Mastering Care Gap Closure: Proven Strategies from HealthHelper's Playbook

Mastering Care Gap Closure: Proven Strategies from HealthHelper's Playbook

Mastering Care Gap Closure: Proven Strategies from HealthHelper's Playbook

Mastering Care Gap Closure: Proven Strategies from HealthHelper's Playbook

Mastering Care Gap Closure: Proven Strategies from HealthHelper's Playbook

Jun 5, 2023

In the rapidly evolving healthcare landscape, the mission to close care gaps has shifted from a nice-to-have to a must-have for primary care practices, IPAs, ACOs, CINs, and Health Systems alike.

The chase is not just about patient care anymore; it's about money on the table. Care gap closure is now a high-stakes game thanks to complex financial incentives woven into payer contracts.

HealthHelper stands at the forefront - tackling the myriad challenges primary care practices and their networks face when trying to close care gaps. With a proven track record of closing thousands of care gaps for our partners, we've cracked the code. Now, we're pulling back the curtain to share our expertise and strategies. Join us as we dive deep into the world of successful care gap closure.

Care Gap Closure Workflow

Let's explore our comprehensive four-step approach to care gap closure:

1. Zeroing in on the Gaps: Uncovering Care Gaps within Your Patient Panel

Reliable software platforms, including Arcadia, DignifiHealth, Innovacer, and Lightbeam, have revolutionized care gap identification. These systems combine both EHR and claims-based data with powerful clinical metric calculation engines, demonstrating impressive accuracy when implemented correctly.

However, no system is flawless, and care gap identification accuracy rates are never 100% due to a variety of healthcare data issues. Therefore, at HealthHelper, we adopt a cautious approach, considering these identified gaps as "purported care gaps". This entails confirming the existence of a care gap before scheduling an appointment.

2. Confirming and Prioritizing: Assessing Patient Charts and Prioritizing Efforts

Having identified the "purported care gaps", we then confirm these gaps and determine the need for outreach. This is essential given that the data used to identify care gaps is not infallible and the need for outreach can be nuanced.

At HealthHelper, we have developed a patient prioritization algorithm that takes into account various factors to maximize clinical and financial value. This algorithm enables us to focus on high-value appointments, thereby optimizing your providers' schedules while scheduling recommended appointments in the community. This translates to more productive appointments and less follow-up work for your staff.

3. Outreach for Scheduling: Delivering Convenient Engagement and Scheduling

With the gaps confirmed and patients prioritized, we move on to outreach, which presents its own set of challenges. When it comes to outreach workflows for your organization, here are a few of the tough questions to consider:

  • Who will conduct the outreach?

  • Is this staff trained and equipped to schedule various types of appointments?

  • What communication channels will you use?

  • What is the sequence of outreach (e.g. a phone call, a text, an email, then another call)?

  • How will your staff stay on top of all these outreach attempts?!

  • How will your staff handle responses?

  • How often should you reach out to a patient?

  • What languages can your staff support?

  • Which facilities and specialists will you guide patients to use?

  • Can your staff schedule with these providers?

The most critical consideration here is ensuring that you're providing a positive patient experience. The goal is to make it easy and convenient for the patient to schedule an appointment. Sending SMS text messages to patients that instruct them to call the office or a centralized scheduling department - only to sit on hold during their workday - can result in poor patient experiences. Like in every part of their lives, patients want to be able to schedule conveniently and immediately.

With HealthHelper, we make it easy for your patients by directly scheduling appointments at your practice and in the community over their channel of choice. In fact, over 70% of our appointments scheduled are done via text message automation - providing great patient convenience and staff efficiency.

4. Continual Learning: Analyzing Outcomes and Improving Processes

Each "Identify - Confirm - Reach Out" cycle is an opportunity for learning and refining our processes. We maintain comprehensive records and analyze them to identify the success rate, potential drop-off points, and effectiveness of different communication channels.

At HealthHelper, we are committed to learning and improving, an approach that has returned five-fold ROI and 10-30% improvement in HEDIS quality metrics for our customers. We continually examine our workflows and outreach methodologies to close more care gaps efficiently and with enhanced patient satisfaction.

