Cutting Costs With Care Gap Alerts

How does a narrowing care gap translate to a payer's bottom line? Miller has yet to perform an analysis on ROI, but sees a "significant benefit." In the first six months, gauging by a single key metric?how often providers looked  at alerts on patients' records vs. how often providers searched to ascertain patients' benefit eligibility?AmeriHealth Mercy saw a 57% improvement in whether care gaps would be resolved.  

And there are analytical benefits. Payers may see the impact of care gaps by region, specialty, and cost. They can look for correlations between actions such as admissions and readmissions that translate into opportunities to close care gaps. Finally, payers can create comparative reports and identify practice outliers that can serve as case studies.

But a greater benefit looms: There are potential savings on services that may be avoided as a result of successful preventive screenings and procedures. Health plans are a long way off from being able to extrapolate what number of hospitalizations and surgeries could be prevented by providers acting on care gap alerts. But "that's exactly where we need to be," says Miller.