What is a "Gap in Care?"

Experienced wellness professionals know that one of the most effective ways to reduce their overall health spend is to focus their efforts on those employees with chronic conditions. One way they can do this is focusing on what are 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, but the most common include:

  • Individuals missing age-based or seasonal screenings or vaccines.
  • Individuals not consulting with their doctors over a prescribed medication that might not be appropriate for a patient.
  • Individuals 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 wellness programs accordingly? Here at Springbuk, we have some pointers.

How to Spot Gaps in Care in Your Population

For most organizations, the most difficult part of closing care gaps is identifying care gaps. Far too often, HR professionals eschew analytics platforms that can produce actionable insights, instead focusing on historical claims data. This means that employers are stuck looking in the rearview mirror while they try to drive their healthcare costs down with an effective wellness program. 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.

The good news is that forward-thinking brokers and wellness vendors are increasingly relying on rich data platforms like Springbuk to consume all of this disparate data sets and crunch those numbers to generate real actionable insights for them. Our platform, for example, provides detailed information about each member of the population who has a Gap in Care, how much that population is projected to cost you over the next year. This helps you make data-driven decisions on where to allocate wellness & chronic disease management budgets in your future plan.

What to do After You Identify 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 account for 39% of total future health spend.

That said, your next steps will vary depending on how your wellness program is currently set up. 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, but they can use this aggregate data strategically to craft their wellness programming and messaging. 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 that are 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 increase your wellness program’s impact in your organization.

Who Usually Has a Gap in Care?

Because our health analytics software monitors gaps in care for hundreds of organizations across the United States, we have a lot 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

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 what gaps exist in your population, or you may have nothing but claims data 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 you have been provided by your broker and other wellness partners, you can use that information to craft your wellness strategy. This means that, instead of blindly planning your wellness activities and educational programming based around intuition, you can plan 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 wellness is truly making your population healthier?. Maybe you’re getting 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.

If you need better data on your wellness programs, are tired of manually manipulating claims data, or just really want to grade your vendors effectiveness on improving the health of your population then, set up a demo of Springbuk.

If you’re interested in learning more about how Springbuk’s Employer-facing Health Intelligence Platform can help you identify cost savings opportunities, manage Gaps and Care ,and you reduce future health spend, click here to schedule a demo or download our E-Guide on Health Analytics.