Providers, Plans, and Patients – The True Cost of Unclosed Care Gaps

The National Association of  Community Health Centers (NACHC) reports that over 100 million Americans face barriers to accessing primary care. Each individual member experiencing gaps has nuanced barriers that they must overcome. For instance, 3.6 million patients put off seeking access to a healthcare facility due to transportation issues alone.

Gaps in care occur when these millions of underserved patients postpone care. They push out routine treatments and seek care only when health concerns become severe. Unfortunately, this acute emergency care is the most intensive and costly for patients, providers, and the healthcare ecosystem. 

All stakeholders face extreme cost setbacks for delaying preventive treatments and leaving such care gaps open. Moreover, patients who are most at risk often face severe and sometimes fatal repercussions of unclosed gaps.

Effective primary care and timely interventions are the first step in closing care gaps. This blog summarizes specific costs associated with gaps in care and recommends proven steps to take now.

Breaking Down the Costs

Active participation by all healthcare stakeholders prevents high costs and drastic health concerns. Health plans and providers should work collaboratively to empower patients, engage members as active participants in care, and invest in preventive measures to address the costliest healthcare conditions.

Here are costs to consider for providers, health plans, and patients/members.

Patients/Members

Deterioration of each patient’s health

Personal finances strained further

Reduced quality of life contributes to higher mortality rates

New Best Practices for Health Plans to Consider

86Borders is a care coordination company specializing in personalized member engagement for at-risk populations. Working together with our health plan customers, 86Borders has effectively closed care gaps and delivered proven outcomes.

Here are five steps we recommend for health plans to begin the process.

• Source data and locate at-risk members/patients
• Tailor outreach to members with preferred language and communication channels
• Build trusted and empathetic relationships with members
• Uncover barriers to care through thorough SDOH screening
• Provide resources within their network, community, and environment to meet social needs – and facilitate until each need has been met

Once a trusted relationship is built, health plans can advocate for preventative care and primary care relationships as follows:

• Connect members with primary and specialty care locations for screenings and preventative care
• Ensure members attend appointments by providing transportation, child-care, or availability around their schedule
• Educate members on the benefits and resources available to them at their level of understanding and language (use member language, not plan language)
• Provide resources for continued care like medication adherence, dietary control, and continued preventative care measures

Proven Results in Preventative Care

86Borders’ best practices prove that member-first relationships decrease costs and improve outcomes for all stakeholders. Personalized interventions combined with empathetic relationships work together to ensure proactive, preventative care and close gaps. Here are two important outcomes we’ve achieved in collaboration with our health plan customers. 

• 3% engagement rate of “non-compliant” marked DSNP members, leading to a one Star improvement
• 247% increase of Medicaid Patient Centered Medical Home Program PCP visits and 19% reduction in inpatient/ER utilization

Closing gaps that hinder progress in healthcare amongst the most at-risk populations requires action from health plans, providers, and members themselves. Putting a strategic process in place specifically tailored for these populations will build trusted relationships between members, plans, and providers, allow for preventative care, and further ownership for improved healthcare.