LOUISVILLE, Ky.--(BUSINESS WIRE)--Bamboo Health™, the leader in Real-Time Care Intelligence™, announces a new solution, Care Gaps, to help health plans and providers improve care and increase quality measure performance by identifying and quickly closing open care gaps. The solution delivers real-time detailed insights into open care gaps, along with best practices for care gap closure and customized workflows to follow up with and engage members quickly.
In particular, Care Gaps can help health plans and providers more effectively collaborate to improve performance on quality measures such as the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage star rating program and HEDIS measures. This is particularly important as CMS’s pandemic-driven streamlining of the measures begins to expire. Using Bamboo Health’s expansive network and Real-Time Care Intelligence, Care Gaps focuses on high-impact moments that matter for members, such as transitions of care from an inpatient setting as well as prompt follow-up care after an emergency department (ED) visit for members with chronic conditions.
Currently, it is difficult to identify and reconcile open gaps in care – such as screenings, post-treatment follow ups, and medication checks. Health plans lack an easy way to surface the gaps across the myriad of electronic health records (EHR) used by providers, making workflow integration difficult. Real-time information and analytics are hard to share when they may be most impactful for the member.
To address this problem, Care Gaps is built on the Bamboo Health Smart Signals™ network, using nationwide patient and visit data with robust analytics to actively surface member events that represent an open care gap in real time, identifying members who would benefit from follow up and transitions of care support. From there, providers can make informed care decisions as well as utilize new workflows to collaborate, complete, and document the closing of identified care gaps.
Bamboo Health’s Care Gaps solution helps healthcare organizations understand gaps in care throughout the member journey, driving the following outcomes:
- Optimized post-discharge transitions from inpatient facilities and follow-up after ED visits
- Greater adoption and adherence to evidence-based guidelines
- Enhanced follow-up care to increase member engagement
- Better care collaboration among providers, and between providers and health plans
- Improved HEDIS measures and Star Ratings through better care gap closure
- Increased revenue and better labor efficiency
Right now, Bamboo Health is working with a select number of customers on the solution to help them move the needle on transitions of care and follow-up quality measures. One such customer is Privia Medical Group of Georgia, LLC (Privia Medical Group — Georgia), a single TIN multi-specialty medical group throughout Georgia.
Privia Medical Group — Georgia and one of the nation’s largest health plans are jointly leveraging the Care Gaps solution to enable effective closure of open care gaps, with the goal of improving patient care and experience. Bamboo Health expects to expand the solution to more health plans and providers in 2023.
“Privia Medical Group — Georgia is committed to value-based care, and a critical piece of that is closing care gaps,” said Ryan Graham, regional vice president of operations for Privia Medical Group — Georgia. “The balance is doing so without overburdening our providers and staff while serving our patients to the best of our ability. The real-time insights and workflow from Care Gaps should help us achieve this balance, in turn equipping our providers to deliver better, more timely care.”
The need to meet quality measures is only expected to increase in the coming years, as CMS has indicated the expectation that all Medicare beneficiaries be covered by value-based care models by 2030. In addition, health plans are losing some of the flexibility in quality measurement they enjoyed during the COVID-19 public health emergency (PHE). Health plans are seeing a significant impact as pandemic-driven adjustments in the CMS star ratings expire. For instance, just over half (51%) of Medicare Advantage plans with drug coverage will have a star ratings of four or more in 2023, down from more than two-thirds (68%) in 2022.
To help overcome those challenges, Care Gaps includes some of the following features:
- Intelligence and analytic features that instantly surface care gaps
- Workflow capabilities for leaders across the organization to prioritize and take actions on areas with the highest business impact and opportunity for improved patient outcomes
- Direct EHR integration that centralizes the solution within the provider’s workflow
- Automated surfacing of open care gaps to provider organizations in real time
- Reporting to enable timely visibility into care gap closure
"Healthcare organizations have been working on finding and closing gaps in care for decades now, but it's still too difficult," said Rob Cohen, CEO of Bamboo Health. "Care Gaps is the first solution that solves that problem for plans and providers, and we expect to see significant adoption across the industry in 2023. It couldn't have come at a better time, as meeting the major quality measures is expected to become more difficult given today’s resource constraints. Timely and effective transitions of care and prompt follow ups will drive the next level of value-based care."
To learn more about Care Gaps, visit our website.
About Bamboo Health
Bamboo Health, the leader in Real-Time Care Intelligence™, provides actionable insights on a patient’s physical, behavioral and social health – empowering healthcare professionals to provide the right care at the right time for the right outcomes. Delivered through our Smart Signals™ network – the largest and most interoperable care collaboration community in the nation – our insights improve more than 1 billion patient encounters a year across more than 2,500 hospitals, 8,000 post-acute facilities, 25,000 pharmacies, 32 health plans, 50 state governments and 1 million acute and ambulatory providers. Connect with Bamboo Health on Twitter, LinkedIn and Facebook. Visit BambooHealth.com to learn more.