CORE Program: Bridging Care Gaps

Provider Engagement

Clearinghouse + EDI


Empower Providers with Services to Bridge Care Gaps

Veradigm CORE Program (Comprehensive Outcomes Realization and Engagement)

Are you ready to close care gaps, improve patient outcomes, and reduce costs and administrative burdens? The Veradigm CORE Program offers proactive, clinically-driven services to help health plans and their network providers do just that.

Veradigm CORE Program – the path to ROI for health plans*

Veradigm leverages digital integration, patented risk adjustment, and quality analytics to streamline provider efforts and drive gap closure. Our CORE services team prioritizes gaps, which helps providers address them quickly without altering existing clinical workflows. This saves time and reduces administrative effort so important care milestones aren’t missed.

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What is a care gap?

A care gap occurs when a patient misses essential healthcare services such as:

  • Annual physicals
  • Immunizations
  • Preventive screenings

Payers can use claims data to identify these missed treatments or conditions that providers should consider. Closing care gaps is paramount because it:

  • Improves patient health outcomes
  • Optimizes patient care quality
  • Reduces long-term healthcare costs
  • Provides compliance with medical guidelines and standards

Why is closing care gaps challenging?

Providers face several hurdles when it comes to closing care gaps. Many are overwhelmed by the number of tools they need to use and the various workflows they must navigate. The impact is significant:

  • 98% of providers agree they could offer better patient care if insights were more accessible.
  • 91% report using 6-20 or more external decision support tools.
  • 80% avoid extra steps required to access insights from tools external to their EHR.
  • 77% say learning to use different third-party solutions adds to their feelings of fatigue and burnout.

Source: “How EHR Workflows Impact Clinician Experience, Patient Care, and Profitability” an Insiteflow Research Study


How Veradigm CORE Program can help

Our comprehensive program unlocks the full potential of your health plan by:

  • Improving the quality of care and driving better outcomes for patients
  • Increasing provider and member satisfaction to support retention and growth
  • Achieving accurate, timely, maximized reimbursement for health plans and their network providers
  • Enabling complete and accurate documentation by augmenting provider practices with supplementary clinical staff

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*ROI = return on investment

-As of February 2025

-Clients pay for completed gap closure services upon confirmation of documentation in alignment with relevant government reporting standards. Cost per closed gap is a fixed rate, below the amount of the payment premium the health plan will receive as determined by the health profile of its members for Medicare Advantage and Medicaid lines of business. Cost per closed gap does not vary based on documented financial value of the closed gap to the client. Data on file.

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