Closing HEDIS®-related care gaps for large numbers of health plan members and patients has long been a challenge for payers and other organizations concerned about value-based care and related quality and cost measures. Outreach has been expensive and cumbersome, and achieving strong return on investment hasn’t been easy.

Why is it so hard to close gaps in care?

The reasons for the challenges are many, but they start with a healthcare delivery system that’s fragmented, confusing and anything but convenient. Healthcare consumers are often frustrated and simply don’t take action on necessary care prevention and treatment adherence. Even when a patient or member is motivated and engaged, there are multiple friction points along the way to an appointment completion; crossing the finish line is often difficult. (And that’s not even considering the coding issues that can be a problem between providers and payers, which can impact whether a gap has really been closed.)

Innovation and optimization in HEDIS engagement

At Carenet Health, we’ve been leading successful HEDIS engagement efforts for our clients for years. But we also know that optimization and innovation are everything. We are always looking for ways to seamlessly reach more members and more providers, schedule more appointments faster and with less work on everyone’s part, and deliver it all at an affordable cost for our clients.

Now, with the acquisition of the OpenMed platform, Carenet is able to offer an even more comprehensive and higher-performing HEDIS engagement solution.

The enhanced solution includes technology-driven, bi-directional communication and access to care—and engages BOTH members and providers digitally first, before any 1:1 live phone outreach is attempted.

Highlights of the expanded solution for closing gaps in care

At a big-picture level, the new Carenet Health solution delivers more effective and efficient gap closures and appointment-setting on a large scale via:

  • Patented, no-integration-needed technology that requires no login or credentials for anyone to use
  • Access to the industry’s largest database of providers (OpenMed’s proprietary network includes all PCPs in the U.S. and Puerto Rico and much more)
  • A focus on the power of the patient-doctor relationship
  • Automated yet personalized messaging
  • Asynchronous communications and actions
  • Simplified member decision-making

Clients can expect that use of the OpenMed platform alone can increase gap-closure conversion rates by a minimum of 20%-30% over other methods of outreach. After a certain number of days (determined by the client), the client can choose to add live phone outreach by Carenet’s highly skilled healthcare engagement teams to reach out to both members and providers not activated through the OpenMed platform. This can improve yield by another 20% to 30%.

So much more than multichannel engagement

This isn’t just a typical digital channel solution, though. Let’s break it all down a little more.

  • First, we leverage the open-network OpenMed platform to send large volumes of highly personalized messages with the touch of a button.
  • AI-driven, behavioral science-based messaging sends messages via consumers’ preferred channels—texts, emails, apps, interactive voice response.
  • Each message includes the name of the individual’s primary care physician if available (or nearby, in-network options if not). Our communications offer patients the confidence of knowing these are physician-recommended actions they need to take.
  • Members choose from a set of appointment options on their own time; practices receive and confirm on their own time.
  • There are no friction points, no three-way calling needed, no engagement fatigue or member abrasion.
  • Practices also receive codes for easy EMR notes, care and billing with appointment requests.
  • Automated follow-ups are deployed to ensure appointments occurred.
  • Continuous outreach can be triggered by new data; no starts and stops of engagement campaigns.

As a final step, we leverage our industry-renowned phone engagement teams to help those who haven’t responded yet.

Think of this enhanced solution as a bit like the restaurant world’s OpenTable app, but for appointment scheduling.

Now for a quick recap of the problem—and the solution.

If you’re interested in learning more, please reach out to us as soon as possible, as demand is high. You can also download this overview.

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