Payors / stars & quality
Close Every Gap Before Year-End
A rating is decided one member at a time. Ana joins claims, labs, pharmacy and charts to every open gap, ranks them by what moves the rating, and sends each one to the team that can close it while there’s still time this year.
Fixed scope: this measurement year’s open gaps, run inside your cloud.
Chase the List, or Close What Counts
- Gap lists arrive monthly, sorted by member ID
- Every open gap treated as equally worth closing
- Outreach to members who already closed the gap
- The rating known when CMS publishes it
- Gaps ranked by what they move on the rating
- The members one step from closing, found first
- Closed gaps dropped from outreach the day they close
- Where you’ll land, forecast from this year’s data
Rank Every Gap by What It Moves
Not every open gap is worth the same call. Ana measures each open measure against its next cut point, so the work goes where it moves the rating — not where the list is longest.
- Every measure against its next cut point
- Members counted toward the threshold, not the total
- Refreshed as claims, fills and labs land
Which gaps are we closest to closing?
Statin adherence: 3,120 members from the next cut point.
- statin adherence 3,120
- diabetes eye exam 0.5× statin adherence 1,480
- colorectal screen 0.3× statin adherence 920
- breast cancer screen 0.2× statin adherence 610
Find the Members One Step Away
The cheapest gap to close is the one a single fill or visit finishes. Ana finds the members who are nearly there, with the fill, the pharmacy and the provider they already use.
- Adherence measured to the day, not the month
- The step that closes it named for each member
- The pharmacy and provider they already use attached
Is member M-11820 going to be adherent this year?
Not yet — one 90-day fill by September puts her over the line.
- 06/01statin fill · 30-day supply
- 07/01refill due · not filled
- pdc76% today · needs 80% by 12/31
- pharmacysame store · 90-day eligible
Send Every Gap to Whoever Can Close It
Pharmacy calls close adherence gaps; provider lists close screenings; care managers close the hard ones. Ana routes each gap to the team that can close it, and drops it the day it closes.
- Each gap routed with the step that closes it
- Closed gaps removed from outreach automatically
- The forecast re-run every week
Who needs to do what this week?
3,120 adherence gaps routed, each with the fill that closes it.
- pharmacy 1,840 members due a 90-day fill
- providers Open screenings for 14 groups, by panel
- care mgmt 310 members with three or more open gaps
- quality Rating forecast from this week’s data
Find the Gaps That Matter
Bring this year’s claims, pharmacy and lab data. We join them inside your cloud and hand your quality team the gaps ranked by what they move.
- 01A 30-minute call to pick the measures and the contracts in scope
- 02We connect inside your cloud under a BAA — nothing leaves your environment
- 03Your quality team works the ranked gaps with us
Where Stars Work Starts
- 01 Medication adherence
Track proportion of days covered to the day and find the members a single fill puts over the threshold.
- 02 HEDIS gap closure
Every open screening and visit gap, with the provider and the step that closes it.
- 03 Stars forecasting
Where each measure lands against its cut points if nothing changes, refreshed weekly.
- 04 Provider gap reports
Each group’s open gaps by panel, sent on a schedule, closed gaps removed.
- 05 CAHPS drivers
The claims and calls behind the survey measures, found while there’s time to act.
- 06 Supplemental data
Labs and chart findings joined to the measures they close, so closed gaps count.
No. Your certified engine stays the system of record for measure results. TextQL reads its output with claims, pharmacy and labs to rank the gaps and route the work.