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Care Gap Closure for Payers & Health Plans

Your Members Know About the Gap.
They Just Don’t Close It.

Care gap reminders reach members. Activation-trained agents move them to action. We close the gap between outreach and completion with behavioral science and barrier resolution.
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The Challenge

The Care Gap Closure Problem

You’ve invested in outreach infrastructure. The gaps remain open. The issue isn’t awareness — it’s activation.

You send millions of reminders. Members still don’t close their gaps.

Letters, portal notifications, automated calls — the volume of outreach is high. The conversion to completed action is low. Because most outreach measures whether the message was sent, not whether the member did anything about it.

Half of non-compliance is driven by barriers your outreach never asks about

Transportation, cost confusion, competing priorities, fear of results — 50% of non-adherence stems from SDOH factors. A reminder can’t resolve what it doesn’t address.

Every unclosed gap is a missed quality measure and potential penalty

HEDIS scores, Star Ratings, and quality bonuses all depend on gap closure rates. The financial impact of low closure rates compounds across your attributed population.
Root Cause

As Healthcare Experts, We See the Deeper Problem

Awareness doesn’t drive action. Activation does. The gap between knowing about a care gap and actually closing it requires human engagement, barrier resolution, and behavioral science.
OUTREACH MODEL

Your outreach program measures sends, not completions

The gap between ‘member was contacted’ and ‘member completed the action’ is where your quality scores are made or lost. Most programs optimize for the former and hope for the latter.
BARRIER BLINDNESS

Automated outreach can’t resolve the barriers that prevent action

A member who doesn’t understand what a ‘care gap’ means, can’t get transportation to the appointment, or is managing three competing priorities won’t be moved by a reminder letter. They need a conversation.
SEGMENTATION

One-size-fits-all outreach produces one-size-fits-none results

Members with different risk profiles, SDOH burdens, and engagement levels need different approaches. A healthy 35-year-old missing a screening needs a different conversation than a complex chronic patient missing three gaps.
TIMING

Outreach that doesn’t match the member’s readiness window gets ignored

Members have moments of receptivity — after a health scare, during open enrollment, at a life transition. Generic outreach on a fixed schedule misses these windows entirely.
Our Approach

Activation-Driven Care Gap Closure

We move members from awareness to action through live agent engagement, barrier resolution, and real-time scheduling — reporting on completions, not contacts.

  • Activation-trained agents, not automated messages

    Our agents are trained in 9 behavioral science techniques to move members from awareness to completed action. Every call is designed to close the gap, not just communicate about it.

  • SDOH-aware barrier resolution

    Transportation, cost, language, and psychosocial barriers are identified and resolved during the call. We don’t just tell members to schedule — we help them get there.

  • Risk-stratified member segmentation

    Our platform segments members by clinical risk, SDOH profile, payer type, and engagement history. Each member gets the right approach at the right time.

  • Real-time scheduling and coordination

    We don’t just encourage members to schedule. We schedule the appointment during the call, confirm transportation, and follow up to ensure completion.

  • Closed-loop reporting on completions, not contacts

    We report on gaps closed, not calls made. Your quality team sees the metrics that matter for HEDIS, Star Ratings, and quality bonuses.

PROVEN AT SCALE

5× Activation Rate Increase in 90 Days

A large clinically integrated network achieved 40% activation rate for ACO provider appointments through activation-trained outreach.
5×
Activation rate increase
40%
Gap closure activation rate
99.4%
QA pass rate
9
Behavioral science techniques

Ready to close gaps instead of just reminding about them?

Schedule a consultation and see how our verification specialists can protect your revenue, free your staff, and keep patients moving toward care.

Schedule a Consultation