scheduling to close measures.

How it works

The Care Gap Closure Agent aggregates quality measure definitions, clinical events, and claims evidence to identify open care gaps by patient. It prioritizes outreach by measure weight, due date, and patient engagement propensity, then coordinates messaging, ordering, and scheduling workflows. Closure evidence is written back to registries and quality engines for accurate performance tracking.

1. Step 1: Identify Open Care Gaps

   • Load HEDIS/STAR/internal measure logic and attribution rosters
   • Reconcile EHR encounters, labs, imaging, and claims exclusions
   • Produce patient-level open gap lists with due dates and evidence gaps

   Result: A trusted inventory of open quality and chronic care gaps is available.

2. Step 2: Prioritize Outreach Cohorts

   • Score gaps by contract impact, clinical risk, and time-to-deadline
   • Segment patients by preferred channel and historical response
   • Assign ownership to care managers or automated campaigns

   Result: Outreach work is sequenced for maximum measure and clinical impact.

3. Step 3: Orchestrate Closure Actions

   • Send multi-channel outreach with measure-specific education
   • Offer self-schedule links or place orders for overdue screenings
   • Escalate non-responders to care manager outreach queues

   Result: Patients receive actionable pathways to complete overdue care.

4. Step 4: Confirm Closure and Report Performance

   • Detect completed labs, imaging, vaccines, and qualifying visits
   • Update quality registries and close gaps with audit evidence
   • Report measure movement, outreach yield, and remaining gaps

   Result: Closed gaps are documented and quality performance is measured accurately.

Why use it

• Improves HEDIS, STAR, and internal quality performance with proactive gap closure. Reduces manual registry work for care management teams. Targets outreach so high-impact gaps close before measurement year end. Creates audit-ready evidence trails for closed measures.