The Financial Upside of Closing Care Gaps in Care
November 20, 2024
Gaps in care harm health and raise costs. QliqSOFT's digital outreach automates patient engagement, boosting screenings and outcomes.
Key Takeaways:
- Eight percent of patients receive recommended preventive health screenings
- ACOs and FFS practices can create predictable revenue streams by using digital engagement to increase patient preventive health volumes
- Practices can earn significant incentive dollars increasing gap closure
Why are gaps in care important?
A gap in care is a discrepancy between medical best practice and the care the patient receives. Gaps in care include things like annual physicals, well-child visits and immunization, colorectal cancer screening, blood pressure monitoring, diabetes screening, and more.
45% of US deaths have been attributed to modifiable risk factors. Routine health screening is key to reducing healthcare burdens. Despite this, only 8% of people obtain all recommended screenings, per the National Institutes of Health. Looking at it another way, in 2021:
We are missing a huge opportunity to improve the population’s health and reduce costs. In 2023 the Medicare Shared Savings Program reduced costs $5.2 Billion, saving $2.1 Billion and paying participating Accountable Care Organizations (ACO) $3.1 Billion in shared savings.
In 2023 the Medicare Shared Savings Program reduced costs $5.2 Billion, saving $2.1 Billion and paying participating Accountable Care Organizations (ACO) $3.1 Billion in shared savings.
Even FFS organizations can benefit by Increasing Medicare Annual Wellness Visits (AWV) and preventive testing. These visits can be done by non-physicians, creating a predictable revenue stream for both clinics and outpatient testing areas. Rural hospitals can especially benefit, giving them a way to connect with their community and engage people who might otherwise go to larger markets for their care.
Influencing Patients is Essential
To succeed, organizations need to change patient behavior. Patients don’t schedule recommended screenings for many reasons, including:
- A lack of awareness
- Limited understanding of the risks and benefits of preventive health
- Cost concerns
- A lack of time
- Health equity concerns
Most patients do not have the health literacy to track and manage their health needs.
“Per the US Department of Human Services Report, America’s Health Literacy: Why We Need Accessible Health Information “Only 12 percent of U.S. adults had proficient health literacy…Over a third of U.S. adults…would have difficulty with common health tasks, such as…adhering to a childhood immunization schedule using a standard chart. There is an urgent need to address the gap between the health information currently available and the skills people have to understand and use this information to make life-altering decisions”
Digital Outreach Outperforms Traditional Calls
Today, physicians work with patients seen in the office to ensure that these patients are following best practice guidelines. EMRs and analytic systems can create lists of patients who are due for various preventive testing for staff to call. Yet, today, closing gaps in care is largely a labor-intensive telephonic effort. Given current staffing challenges, staff are only able to contact a small subset of patients who are due for testing. Compounding these challenges, a recent survey revealed that 75% of people do not answer an unknown phone call.
Talk to many healthcare providers and they will say that they don’t have the time or the resources to proactively contact patients to close gaps in care. There is an alternative. Proactive digital outreach with QliqSOFT’s digital communication platform enables organizations to use their EMR or analytic patient lists to automate the entire outreach and scheduling process:
Campaign automation enables the practice to connect with all patients in need of care. The virtual assistant delivers a personalized message to the patient at a 5th grade reading level explaining the preventive care needed, why it is important, and makes it easy to connect with portal self-scheduling systems. The result is a significant reduction in staff effort, increased revenue for the organization, improvements in population health, and increased patient loyalty.
Let us show you how we can help you.