Why this Matters From Gaps to Gains: HEDIS Excellence Training
HEDIS: A set of standardized quality measures from NCQA that track how well health plans and providers deliver evidence-based care (e.g., cancer screenings, follow-ups).
Gaps in Care: When a member has not received recommended care according to HEDIS guidelines (e.g., missed follow-up after hospitalization).
Closing Gaps improves:
Health and quality of life for members
Member satisfaction with healthcare
Quality ratings and cost reduction
Mindoula’s Priority Gaps (2025)
Follow-up after hospitalization for mental illness (FUH, within 7/30 days)
Follow-up after ED visit with substance use diagnosis (FUA, within 7/30 days)
Follow-up after ED visit with mental illness or self-harm diagnosis (FUM, within 7/30 days)
Avoiding unplanned readmission within 30 days (PCR) (should always close with the other applicable follow-up measure)
Steps
1. Monitor Alerts & Dashboard
Hospitalization alerts appear on the bell icon.
Check the dashboard daily to stay updated.
2. Contact the Member
Call the hospitalized member to check in, offer support, and gather details.
3. Review the Care Gap
Go to the member’s profile.
Select the Care Gap tab.
4. Complete the Checklist
Choose the relevant care gap.
Open its checklist.
Work through each item step by step until done.
5. Close the Care Gap
Select “Close Care Gap” to document resolution.
6. Update Hospital Tab
7. Update External Care Team Providers
8. Document in Case Notes
Record the call and all actions taken in a case note. Make sure to use both the hospitalization AND care gap intervention.