Closing HEDIS care gaps

SPH Analytics’ HEDIS Care Gap Outreach helps close the gaps in member care which impact HEDIS compliance measures. We provide outreach to members, who have been identified as having gaps in their care, to educate and encourage these members to take action. Our agents can even proactively schedule appointments with the member’s physician to facilitate needed care.

SPH Analytics’ HEDIS Care Gap Outreach provides:

  • A warm outreach from trained and courteous phone agents
  • Encouragement to members to obtain appropriate screenings and preventative care
  • An effective method for closing care gaps in HEDIS compliance
  • An onsite call center with English/Spanish/Mandarin language options
  • Innovative technology and the ability to interface with other health plan systems

A high-touch, personal approach Call center agent

Knowing which members have gaps in their care is a critical first step. However, once identified, it is important that health plans then work with members to close these care gaps.

Our courteous and professional phone agents reach out to targeted members who are not meeting HEDIS compliance standards for treatment of specific conditions or for receiving important preventative screenings. We provide education, encouragement, and assistance to help ensure your members obtain needed care. Our HEDIS Care Gap Outreach is designed to engage members and empower them to take needed action. 

Closing the care gaps that impact HEDIS measures

Population health care gap icon

SPH Analytics recommends that plans begin by focusing on gaps that impact a large number of members, such as mammograms, colorectal screenings, diabetes care, heart disease, and flu shots. We work closely with our clients to develop an outreach program that meets your specific needs.

SPH Analytics can send a co-branded message to provider groups with large numbers of your members and/or with significant numbers of members identified as having gaps in care. This informs providers of the program and establishes office preference for appointment scheduling.

Member Outreach to Close Gaps in Care

We help you connect with members through multiple outreach programs to measure experiences and perceptions, analyze results, and provide experienced guidance to develop target action plans for measurable improvement. SPH  has the experience and expertise to successfully manage effective HEDIS Care Gap Outreach programs. Our onsite call center provides the innovation and technology to serve as an extension of your health plan, and we work diligently to improve the health of your members and close HEDIS care gaps.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Engaging Patients for Higher Measure Performance

multi-model patient outreach programs, by mail, email, text, live call, and IVR

A large academic medical center used SPH Analytics’ solutions to support an influenza vaccination campaign to close care gaps. The targeted patient contact emails and follow-ups had significant results. A first wave of emails was sent to 61,000 patients without documentation of a flu vaccination in the previous 12 months. A second wave of emails was sent to the non-respondents.

Results:

  • 7.4% of contacted patients responded affirmatively with the date and location of their current vaccination.
  • There was a 50.4% increase in the number of patients with a documented influenza vaccination from the previous 12 months.
  • The MIPS influenza vaccination measure performance improved from 13.2% (CMS Decile 3) to 40% (CMS Decile 7), for an overall increase of 203%.

Partner with a Trusted Leader

For more than three decades, SPH Analytics has helped healthcare organizations improve the experience and engagement of their patients and members. Let us bring our unique expertise and analytical and predictive approach to your organization’s challenges.