Identifying and closing potential gaps in care is a crucial step in improving patient care and patient outcomes, but providers aren’t always aware of existing potential gaps in care for their patients—and the current methods payers use to communicate potential care gap information are not always effective. Current methods require providers to proactively log into multiple payer portals to access the health plans for their various patients and alerts to potential gaps in care.

Unfortunately, those portals aren’t the only clinical support tools demanding clinicians’ time. Many providers juggle 6 to 20 technological support tools. These tools are external to practices’ electronic health records (EHRs) and, as a result, are generally more difficult to access. The exponential growth of this type of technology has created a serious challenge for modern clinicians, recently dubbed the “crowded desktop” problem.

Such third-party solutions have demonstrable benefits: 74% of physicians using such tools report changing patient diagnoses or treatment plans based on insights gained from them. However, the “crowded desktop” problem means that providers often fail to use EHR-external tools despite their benefits. The result? Numerous opportunities to improve patient care and patient outcomes are missed.

Identifying potential gaps in care

Research from the Agency for Healthcare Research and Quality (AHRQ) highlights the importance of identifying and closing gaps in patient care, revealing that only 8% of patients receive all recommended preventive care. Nearly 5% of patients receive none of these recommended services. By identifying potential gaps in care and communicating relevant care gap information to physicians, payers can help providers access a more complete view of their patients’ health—creating a valuable opportunity to improve patient care.

Payers have access to large quantities of potentially helpful data on their members’ health, enabling them to identify risk and care gap information beneficial to providers. However, this care gap information is currently delivered via multiple difficult-to-use external systems, significantly contributing to the crowded desktop problem. The required processes are generally time-consuming, error-prone, insecure, and unreliable. Even if providers do access care gap alerts for their patients, that information may not align with currently scheduled patient visits. As a result, care gap information is significantly less likely to be seen at a time and place when it can be applied to patient care. 

Need for a solution

For care gap information to positively impact patient care, that information needs to be accessible at the point of care, during the provider’s normal clinical workflow for their patients. Payers and providers need a better way to communicate relevant care gap information—a method that seamlessly coordinates with the provider’s existing processes and workflows. That doesn’t mean adding more steps, more apps, or more tools to the provider workflow; a true solution needs to reduce the current “crowded desktop” burden on practice staff and clinicians, not increase it.

This means a true solution must replace the disparate tools currently required to access potential care gap information, instead presenting information from multiple payers in a single, aggregated view.

To be effective, a successful solution must:

• Consolidate information from multiple payers into a single common workflow
• Be easy to use—which, ideally, means it must be EHR-agnostic, free for provider use, and able to deliver care gap alerts to the point of care, directly to individual patients’ EHR records 
• Deliver alerts in a timely manner
• Providing relevant, patient-specific considerations for providers to evaluate and address with patients 

Veradigm Payer Insights

This need for improved payer-provider care gap communications is the reason behind one of Veradigm’s recent developments: Veradigm Payer Insights. This dynamic solution is unique in its ability to deliver care gap alerts to providers and staff via their EHRs, directly within their existing clinical workflow. A provider-facing alert is generated within the specific patient’s EHR record when a potential care gap has been identified. Integrating alerts into providers’ existing clinical workflows makes care gap information significantly more likely to be seen and addressed when and where it can be most beneficial. 

How it works

Veradigm Payer Insights functions by connecting to the practice’s EHR and analyzing upcoming appointment information to identify eligible patients. Patient information is sent to appropriate payers (from a network of over 100 payers); payers analyze patient data to identify potential care gaps and then generate alerts, which are returned to practices. Veradigm Payer Insights notifies providers of relevant alerts via a visual prompt within the appropriate patient record(s).

Alerts contain patient-specific considerations, which providers and support staff review, evaluate, and address with patients as part of their existing clinical workflow. They also provide supporting documentation as needed. 

Benefits to payers, providers, and patients

Veradigm Payer Insights simplifies the process of identifying and communicating about potential care gaps for both payers and providers. It enables payers to utilize providers’ EHR data to identify potential care gaps according to their criteria and then deliver alerts directly within the patients’ EHR records. It also streamlines the communication process for providers and staff, removing the need for them to waste time and energy logging in and out of multiple payer portals to access care gap information. As a result, providers can be more confident of meeting their patients’ needs and improving overall patient care. 

Patients benefit from improved health outcomes and fewer unnecessary tests.

Improving patient care

Identifying and addressing gaps in patient care is a crucial step toward improving patient care and improving patient outcomes. Increasing the number of patients who receive recommended patient care leads to earlier diagnosis of numerous diseases and chronic diseases; earlier diagnosis often allows treatment to begin sooner—which can lower healthcare costs, improve patients’ quality of life, and improve patient outcomes.

Contact us today if you’d like to see how Veradigm Payer Insights can help you improve the level of preventive care delivered to your patients.