Part 1: Closing Care Gaps to Achieve Quality Goals

Article 3:

Best Practices for Closing Care Gaps

In articles one and two of our delivering value series we discussed the different types of care gaps, the effect gaps have on quality of care and suggested ways to identify and prioritize them.

In this article, we present ways that providers can best close care gaps after they have implemented an operating strategy that incorporates cyclical review of all gap types and prioritizes regular information sharing with the providers who manage patient relationships.

How Successful Providers Close Gaps and Increase Quality of Care

There is no substitute for face-to-face communication, and in fact, it is critical to addressing and closing care gaps.   We have found that no piece of technology can do a better job reconciling health measures than a prepared provider can do in the presence of a patient.

In an article published in Athena Insight, Dr. Kirsten Meisinger, marshaling her experience combining data and personal connection to improve quality of care, wrote “Relationships still matter.”  We agree.  Time spent reviewing the myriad of recommended screenings and measures builds the relationship and improves adherence.  In fact, patients deeply appreciate the attention to detail, feeling it as affection, reports Meisinger.

From our own experience, it is clear that high-performing providers focus on two simple things:

  • getting each patient into the office, and
  • focusing on their care needs during the visit.

While these priorities are not complex ideas, operationalizing them can require resources, planning, and discipline.

Get Patients into the Office

Providers’ personal connections with their patients are of paramount importance to closing care gaps, but that doesn’t mean technology doesn’t have a role to play. There can’t be a successful provider-patient relationship if the patient doesn’t make it into the office.  This requires patients both make and keep appointments.

In our previous article, Welcoming New Members in a Value Based-Care Environment, we described having an active scheduling process for making appointments.  Triage, outbound calling, and welcome packages are all part of the process for getting the first appointment scheduled, and follow-up appointments need to be booked as part of the office visit discharge process.  However, making sure patients keep their appointments is important to avoid waste as well as to achieve outcomes.

Once an appointment is booked, forward-thinking providers have discovered that robocall reminders are not effective. They’re automated, yes.  But they are also impersonal and easily ignored.  Instead, modern appointment management solutions engage patients through voice calls, texts, emails, smartphone apps, or push notifications or a combination of all five.  An interesting study of appointment no-show reduction techniques in an orthopedics practice setting by Wegrzyniak et all. suggests that text and phone reminders are the most effective but emphasizes the effectiveness of patient-chosen channels over all others.  Further, however, a 2010 study by authors Parikh et all. shows that the best reminder is the call from the office staff.  While this is not always practical, other research compiled by Athena Insight advocates a multi-mode reminder program to cover all the options and leverage premium resources.

Focus on Patient Needs

With the opportunity for face-to-face contact afforded in an office visit, providers are in a unique position discuss an integrated view of the patient data available and solicit patient comments.  Preparation for such an encounter is very important to make the most of the time, and reviewing the information you do have available with the patient is vital.

Preparation for a visit can flow from the development of an After-Visit-Summary (AVS).  Authors  Hummel and Evans emphasize in a technical guide published by Health that the process of preparing to have the necessary information to produce an AVS can focus a care team on making ready for an encounter through a process they refer to as a huddle.

Further, according to the guide, carrying through on the AVS production process can have three significant benefits on the encounter at hand and encounters that the patient may have with other care providers:

  1. Enhances memory of the specifics of the encounter
  2. Supports patient engagement
  3. Improves quality of information captured in the EMR.

The AVS production process can, in fact, start conversations at the beginning of an encounter through discussion of the requisite pre-visit summary with the patient.  Such an approach reflects the fundamental truth that the patient is the common link across providers and can help providers identify immunizations or other interventions performed at work or in other clinical settings about which the provider may not be aware – especially as AVS become commonplace and meaningful use requirements are met.

Further, patient dialog can highlight other findings in the form of patient reported outcomes measures which can guide the process of care delivery and may ultimately impact health outcomes surveys and revenue flows.  Gayle Pryor reports that PROMS are reshaping patient encounters and that some physicians have discovered that asking key questions can provide crucial missing data at the same time improving the patient experience. Clearly, the patient has the potential to fill in gaps in information, if you’re listening.

A Team of Listeners

Getting the patients to the office and organizing the encounter takes preparation and resources and technology.  To meet these goals some providers are hiring physician extenders to handle basic tasks, freeing up time for more meaningful patient encounters.  Clinical assistants and physician assistants who can organize the care gaps and information needs to facilitate the huddle and the patient encounter are common recommendation in the earlier citations and the literature.   And each member of the team should work to the top of their licensure to help the patient experience and data gathering process be as efficient as possible.


Relationships still matter. Building relationships requires face time and the type of interaction which builds confidence.  Leverage a mix of technology and personal appointment reminder techniques to reduce no-show rates, and make the in-office time effective by having a team of extenders marshal all the care gap and activity data available for review with the patient.