Gaps in care represent missed or delayed opportunities to improve a member’s health. These can occur when patients are unable to follow recommended care plans or when providers lack timely insight into member care opportunities in a member’s condition. Identifying and closing these gaps is critical for improving outcomes, reducing costs, and supporting value-based care initiatives.
Analytics platforms are key to uncovering gaps in care. By comparing claims data, diagnosis codes, and demographic information such as social determinants of health, these platforms flag potential risks and care opportunities to keep healthy members healthy, while managing care for members identified as higher risk. For example, a member may show elevated blood pressure and borderline diabetes on recent lab results. Analytics highlight these findings as gaps in care that, if not addressed, could lead to chronic disease progression and higher medical costs. Recognizing gaps early gives providers the chance to act proactively instead of reactively.
Identifying gaps is only the first step. Providers often lack accurate or current information to engage members effectively. Members themselves may be difficult to reach through traditional methods, and without timely communication, providers cannot intervene before compliance and tight turnaround deadlines pass. Regulatory measures such as STAR ratings further raise the stakes, as open gaps negatively affect both performance scores and member satisfaction. When members feel underserved or face unexpected costs due to inadequate networks, payer ratings suffer as well.
Unresolved gaps translate to higher member chronic disease or mortality risk, poor whole person care, and increased expenses to the member and payer. High-risk members cost significantly more, which makes early intervention a financial as well as clinical priority. Closing gaps not only improves individual health but also strengthens payer performance in quality programs. Better engagement with both providers and members supports stronger adherence to care plans and measurable improvement in satisfaction.
HealthLink Dimensions helps organizations close gaps in care by leveraging our four HealthLink Pillars. We enrich data with up-to-date provider information, enable timely care team engagement, and provide real-time actionable dashboards for task prioritization.
Accurate Data: HealthLink’s Practitioner & Facility Demographics and Healthcare Networks & Affiliations ensure outreach targets the right providers. Network Directory Validation eliminates ghost providers, reducing delays in access to care.
Effective Communication: Email Deployment and Trigger Email provide timely notifications to providers and care managers. Programmatic Advertising and Paid Social extend outreach to members who may otherwise be unreachable.
Real-Time Alerts: Trigger-based workflows notify care teams the moment a gap is identified, ensuring compliance with CMS turnaround times.
Measurable Outcomes: Pulse solutions deliver campaign performance metrics and real-time dashboards, giving payers visibility into what is working and where immediate action is needed.
Closing gaps in care requires more than analytics alone. It takes accurate data, timely engagement and measurable adherence to tight compliance timelines. HealthLink Dimensions delivers the tools to help payers and providers act quickly, engage effectively, and measure success. The result is healthier members, reduced costs, and stronger performance against quality benchmarks.
HealthLink Dimensions empowers life sciences companies, health plans, hospitals, recruiters, and agencies to precisely target and engage healthcare providers. Through our four strategic Pillars: Profile, Enrich, Engage, and Pulse, we deliver verified provider data, data enrichment services, omnichannel outreach, and real-time analytics. With over 25 years of healthcare data expertise, 98 percent coverage of U.S. providers, and industry-leading accuracy validated by TrustArc certification, we are the trusted partner for organizations seeking to improve outcomes and achieve measurable marketing performance.