Mary is 65 and has high blood pressure. She thought she was in good health and managing her condition well, but little did she know there was more she could be doing to improve her health. Her health plan found a gap in care for high blood pressure, and they also see that Mary qualifies for programs to help manage her condition.

Her health plan uses advanced analytics to identify care gaps for Mary and thousands of members like her. With a powerful system that analyzes data for 80% of all NCQA-covered lives and over 192 million lives each year, the plan runs clinical quality metrics and risk analytics to turn patient claims into clear care gaps.

Mary’s care gaps are flagged to the health plan, engaging care coordinators at the right place and time along her care journey. The health plan sets an outreach plan in motion to start closing her gaps and engages Mary’s provider in the outreach to strengthen their value-based care efforts

Based on the letter she receives in the mail from her health plan, Mary makes an appointment with her doctor – who addresses her care gap and tells her about supplemental ways to manage her blood pressure, available from the health plan.

Every month, the same software calculates 1.6 trillion decisions5 to help health plans across the U.S. address quality gaps and improve member outcomes. This software is trusted by 15 of the top 15 health plans,6 and has been NCQA HEDIS® measure certified for 24 years.5