What is a "Gap in Care?"

Experienced benefits leaders know that one of the most effective ways to reduce their overall health spend is to direct their efforts on those employees with chronic conditions. One way they can do this is by focusing on what is known as “gaps in care.”


If you’re looking to implement this strategy in your organization, it raises a fundamental question: What exactly is a “gap in care?”

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.

See it in action

Discover how Springbuk empowered a consulting firm to improve care efficiency of members through curated strategies that mitigate risk and decrease overall cost.