Cutting Costs With Care Gap Alerts
Qualify for a free subscription to HealthLeaders magazine.
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.
Cora Nucci is the Digital Associate Editorial Director for HealthLeaders Media.
- CMS Sets 2014 Pay Rates for Hospital Outpatient and Physician Services
- FDA hopes hospitals will switch to newly regulated pharmacies
- The 5 Biggest Healthcare Finance Trouble Spots
- Not-for-Profit Hospitals Find Opportunity Amid Uncertainty
- Nonprofit Hospital Outlook 'Negative' in 2014
- The Most Polarizing Topics in Healthcare IT
- How CPOE Will Make Healthcare Smarter
- Why You Should Involve Patients in Nursing Handoffs
- Are ACOs Really Different from HMOs?
- Rise of the Chief Strategy Officer