Our expertise in panel management technology and care coordination services ensures the successful and efficient closure of care gaps, optimization of provider schedules, and improvement of network efficiency.

If you're interested in delving deeper into our effective strategies for care gap closure, feel free to schedule a Zoom call with our team. We're ready to share our best practices and insights. Mastering Care Gap Closure

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Care New England and Integra Achieve Remarkable Improvements with AI-Powered Care Gap Closure Services from HealthHelper

Care New England and Integra Community Care Network (Integra) embarked on a transformative partnership with HealthHelper, aiming to address care gaps and enhance population health management. In just the first year of the HealthHelper partnership, this collaboration has led to significant advancements in patient retention and quality metrics, underscoring the impact of innovative healthcare solutions.

Achieving Notable Increases in Preventive Screenings and Quality Metrics

Through the integration of HealthHelper’s technology-enabled care gap closure services, Care New England reported substantial improvements in preventive care screenings:

  • Breast Cancer Screenings: 13% increase

  • Colorectal Cancer Screenings: 16% increase

  • Hypertension Screenings: 10% increase

  • Diabetic Eye Exams: 61% increase

  • Diabetic HbA1c Screenings: 29% increase

These enhancements reflect a concerted effort to close care gaps and promote early detection, pivotal components of effective population health management.

Strengthening Patient Retention and Care Coordination

A cornerstone of the partnership’s success is the impressive 88% in-network retention rate for screening mammograms. By ensuring patients receive coordinated care within the Care New England system, the collaboration has fortified patient trust and continuity of care. This strong care coordination helps ensure that patients receive their follow up care while also improving the financial standing of an important healthcare provider to the Rhode Island community.

Financial Impact and Return on Investment

The partnership has also yielded significant financial benefits:

  • Appointments Scheduled: 5,245 across the care continuum in the first year

  • Return on Investment: 3.4x

These outcomes highlight the dual advantage of enhancing patient care while achieving financial sustainability.

Seamless Epic Integration and Provider Workflows

Implemented in under two months, HealthHelper’s solution seamlessly integrated with Care New England’s Epic platform. This swift deployment alleviated administrative burdens, allowing providers to focus on delivering exceptional patient care. One team member remarked, “This is the easiest implementation project I’ve ever had!”

Leadership Endorsement: A Model for Scalable Success

Dr. Ana Tuya-Fulton, President and Chief Operating Officer of Integra and Chief Population Health Officer of Care New England, emphasized the strategic value of the partnership:

“Our partnership with HealthHelper has delivered measurable value for both our health system and our ACO. Their AI-powered Care Gap Closure services have improved performance, driven results, and seamlessly integrated into our workflows.”

Better Population Health with AI-Powered Care Coordination and Care Gap Closure Services

By combining technology-driven automation with high-touch patient engagement, HealthHelper is transforming how healthcare organizations identify, engage, and close care gaps at scale.

To learn more about how HealthHelper’s AI-powered Care Gap Closure services can support your organization, contact Jake Kahane at jake@healthhelper.co. To read more about the partnership between HealthHelper, Care New England, and Integra, check out this post by Care New England.

Feb 27, 2025

AI & Automation in Care Gap Closure and Practice Workflows – A Q&A with Jake Kahane, Co-Founder of HealthHelper

At HealthHelper, we believe that healthcare providers should spend their time delivering care—not chasing administrative tasks, managing fragmented workflows, or struggling to keep up with complex payer contracts. Our mission is simple: to take the work off providers’ plates so they can focus on their patients.

To dive deeper into HealthHelper’s journey, the challenges we’re solving, and what’s ahead, I sat down with Jake Kahane, Co-Founder & Chief Product Officer. We talked about what inspired him to start HealthHelper, the role AI plays in scaling care coordination, and his vision for the future of provider workflows.

From automating care gap closure to orchestrating complex workflows across healthcare networks, HealthHelper has built the infrastructure that allows providers to do more with less. Here’s what Jake had to say about how we got here—and where we’re headed next.

