According to the National Committee for Quality Assurance (NCQA), “the Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 92 measures across 6 domains of care. Because so many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an “apples-to-apples” basis.”

The challenge with managing care gaps at the provider level is two-fold:

1. How do we identify patients with a potential gap in care and then confirm the gap exists?
2. How do we engage the patient to close the care gap and follow through to make sure it is closed?

Silverline, a platinum Salesforce consulting partner with a dedicated healthcare vertical, has designed a solution to both challenges on the Health Cloud platform. The key components include:

• Care Gaps Case Record Type
  • Similar to a referral management or appointment scheduling case, it includes details about the patient, care gap, and service required to close the gap (for example, a colorectal cancer screening via colonoscopy)
  • This record can be created based on health maintenance information from the EHR identifying the patient as a candidate for engagement based on a care gap
  • This can also be created based on claims data for a specific managed care population
• Campaign linked to Care Gap case for outreach to a group of patients to notify them of a health maintenance gap with a call to action to close this gap
  • This can be an email campaign directing the patient to call and schedule
  • This also can be a queue for outbound calls from a call center agent
• HEDIS Measure Custom Object
  • Consolidates specific information about the appropriate quality measure including eligibility criteria, options for closing the care gap, and best practice
  • A Care Gap Case is always linked to a HEDIS Measure record
• Knowledge Article – FAQs
  • Includes the purpose of the test/procedure, screening options
  • Can be emailed to the patient by the agent or automatically included in the campaign email
• Provider Search and Appointment Scheduling
  • Incorporates Silverline’s robust provider search accelerator to determine the appropriate provider and facility, within the healthcare organization’s provider network, to close the care gap
  • Leverages the Silverline ScheduleMe.Health to provide real-time availability of provider availability across multiple external scheduling systems
  • These functions can also be used online in a self-scheduling model

These components provide the framework for identifying care gaps for patients, creating actionable records in Health Cloud, and automating engagement to close the care gap and update the EHR.  Since every healthcare organization is unique, the care gaps accelerator can be configured to meet specific care gap management needs and process flows.

Silverline, with its care gap management solutions and accelerators, can provide a framework for developing programs to address gaps in care, keep more patients in network, and exceed quality measures. Silverline can help organizations build the tools to manage referrals, perform nurse triage, manage a provider network, manage a risk-based population and much more.  Wherever you start, Silverline has the tools and the experience to help you be successful.

Learn more about Silverline’s gaps in care solutions.