Close gaps in care and fulfill HEDIS and STAR Measures with Proactive Claims Tracking and Direct OutreachFor any risk adjustment submission to be compliant and make an impact, it must be linked to care. CareConnectTM helps plans and medical groups identify and follow up on gaps in care by ensuring there is some combination of monitoring, evaluation, and/or treatment of the diagnosis by that member's primary physician.
When a member receives an Advanced Evaluation™, and a gap is noted (or the procedure is out of the HEDIS date range), the member, PCP and plan are all notified to ensure follow up and assist with scheduling, if necessary. Meanwhile, CenseoHealth will then scan claims to look for evidence that the service was completed after the initial prompt. If not, CenseoHealth will re-prompt to ensure no member is forgotten, and no quality improvement opportunity missed.