1. What inspired you to start HealthHelper?

The idea for HealthHelper really started with a simple observation: In population health, there’s no shortage of data—but providers struggle to turn that data into action. Health systems and medical groups have dashboards, reports, and lists of patients who need care, but actually operationalizing interventions—getting patients scheduled, closing care gaps, and ensuring follow-through—was a major challenge.

Over the years, I have learned a lot about patient engagement, care navigation, and what actually works to activate patients in their healthcare. It became clear that the place where this mattered most was primary care and preventive medicine—where the right intervention at the right time can prevent complications and improve long-term outcomes.

I wasn’t sure we were going to start a business, but I’ve always subscribed to the belief that when you have an idea, you just keep taking small steps forward and reassess along the way. The more we dug into the concept, the clearer it became that primary care providers were drowning in work. And when we started talking to them, practice managers, and staff, their reaction was the same: this would be a huge help.

That’s what keeps driving us today. We continue to hear from our clients that we’re making a real difference—offloading administrative burden, improving patient engagement, and ultimately helping practices succeed in both value-based and fee-for-service care.

2. What’s the biggest problem HealthHelper is solving today?

The biggest challenge we’re solving is simple: helping practices get more done with limited resources. Whether it’s a high-performing practice trying to scale or a group struggling to improve quality scores, the core issue remains the same—there’s too much work and not enough time or staff to handle it all effectively and efficiently.

We hear this all the time: “We’re doing fine now, but as we grow, we know this isn’t a scalable approach.” Even top-performing practices run into this. They’re doing well, but everything still feels manual, fragmented, and inefficient—and they know they can’t just keep working harder forever. And with constantly changing rules, payer demands, and operational complexities, it’s impossible to keep up without burning out.

The reality is, health systems, FQHCs, and medical groups know they need to close care gaps, improve coding accuracy, and meet quality targets—but they simply don’t have the bandwidth to do it efficiently. Staff are stretched thin, payer contracts keep evolving, and existing technology isn’t built to fit seamlessly into their workflows.

To make things even more challenging, hiring more people isn’t always the answer. Human capital is expensive, and many organizations can’t afford to throw money at the problem just to end up right back where they started. And when staff leave, it creates an even worse situation—disrupting workflows and setting them further back.

That’s where we come in. HealthHelper eliminates these barriers. We bring the right mix of technology, automation, and people to help practices actually get this work done—without adding to their burden.

From a product perspective, we’ve built a reliable, future-proof solution that not only helps practices scale—but also protects them when they need to contract. Whether they’re expanding or facing staffing shortages, they can rely on HealthHelper to provide stability, efficiency, and sustained performance—no matter what comes next.

3. HealthHelper is expanding its capabilities beyond closing care gaps. What’s next?

We’ve got some big product enhancements coming this year that we’re really excited about. I can’t share all the details just yet, but what I can say is that our clients keep asking us the same question: ‘What other workflows can HealthHelper help us scale?’

The reality is, healthcare has no shortage of inefficiencies and operational challenges. But solving them isn’t just about building technology—it’s about earning the trust of provider organizations to take these problems off their plate. That’s exactly what we’re doing.

Moving forward, HealthHelper will orchestrate and augment more of their workflows. We’ll be rolling out new solutions that allow practices and networks to quickly spin up tech-enabled workflows that scale, orchestrate, and hardwire best practices for specific patient populations. But this isn’t just technology, this includes the nimble service augmentation that actually gets the work done.

One of the biggest pain points we’re tackling is the constant changes in and impressive complexity of having to deal with a multitude of payer contracts. Every time a contract changes, practices aren’t in a position to completely overhaul their workflows for that payer’s patients. But with HealthHelper, they don’t have to. We combine technology and coordination resources to make those adjustments seamless.

Instead of spending weeks on planning, staffing, and change management, practices and networks can turn to HealthHelper to activate high-value workflows that drive performance improvements—without having to change their own workflow, without having to worry about tech integrations, and without adding more administrative burden. We orchestrate the workflow…and we execute the work.

