Stage 3: Targeting Opportunities to Improve Care Quality and Performance
With a solid understanding of the projected disease burden, treatments and aligned costs for Jane and her population cohort, healthcare organizations can determine the appropriate targeted interventions to advance care quality and outcomes while reducing costs. The overall goal is to optimize care delivery, resource utilization and patient/employee experience. Analytic tools, machine learning and bots aid care professionals in delivering these targeted interventions.
Potential gaps include:
- Care inconsistent with clinical guidelines
- Patients’ nonadherence to treatment and medication plans
- Lab reports indicating poorly controlled or managed disease
- Inappropriately monitored treatments
Gap analysis can help determine which patients and treatments will likely incur unnecessary care and resources. These patients may benefit from enhanced engagement, direct interventions and/or enrollment in disease management programs. Not all gaps are equal. It is important to address care gaps where targeted interventions offer the highest potential for better care outcomes.
With these insights, healthcare organizations can make strategic decisions regarding the treatment of specific populations that absorb disproportionate care resources. Depending on overall care utilization and financial risk predictions, the organization might focus more directly on populations with specific chronic diseases or on individuals who are frequent emergency department visitors, for example.
Organizations can also use gap analysis analytic tools to enhance clinician performance. After identifying certain physicians drive disproportionate utilization and costs, analytical tools can recommend specific changes to drive better outcomes, processes and results.