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Healthix Gaps in Care

Healthix Gaps in Care reporting is instrumental in identifying closed gaps previously unknown (e.g., patients who received care outside your network), which in turn improves quality metrics. Additionally, the reporting provides an understanding of how patients receive care for common, acute and chronic conditions. The knowledge gained can positively impact resources and outreach strategies.


Healthix Gaps in Care

Identifying gaps in care is a difficult task, because in New York, patients often receive care across multiple healthcare provider networks. This presents a challenge in identifying tests and procedures that may have already been performed elsewhere.

The Gaps in Care report is a new Healthix solution that delivers data for specific HEDIS quality metrics to facilitate Healthix customers in identifying patients whose care gaps have been closed elsewhere.

The primary audience of this report is Healthix participants who focus on care coordination and quality improvement to optimize their fee schedules under various value-based reimbursement models. This report enables customers to reduce care coordination expenses and increase VBC premiums and bonuses.

Healthix uses the HEDIS Measure specifications and the HEDIS Value Set Directory to search for matches to diagnosis codes, procedure codes, lab codes and more. It then gathers the data for all consented patients at the receiving facility who have a code match and compiles it into a single report for each measure.

The Healthix consolidated Gaps in Care report contains the following measures and individual lookback period, organized in separate tabs in a downloadable file:


Adherence to antipsychotic medication (SAA)1-year lookback
Asthma medication ratio (AMR)1-year lookback
Annual visits1-year lookback
Controlling blood pressure (CBP)Current measurement,
1-year lookback
Breast cancer screening (BCS)2-year lookback
Cervical cancer screening (CCS)5-year lookback
Colorectal cancer screening (COL)10-year lookback
Comprehensive diabetes care (CDC)1-year lookback
Follow ­up after emergency department visit for alcohol and other drug abuse or dependence (FUA)Current measurement
(30 and 7-day period)
Follow­ up after emergency department visit for mental Illness (FUM)Current measurement
(30 and 7-day period)
Viral suppression load1-year lookback


    • Saves provider time tracking down patients who are already compliant
    • Supports meeting quality measures
    • Assists in increasing reimbursement


Use Case Scenarios

  • Care Coordination: Improves quality of care and care coordination for targeted patient populations.
  • HEDIS and QARR Measures*: Assists in meeting measures to optimize fee schedules under value-based reimbursement.
  • The report acts as a supplemental source for HEDIS measure and Participants may need to update or add data from other sources they may have for HEDIS submission.

*HEDIS (Healthcare Effectiveness Data and Information Set), QARR (Quality Assurance Reporting Requirements)

Data Fields

Currently the report includes the following fields:

Gaps in Care