4. What role do AI and automation play in HealthHelper’s future?

It’s an exciting time to be in care navigation—moreso than ever before, AI is allowing us to do more with fewer resources. But let’s be clear: AI isn’t here to replace providers or care teams—it’s here to amplify their impact.

At HealthHelper, we’re AI-enabling our care coordinators so that most of the patient engagement and care coordination can run on autopilot, while our team steps in when human judgment, creativity, and problem-solving are needed. Many patients want to know that there is a human there to help. HealthHelper clients learn quickly that in fact there are so many gaps and inefficiencies in healthcare that still require a real person to connect the dots, and that’s where the AI-plus-human approach becomes so powerful.

That’s also why we’re skeptical of companies claiming AI can do it all. Healthcare is complex. Data is messy. Systems don’t always talk to each other. We’ve seen firsthand that you still need people in the loop to ensure nothing falls through the cracks. That’s why our focus is on AI working alongside humans both to scale adoption of coordinator best practices and to actually take work off our clients’  plates—end to end.

5. Where do you see HealthHelper in five years?

When I think about where HealthHelper will be in five years, I think about the brand we’re building. Right now, we’re known as a trusted partner for primary care providers—an extension of their team that actually helps them get work done. That trust is everything, and it’s what sets us apart.

Five years from now, HealthHelper will still be that trusted partner—but our impact will go far beyond care gap closure. We’ll be known for orchestrating and augmenting all types of provider workflows—helping practices and health systems run more efficiently, scale operations, and do more with less.

We’ve already proven that we can seamlessly integrate into primary care teams and take work off their plates. That foundation gives us the ability to expand—taking on more administrative and operational burdens so that providers can focus on patient care. And as we grow, we’ll continue leveraging AI and automation to make our solutions even more effective and efficient.

Ultimately, I see HealthHelper becoming a critical infrastructure piece for primary care, health systems, and the networks that support them. We’ll be the go-to partner for healthcare organizations that want to scale highly effective provider workflows—powered by smart automation and deep healthcare expertise.

That’s where we’re headed, and I couldn’t be more excited about what’s next.

Feb 19, 2025

HealthHelper: Born From the Frontlines of Primary Care

I didn’t start my career thinking I’d build a company. I became a primary care physician to help people—to care for patients and make a real difference in my community. My days were full but meaningful—managing medications, seeing patients back-to-back, addressing urgent issues, and keeping the practice running smoothly.

But over time, something shifted.

Increasingly, my clinical responsibilities weren’t the only thing demanding my attention. I was handed chase lists—long lists of tasks tied to closing care gaps and meeting payer performance metrics. These lists weren’t just overwhelming—they were riddled with inaccuracies and existed completely outside of my primary systems and workflows. I’d review the lists, often feeling frustrated. I knew my team and I had already discussed many of these preventive screenings and follow-ups with our patients. So why were they still appearing?

Oh yeah…patients have lives outside of my clinic, they get busy and forget. So what am I supposed to do about this? I didn’t have the staff, tools, or time to systematically tackle this extra workload.

Some of my colleagues were using ad-hoc methods. One provider handed out bright pink slips to patients reminding them to schedule their mammograms, while others made verbal reminders to “come back in six months” for a diabetes follow-up. My team and I took to making phone calls when we had a spare moment (which were few and far between). It was inconsistent, inefficient, and often ineffective.

The challenge wasn’t just closing care gaps. It was that meeting these payer requirements directly impacted our ability to succeed as a practice—yet no one had a scalable, effective way to manage it.

I knew there had to be a better way.

The Turning Point

That’s why I founded HealthHelper.

I wanted to create a solution that took the work off providers’ plates—so they could focus on their patients, not on the endless administrative tasks required to perform well on payer contracts. I wanted to offer something that gave providers relief—the confidence that their practice could meet performance goals without compromising patient care. AND, it had to make it easy for patients, otherwise, it wouldn’t move the needle.

HealthHelper was built to solve exactly this problem.

