By Jon Warner, June 2023
“Care gaps” “is a frequently-used term that identifies something that needs more attention and effort to improve the situation. These gaps can be categorized into three main areas:
A. Health insurance or payer/risk-bearing side: When patients can't get needed care due to insurance limitations unless they pay out-of-pocket. For example, a patient may need 10 physical therapy sessions after an injury, but insurance only covers 5 even though the physical therapist recommends the full quota of sessions for a full recovery.
B. Provider Side: When providers lack the experience, availability, or necessary equipment to care for patients. For instance, a primary care doctor may be too busy to see a patient promptly for several weeks for a non-emergency issue, but it is nonetheless important for a quicker recovery for the patient.
C. Patient Side: When patients are unable or unwilling to properly care for themselves. A simple example is when a patient is non-adherent in taking their prescribed medications as directed.
While closing insurance/payer-side care gaps is challenging due to the need for policy changes, we can be more aware of these care gaps and use innovative technology solutions to quickly identify where the gaps may exist and alert both providers and patients, offering alternative pathways to avoid dead-ends. Technology can often readily address many pressing care gap needs cost-effectively, particularly for provider and patient-side gaps. We will highlight 10 best practices used to identify and deploy solutions such as clinical coordination platforms, digital health, digital therapy, telehealth, virtual care, remote patient monitoring, AR/VR, chatbots, AI solutions, and more.
1) Identify Key Needs and Gaps
The first step in any effort to close provider or patient-side care gaps is to carefully analyze and identify the most significant needs or gaps impacting patients and/or providers. Consider factors like long wait times, staff burnout, medication errors, readmission rates, chronic disease management challenges, care/workflow friction points, and more. Ideally, this analysis initially prioritizes the top 3-5 issues that, if addressed, could make the biggest difference. Having a clear understanding of the specific problems faced will help guide the search for the best and most applicable technology available.
2) Research Emerging Solutions
Once key needs have been identified, the best next step is to research what innovative solutions may be emerging to address similar challenges faced by other healthcare organizations and their patients. It is helpful to review industry publications, attend conferences, and connect with professional networks to learn about new technologies, care models, digital tools, and approaches that show promise. Some areas ripe for innovation include virtual solutions, remote monitoring and the data analytics that go with it, clinical decision support, predictive analytics, and automated workflow solutions.
3) Consider Pilot Programs
Rather than implementing an untested solution on a large scale, pilot programs are often a good way to test promising innovations on a smaller level first. This lower-risk approach allows real-world effectiveness, ease of use, ROI potential, and fit within the organization to be evaluated before a major investment is made. Pilot opportunities on a given technology can readily be found through innovation incubators, technology vendors, and professional consulting organizations (such as CHS) focused on accelerating healthcare transformation. However, an organization can also choose to pilot a range of possible solutions by electing one area of focus, such as heart health or diabetes as a disease, or by focusing on a particular group of patients such as children or pregnant women.
4) Leverage Industry Best Practices
It is important to avoid ‘reinventing the wheel’ when proven solutions may already exist. Providers and patients of all types have often already addressed care gaps in other facilities, cities, states, and even countries. These can be found in research case studies and published results about healthcare organizations that have successfully addressed similar needs through innovative projects. A good worldwide example is the Nonprofit ECH Alliance, which seeks to help all health and healthcare sector organizations find or build upon innovative best practices. In these cases, look for common themes and best practices that emerged around solution selection, implementation strategies, change management tactics, measurable outcomes, ROI, and lessons learned. Understanding what worked well for others increases the overall chances of success.
5) Consult External Experts
While internal brainstorming is important, bringing outside perspectives can uncover creative solutions you may not have considered. Consult with industry analysts, innovation advisors, technology consultants, and subject matter experts who closely track emerging healthcare trends. They can help match your specific needs to the most cutting-edge and applicable solutions. Outside experts also provide objective viewpoints untainted by internal preconceptions or understandable knowledge gaps.
6) Attend Healthcare Innovation Events
Conferences, expos, and showcase events focused on healthcare innovation and transformation are great places to discover new solutions in development. Interact directly with technology vendors and innovators to learn about their offerings. These events also provide opportunities to network with peers tackling similar challenges, exchange ideas, and find potential pilot partners.
7) Leverage Purchasing Partnerships
A little-used but useful step on this care gap-closing journey is to consider joining group purchasing organizations (GPOs), accountable care organizations (ACOs), regional health information exchanges (HIEs), and other collaborative networks to expand your access to vetted solutions, pilots, and best practices. The aggregated purchasing power of partnerships allows smaller providers to benefit from innovations typically out of reach. Partnerships also facilitate sharing lessons learned from early adopters. Ideally, make sure that any group you join is focused on emerging technologies, care models, and value-based solutions applicable to your needs.
8) Evaluate Vendors Thoroughly
When a promising solution is identified, it is critical to conduct rigorous due diligence on potential vendors. This means understanding technology capabilities, implementation requirements, pricing models, customer support offerings, security protocols, upgrade policies, and real client references with measurable outcomes. This may also mean requesting vendor demonstrations showcasing how their solution has addressed comparable needs at other clients and sites. Once again, pilots can help further evaluate fit and functionality before a larger investment.
9) Organize/Reorganize Around Care Gaps
The more we increase our efforts in a care gap-closing strategy, especially when it spreads to multiple populations and areas of focus, the more likely we may need to re-organize our teams or change how they operate. Care gap-closing initiatives may start under the aegis of one person, such as a chief innovation or strategy officer or perhaps a CIO or Head of patient experience. However, it is often helpful to have a range of people across the organization report to this person, albeit on a dotted line basis, and to hold regular group meetings to both learn about new approaches being tried and to compare notes about how innovation or technology solutions were discovered and adopted (successfully or not).
10) Promote your Change Efforts
Successfully closing care gaps is typically popular with patients, clinicians, provider management, and even payers, who can save time and money in the long run. It therefore often pays us to promote and advocate for our efforts widely so that more people support the effort and may even want to help. Apart from the direct benefits that accrue in terms of savings in time and money, there are also benefits in quality, patient satisfaction, and even job satisfaction for clinicians, all of which help improve the organization’s reputation as a leader in health and healthcare innovation.
In summary, taking a proactive and multi-pronged approach to identifying innovative solutions through research, partnerships, pilots, and expert guidance increases the chances of successfully closing critical care gaps for providers and patients. It may even influence payers to join the effort, as closing the gaps often means fewer claims down the road, improves long-term wellness, and offers overall better healthcare. With strategic sourcing of applicable best practices, even resource-constrained organizations can transform care through fit-purpose innovation and technology. Ultimately the more care gaps we close, the more ‘care continuity’ we get -and that’s a win for everyone!
This article was written by Jon Warner, Executive Chair of Citizen Health Strategies (CHS). CHS optimizes the end-to-end care experience with advisory, consulting, and product-building services to help deliver the Quintuple Aim – enabling better, faster, and more personalized well and sick care for all.
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