Closing the ‘Care Gaps’ That Drive Up Health Care Costs

4-minute read

Chronic illnesses are killing any hope of reigning in ever-higher health care and insurance costs.

While smoking rates in the U.S. have fallen in recent years, diabetes, high blood pressure, physical inactivity and obesity are only growing, costing U.S. employers tens of billions of dollars a year in missed work alone.

Approximately half of Americans suffer from a chronic disease. In fact, one in four American adults has two or more of these diseases at any given time.

Closing "care gaps" is helping lower the cost of group health insurance.


This is old news to anyone anywhere close to the front lines of health care. But how to solve this problem?

One way is to make sure your group health plan is truly committed to closing what’s known as the “care gap.”

Gaps in care are the gulf between the recommended treatment plan for a patient and the treatment that patients realistically seek and receive. A care gap might refer to a patient who misses her breast cancer screening or a diabetic who doesn’t get their A1C level tested.

Care gaps also occur because a patient new diagnosis isn’t shared with their primary-care physician or because a patient can’t find the care they need in their network or area.

Care gaps can result in missed or delayed diagnosis, more costly and potentially more invasive treatment down the line, and, of course, chronic illnesses that only worsen.

Identifying who in your plan is at high risk for serious illness requires a close examination of your company’s clinical and claims data.

In a world where premiums collected sometimes matter most, some carriers direct their resources to doing this sort of data-mining more carefully, more diligently than others.

Suffice it to say that the more your plan can mine your data, the better job it will do in identifying care gaps. And once it’s done that, it can then begin the work of patient outreach.

Patient outreach is just what it sounds like: the process of communicating with enrollees to educate them about their care options.

How well this approach works will depend on several variables, including a willingness by your employees to engage in their own care, especially those who might be in a high-risk population but not yet be sick.

There are no magic bullets in health care, no quick fixes. But that’s no reason to accept the status quo, and definitely not a reason to leave people with chronic illness without the care they need.

3 More Ways to Address Care Gaps

  1. If your company isn’t already using them, the care management programs in your plan are critical to addressing care gaps. There are care management programs for every chronic disease. A diabetes care management program, for example, can offer members coaching, regular check-ins, and other help complying with treatment protocols.
  2. Employee education campaigns and communications like email blasts, mailers, and plan documents can help. Your benefits teams, for example, can work with your broker or health carrier to send out reminders to members who are 50 and older for certain recommended health screenings.
  3. Review your network and care options. If employees in, say, one community are using the ER for mental health care more than in another, you may want to expand your network of mental health professionals.

The Mahoney Group, based in Mesa, Ariz., is one of the largest independent insurance and employee benefits brokerages in the U.S. An employee-owned organization, we’ve been providing our clients with the confidence to face whatever lies ahead for more than 100 years. For more information, contact us online or call 877-440-3304.


Scroll to Top