We take on the work providers don’t have time for:

  • We close care gaps by identifying patients overdue for preventive services and actually scheduling their care for them.

  • We help you perform better on payer contracts by managing the operational lift of care coordination and patient engagement.

  • We become your performance partner, ensuring you meet key performance measures while reducing staff burden.

The Impact We Strive For

Today, HealthHelper works with providers and health systems to make sure no care gap goes unaddressed. Our team handles the administrative complexity, allowing care teams to focus on what they do best.

We’re not just a technology platform or service; we’re a true partner in performance.

To my fellow providers: I see you. I know how hard you’re working. HealthHelper exists to ensure you can keep doing what you love—caring for patients—while we take care of the rest.

Let’s make healthcare better, together.

Jan 11, 2025

Closing Care Gaps and Retaining Patient Care - Everyone is a Stakeholder

When we engage with a prospect, almost every individual within a healthcare organization, regardless of title, is a stakeholder. Many vendors lose sight of this fact and focus only on a narrow set of individuals based on their job descriptions. We don’t. We take a broader perspective, recognizing how our solutions impact various roles across the organization. For example, here’s a foundation on how we think about what we do and how it affects them:

Close Gaps in Care

CEO - You want the best for your patients and your employees while you continue to grow. Our tech-enabled services deliver concierge-focused patient engagement services. This not only enhances patient satisfaction and retention, but it also allows your clinical providers to focus on delivering care that truly makes a difference, enabling them to work at the top of their license. Providers who feel supported and have the tools they need are less likely to experience burnout or leave, fostering a stable and high-functioning clinical team.

CFO - You’re focused on the bottom line and want to ensure that partnering with HealthHelper generates a positive return on investment. Our solution drives clinical and financial success by enabling providers to concentrate on delivering care that meets the organization’s quality metrics and payer contract requirements. For multi-specialty groups, our proactive patient engagement reduces network leakage and retains patients within your system, enhancing patient loyalty and ensuring revenue capture. Across our customer base, we consistently deliver a 5X+ ROI by reducing administrative burden, retaining care, and improving outcomes.

Care Providers - You became a provider to practice medicine, not to spend your days making follow-up calls or chasing down patients. Our solution is designed to offload administrative tasks, so you can focus on delivering excellent care. We take on the burden of reaching out to patients, scheduling needed services, and ensuring they’re up-to-date on preventive and chronic care. This means fewer distractions and more time for meaningful patient interactions. Reclaim your time and focus on the work that inspired you to become a provider in the first place.

Practice Managers - Your role is to keep both your practice and your team running smoothly. Our services enable you to maximize productivity without burning out your staff. By offloading patient outreach and scheduling responsibilities to us, your practice team can prioritize higher-value tasks that keep the practice operating efficiently and effectively. You’ll notice the impact not just in workflow, but in team satisfaction and patient experience.

Risk-Bearing Entities - Whether you’re a health plan, ACO, MSO, or pay-vider, your mission is to deliver higher quality care at a lower cost. Achieving this requires closing care gaps that impact quality metrics, star ratings, and drive downstream costs. Yet, with practices already overwhelmed, it’s crucial to implement solutions that reduce, rather than add to, their workload. Our approach relieves your practices by taking on care coordination tasks and focusing on the outcomes you’re measured against. The result? Better quality scores, enhanced patient outcomes, and a stronger financial performance.

Lastly, but definitely not least, the patient. The whole reason all of us have a job. The reason we wake up every day and do what we do. When everyone in the healthcare ecosystem understands their role as a stakeholder and consistently delivers, the patient is the ultimate stakeholder and beneficiary. When they know where they need to be, when they need to be there, and why—and follow through—everyone wins. They reap the reward of happy providers, happy care providers, thought-leading CEOs, CFOs, and clinical leaders within any healthcare organization. THE PATIENT is why you succeed. THE PATIENT is why HealthHelper exists.

It’s time we look at the whole picture. Eliminate the tunnel vision, and provide solutions that benefit all stakeholders.

Oct 1, 2024

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About

© 2025 HealthHelper

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Work completed. Results delivered.