Veradigm® Payer Insights: Helping You Spot and Eliminate Gaps in Patient Care

Video  |  30 August 2023

Addressing gaps in care is a key component of enhancing patients’ quality of care and improving patient outcomes. Research has shown that failing to close care gaps can be costly as well as harmful to the patient. For instance, failure to manage some chronic diseases can lead to serious complications with rapidly expanding treatment costs.

On the other hand, successful gap closures can help you better manage patient populations by improving the coordination of recommended preventive care and improving your ability to identify patients with chronic conditions and potentially life-threatening illnesses. Closing gaps in care also helps you appropriately minimize risk and improve quality scores.

From a patient perspective, closing gaps in care means they receive timely diagnoses and treatment, personalized care plans, and an overall improvement in their health and wellness.

But providers aren’t always aware of existing care gaps. Identifying those gaps in care and effectively communicating that information to providers at the right time and place—when it could positively influence patient care—is crucial for making a difference in patient outcomes. Veradigm Payer Insights can help you do precisely that.

Veradigm Payer Insights

Veradigm Payer Insights is a dynamic new solution that enables payers to deliver gap alerts to providers at the point of patient care. This automated solution is embedded within the provider’s EHR (Electronic Health Record) workflow, where it identifies patients with potential care gaps from within the list of upcoming patient appointments—using EHR data based on your prespecified criteria.

Prior to patient visits, this information is sent to the payer for their members. The payer can review patient details and trigger alerts for potential care gaps before the patient appointments.

Alerts are delivered to providers within the patients’ electronic health records, during the providers’ normal patient care workflow. This allows the provider and support staff to review alerts during pre-visit planning or the actual patient visit. The alerts contain relevant, patient-specific considerations for the provider’s evaluation and response.

Providers can review and address gap alerts from within their EHR. Their feedback, and any supporting documentation, are automatically communicated to the payer, completing the gap closure. If needed, the payer can request a patient’s chart for supporting documentation. The chart will be pulled and delivered, automatically and securely, using Veradigm eChart Courier.

Benefits of Veradigm Payer Insights

Veradigm Payer Insights can help you improve patient outcomes and appropriately minimize risk, including risk related to Medicare Advantage Risk Adjustment Data Validation (RADV). It can also help enhance your performance on key quality measures, such as HEDIS (Healthcare Effectiveness Data and Information Set) scores and STAR ratings. By helping you improve the identification and closure of your members’ care gaps, Veradigm Payer Insights helps strengthen your ability to meet your clinical and financial goals.

At the same time, Veradigm Payer Insights helps to streamline interactions with your providers by providing them with a free, easy-to-use solution that delivers alerts directly into their EHR workflow. Veradigm Payer Insights eliminates the need for providers to log into multiple different portals to access their patients’ various health plans. Instead, it enables you to deliver information directly to the provider’s EHR, information that can strengthen their pre-visit planning, reduce their practices’ administrative burden, and improve efficiency for both physicians and staff.

Watch this brief video for more information, or contact us to learn how Veradigm can help you improve the identification and closure of gaps in care for your members.

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