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Third-Quarter Push—and Why Closing Care Gaps Is Only Going to Get More Difficult


The second half of the year is in full swing now, and you’re likely (and smartly) conducting a Q3 business review to see where you stand with your yearly goals.

If you have outstanding gaps in care, and most plans do at this point, or your outcomes metrics aren’t headed in the right direction, now is the time to follow up with members. A particular focus for some plans might be reaching out to members who haven’t completed their annual physical exam or HEDIS® preventive care measures, like colonoscopies and breast cancer screenings.

But the sooner you act, the better.

“Waiting until the end of the year to address outstanding care gaps can put both your population’s health and your plan performance at risk,” says Carenet Chief Client Officer Vikie Spulak. “Scheduling an in-person doctor’s appointment at any time during the year can take weeks, even months. Booking an appointment at year-end can be even more challenging, if not impossible.”

High healthcare consumer demand, and providers only have so many appointments

Year-end appointments are often in high demand as plans make last-minute attempts to close gaps in care and meet their annual HEDIS goals by getting their members into providers for exams and health screenings.

Provider offices are also inundated with people who have money remaining in their flexible spending accounts rushing to spend it before they lose it, and with those who have met their insurance deductibles scrambling to take advantage of cost-savings before the calendar flips.

The fourth quarter is also the busiest time of the year for many people, both professionally and personally, thus making it even more difficult to schedule medical appointments.

Keep member satisfaction and treatment timelines in mind, too

Limited provider availability and appointment scheduling challenges can contribute to member frustration, higher nonadherence rates, and services performed outside of the recommended timeframe and plan network.

“While a year-round approach is the best strategy for achieving a high gap-closure rate, there is still time to contact members, coordinate appointments and follow up to ensure follow-through,” says Spulak. “But plans need to act now, otherwise they could jeopardize their member satisfaction, clinical outcomes, and bottom-line results.”

Is your health plan on track to meet year-end goals? Read about two more customer-centric steps you can take right now to make a difference, quickly. Or contact us to connect today.

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


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