Improving gaps in care closure through digital innovations

Transforming HEDIS (Healthcare Effectiveness Data and Information) through EXL health’s HEDIS gap allocation prioritization solution

Client profile

A leading national health plan

Client need

The client reached out to EXL Health to help improve their HEDIS process, improve gap closure rate and gaps in patient care, reduce average handling times, and improve the number of cases handled per day.

They also had a strong focus of improving the star ratings of their low performing plans, and maintaining the ratings of their high performing plans.

The solution

EXL Health curated a personalized digital pathway through its HEDIS Gap Allocation Prioritization solution (GAPS). GAPS is an integrated workflow solution for healthcare payers with record stratification, prioritization, provider outreach, indexing and abstraction functionality, and gaps in care closure.

  • It helps with data orchestration for HEDIS gaps from various backend applications, along with easy abstraction workflow of relevant clinical information.
  • Setting up workflow and allocation of tasks through inbuilt logic to pull work and streamline operations by building work queues.
  • Its smart recommendation engine provides real time actionable insights and actions to be taken for efficient provider outreach.

Key features

  • Data-based provider fax tracking
  • Improved provider outreach and education
  • Reduction in HEDIS gaps in care increases Star ratings
  • Standalone modular solution and platform agnostic

Outcomes

Improving Gaps in care closure through graphics