A “gap in care” is defined as the discrepancy between recommended best practices and the care that is actually provided. This can manifest itself in several different ways; the most common include:

  • Individuals that are missing age-based or annual screenings or vaccines
  • Individuals who do not consult with their doctors over a prescribed medication that might not be appropriate for a patient
  • Individuals that are not adding a medication to meet evidence-based guidelines

So, given this definition, how do you identify gaps in care in your population and design benefits programs accordingly? Below are a few key areas to help you get started:

How do you identify gaps in care?

For most organizations, the most challenging part of closing care gaps is identifying care gaps. Instead of focusing on actionable data that could craft tomorrow’s wellness initiative, too many employers rely on carrier reports that only identify what’s already happened, not what they can do moving forward. This means that organizations are stuck looking in the rearview mirror while trying to drive their healthcare costs down with effective initiatives.

The good news is that forward-thinking benefits leaders and vendors are relying on intelligent solutions to consume all of these disparate data sets and generate actionable insights for their populations. The Springbuk Health Intelligence platform, for example, provides detailed information about each member of the population who has a gap in care and projects how much that population will cost you over the next year. This helps employers and consultants make data-driven decisions on where to allocate chronic disease management budgets in your future plan.

What are steps to closing gaps in care?

Once you’ve identified a gap in care, it is extremely important that you take action. According to the data that we’ve seen from hundreds of employers, organizations could save, on average, $439,000 from members with gaps in care. In fact, 26% of members have a gap in care, but they account for 39% of their total future health spend.

Your next steps will vary depending on the current step-up of your organization’s benefits plans. Ideally, employers who work with a third-party wellness vendor or clinic can focus on closing gaps with members of your population.

Employers without third-party wellness vendors will likely be unable to intervene at an individual level. Still, they can use this aggregate data to craft their benefits programming and messaging strategically Some of the successful employer initiatives that we’ve seen include:

  • Email campaigns educating populations on their most common gaps in care, and emphasizing the importance of closing those gaps
  • Seminars focusing on chronic disorders commonly found in most organizations
  • General education or activities designed to appeal most directly to individuals who have a gap in care

In this way, it’s not always essential that you intervene directly with an individual who has a lapse in care. Instead, you can use this high-level overview data to inform your decisions and maximize the impact of your organization’s health investment.

Who usually has a gap in care?

Because our Health Intelligence platform monitors gaps in care for thousands of employers across the United States, we have a vast amount of data around the impact that gaps in care have on healthcare spend. While every organization is different, we’ve noticed trends in general healthcare compliance. Based on our research, these are the percentages of members who are compliant to care:

  • Diabetes: 3% Member Compliance
  • Coronary Artery Disease (CAD): 19% Member Compliance
  • High Blood Pressure (HBP): 29% Member Compliance
  • Cholesterol: 37% Member Compliance
  • Rx Management: 64% Member Compliance

How has the 2020 global pandemic impacted gaps in care?
When our team began gauging the impact COVID-19 could have on gaps in care, our Sr. Director of Health Strategy Services, Jennifer Jones, highlighted that 60% of Americans currently have a chronic disease. Furthermore, 40% of these individuals have two or more conditions.

"This is important because we know when members meet all their care guidelines, they're more likely to have more control over their condition. And, in turn, control future costs to treat those conditions, minimizing the risk of complications moving forward." - Jennifer Jones

Over the coming months, we are likely to see an uptick in non-compliance with chronic conditions. This could lead to increased risk and drive up costs for long-term condition management solutions.

To provide employees with additional support during these times of social distancing and stay at home orders, one tactic employers might explore is the introduction or expanded use of telemedicine. While some organizations may experience a learning curve at first, this alternative could be a reliable substitute for in-person visits, be that condition-focused or preventative.

Next Steps: Actionable insights that you can use to close gaps in care

If you’re interested in identifying and closing gaps of care in your organization, there are a few things that you can do today that can make a giant impact on your future healthcare costs.

Step 1: Get a Grip on Data – The first and most important step you can take is looking at the data that you’re currently collecting on gaps in care. Depending on your broker and analytics provider, you may have extremely robust data around your population gaps. However, you may have nothing but claims data that you have to piece together yourself. These may come in the form of static PDFs and carrier reports, or you may be able to dive into a platform that analyzes the data for you.

Step 2: Educate Your Population – Once you have a solid understanding of what data your broker and other vendors have provided you, you can use that information to craft your benefits strategy. This means that, instead of blindly planning your wellness initiatives activities and educational programming based around intuition, you can design them around actionable data.

Step 3: Evaluate Your Vendors – Finally, if you’ve gone through this process, there’s a good chance that you’re not happy with the results you’re getting. Maybe you’re not getting robust enough data from your broker or unsure if your benefits plan is truly making your population healthier. Perhaps, you’re receiving data, but your inability to intervene directly is hurting your population. Either way, now that you’ve exposed a pain point, explore options that can augment or replace your current vendors to improve your situation.