The U.S. healthcare system is highly fragmented in nature. Poor care coordination and disparities between best practices and the care received can lead to dangerous clinical errors, poor patient outcomes, and increased healthcare spending.
As such, payers and other healthcare organizations are increasingly searching for ways to identify and bridge gaps in care to improve care coordination, quality performance, and individual health outcomes. Care management is especially important in treating patients with chronic and often costly conditions, as the consequences of non-adherence (or other gaps in care) are often more substantial.
Additionally, the COVID-19 pandemic created numerous gaps in care. According to the Centers for Disease Control and Prevention (CDC), approximately 41 percent of U.S. adults have either delayed or avoided medical care during the pandemic, putting off provider visits and screenings, medication refills, and more.
Here is what you need to know about identifying and addressing gaps in care:
What Are Gaps in Care?
What exactly are gaps in care? Although they can manifest in many ways, some of the most common examples in modern healthcare include:
Skipped Health Screenings
Recommended health screenings for U.S. adults that meet certain qualifications—such as age, gender, or diagnosis of a chronic condition—are essential to minimize health risks. Screenings help providers catch warning signs early on, making health issues easier and more cost-effective to treat. Pap smears, prostate cancer screenings, mammograms, and blood pressure screenings are examples of age- and gender-related recommendations that can pose significant risks when skipped.
Poor Medication Adherence
Medication non-adherence is probably the most common issue as far as gaps in care are concerned. Poor adherence to prescribed medications can lead to negative health outcomes, unwelcome side effects, worsening health conditions, and even mortality. Plus, medication non-adherence negatively impacts the health system as a whole by increasing the costs of care due to having to manage adverse effects from not taking medications properly.
Insufficient Medication Management
Medication management—the ongoing process to identify and address common drug-related concerns—is another area in which patients experience gaps in care. When medication management is lacking, patients can experience drug-disease contraindications, drug-drug interactions, and improper duration of treatment. Poor medication management can also lead to missed patient-specific precautions, creating safety concerns for certain individuals.
Missed Vaccinations and Boosters
Missed vaccinations and vaccine boosters also create gaps in care. Flu shots and shingles vaccines are examples of immunizations that, when missed, can pose increased health risks. Additionally, failure to get recommended vaccinations can put others at risk.
Using AI to Bridge Gaps in Care
Bridging gaps in care is possible with the right technology, data, and strategic approach. Healthcare organizations are now leveraging artificial intelligence (AI) to identify and bridge gaps in care. AI-powered patient engagement programs make a positive impact on medication adherence, therapy initiation, and other gaps in care.
How? Using AI, machine learning, and predictive analytics, it is possible to predict each patients’ risk of non-adherence or similar gaps in care. Once the AI identifies high-risk individuals with the greatest likelihood of being influenced by an intervention, it predicts the best channel, messaging, timing, and frequency for each of them.
This highly personalized approach allows payers, pharmacies, and other healthcare organizations to provide clinical education that closes gaps in care and improves quality performance—and your organization could be next.
About the Author
Dr. Linda Schultz
Dr. Linda Schultz is a results-oriented Healthcare Pharmacy Executive who excels at leading transformational, top-notch, interdisciplinary healthcare teams to create and execute outcomes driven clinical operations and account management initiatives. Dynamic and knowledgeable in all healthcare business segments, most passionately within the complex Medicare, Duals and Medicaid markets, she is an accomplished, creative motivator and driver of innovative quality and cost of care pharmacy interventions. Dr. Schultz is currently VP, Customer Success at AllazoHealth, a cutting-edge, healthcare artificial intelligence company. Prior to her leadership role at Allazo, Linda founded and led RxHorizons, LLC., an international healthcare consulting group. Her expertise stems from over 25 years of experience within the Managed Care industry, with a focus on leading, strategizing, developing and implementing pharmacy benefit management activities within national PBMs and health plans.