Care Gap Agent: Proactive Quality Management
Identifies patients overdue for preventive care, chronic disease management, and quality measures—then automatically schedules outreach and appointments.
Key Capabilities
- Quality Measure Tracking - Monitors HEDIS, MIPS, Star Ratings, ACO measures
- Gap Identification - Flags patients overdue for mammograms, A1C tests, colonoscopies, etc.
- Risk Stratification - Prioritizes high-risk patients (diabetic, no A1C in 12 months)
- Automated Outreach - Sends SMS, email, or phone call to schedule appointment
- Provider Alerts - Flags care gaps during scheduled visits
- Real-Time Closure - Updates quality dashboard when gap is closed
- Population Analytics - Tracks quality measure performance across entire panel
- Incentive Tracking - Monitors quality bonus payments and opportunities
Impact
Gap Closure Speed
3x faster
HEDIS Improvement
+40%
Quality Bonuses
$50K-$200K
Patient Outcomes
Better
Technical Details
Integration & Features
- Data Source
- EHR clinical data integration
- Measure Logic
- NCQA, CMS quality specifications
- Outreach
- Multi-channel patient communication
- Dashboard
- Real-time quality measure reporting
Security & Compliance
- HIPAA Compliant
- SOC 2 Type II Certified
- Real-time processing and logging
- End-to-end encryption
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