How You Can Help Close Gaps in Care

By: AvMed News AvMed News

As an AvMed Provider, you play an integral role in closing gaps in care. That’s why we provide you with a variety of relevant resources and tools, including Care Opportunity Reports. These Care Opportunity Reports allow the tracking of gap closure from month to month on select HEDIS Quality Measures.

These measures span a number of categories such as Preventive Care and Medication Management. Among the ones that can appear in a COR:

  • Cervical Cancer Screening
  • Flu Vaccination
  • Readmissions
  • Osteoporosis Management in Women With Fractures
  • Controlling Blood Pressure for Hypertensive Members

The reports are just one tool that can address gap closures. Other resources at your fingertips include:

HEDIS Measures Provider Matrix: A reference tool to learn population, measure specifications and appropriate coding for select quality measures.

Care Opportunity Report Provider Response Form: A supplemental data process for un-claimable supporting documentation to close off gaps; Provider may submit Care Opportunity Response forms via fax or email.

Quality Stars Measures Reminder: This guide includes star measures codes, weights, age range and time frame for compliance.

HEDIS Encounter Coding Guide: This document may be included as part of an encounter to check off any services performed during the Member’s visit. (form includes CPT II codes).

In addition to these tools, you can also improve quality ratings by:

  • Encouraging patients to schedule appropriate screenings and comply with necessary treatment listed as a gap in care.
  • Reminding your patients to follow up with ordered tests and filled prescriptions.
  • Avoiding unnecessary testing and educating patients on the proper use of medications and screenings. 
  • Submitting claims with HEDIS-relevant CPT/ICD-10 codes or Care Opportunity Responses.

To access your Care Opportunity Report, visit AvMed.org/Web/Provider and enter your username and password. You can also request it through your AvMed Provider representative.

Have questions? Contact the AvMed Provider Services Center at 1-800-452-8633.