Five ways to close gaps in care and build a successful quality improvement program

A core requirement for health plans across the country is measuring and reporting on quality metrics. However, directly influencing those metrics can often be a struggle. Improving quality metrics is directly correlated with identifying and addressing gaps in care. By deploying a proactive, year-round strategy that aligns data analytics with a focused approach for addressing gaps in care, your organization can turn routine quality measurement and reporting activities into a true strategic advantage by ensuring that quality measurably improves across key metrics.

Gaps in care: clinical perspective

A critical component of improving quality scores and outcomes is recognizing the challenges faced by your physician network in closing gaps in care and engaging with providers about building a quality improvement strategy. Physicians and staff spend an average of 15 hours per week closing gaps in care and satisfying quality measures, while provider organizations spend an average of $40,000 per physician per year to satisfy their quality initiatives-and that cost is expected to go up due to the prevalence of risk-based contracts. Often, providers are not well equipped to meet the primary driver of quality: closing gaps in care.

There are three foundational pillars that make up the strategy for providers to follow to improve quality: patient engagement, quality scorecards, and population health management.

Using claims data is the easiest way to identify patients who have not been seen before the measurement period ends. Providers can create patient lists in early September to have patients come in by the end of the measurement year to close as many gaps as possible. From there, staff can perform immunizations, order lab tests that were missed, and most importantly, schedule patients for face-to-face visits with their primary care provider. The most meaningful patient engagement occurs in the exam room. Face-to-face contact is the number one tool to close gaps in care, outranking mobile apps, patient portals, social media, or surveys.

Timely and actionable quality scorecards also demonstrate to providers where the gaps in care are for their patients. Physicians should be engaged in how the scorecards are designed and at what intervals they should be delivered, such as monthly or quarterly.

Finally, population health analytics help providers aggregate member data, assess population risk, stratify their patients based on risk/gaps identified, identify gaps in care, engage patients based on need, and close gaps in care and improve quality.

Next: Five ways to build a strategy

Building a strategy to address gaps in care

When building out a year-round quality improvement program, there are several key items to consider: you need senior leadership buy-in and organizational investment to create a sustained program, the program must be continuous to make an impact (not seasonal), and you need to prioritize quality improvements to create change. Furthermore, you need an adaptive company culture that always seeks improvement.

1.   One challenge that exists in creating a year-round quality improvement program is selecting the right HEDIS measures to target. Examine the measures that are likely to have the largest financial impact for your organization, or where you’ve seen the largest cost increases. Use your most recent HEDIS submission run as a baseline, then prepare for monthly proactive runs to track improvement. Use NCQA percentiles or CMS Five-Star cut points as benchmarks while also factoring in internal or state benchmarks.

2.   From there, formulate your strategy to achieve buy-in from your provider network. Determine what kind of financial incentives you’ll provide them-if that’s the appropriate strategy-what targets they must hit, and how often these incentives will be distributed. Structure the incentives to ensure your providers drive continuous improvement.

3.   Another key component of a successful quality improvement program is to establish a platform for collaborative learning, creating a space to discuss the program to encourage cooperation among team members and allow the sharing of knowledge, evidence-based practices, successes, and challenges. It should also serve as a space for the team to provide feedback to leadership on the program.

4.   Choosing the right team for your quality improvement project and making sure they have the right tools to support them is critical. Identify key players who can drive performance across your measures, then pinpoint areas of improvement, plan and make changes, and track progress over time. In addition to the right people, you also need the right tools to find gaps in care and report the data accurately and efficiently.

5.   Finally, it’s critical to continually evaluate performance, share results, and make adjustments based on those results. It’s not about crossing items off your list in the short term, but planning for the lifecycle of your program in the long term.

To close gaps in care and build a successful quality improvement program, payers not only need to engage directly with providers and members, but their own internal staff and leadership. Without extensive organizational buy-in and a sustained investment in ongoing resources, your program won’t succeed in the long term. By making a data-driven decision to determine which measures to prioritize, creating targeted financial incentives that will help drive improvement, measuring results, and then making adjustments based on successes and failures, your organization will be well positioned to support better care going forward and see greater success during each annual HEDIS season.

Philip Finocchiaro, MD, FACP, is senior medical director of quality and clinical outcomes at Verscend Technologies.