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October 22

What is Gap Closure in Healthcare and Why Does it Matter to Patients?

Have you ever put off scheduling an appointment for bloodwork until you have more time, and then forgotten about it completely? Or have you ever checked out of a pediatric visit for your child, saying that you will call back to schedule their next appointment, but never got around to calling?

Missing the next step in any type of healthcare process creates a gap in care, and it happens all the time for all sorts of reasons. At LCH, we recognize that our patients are busy, have financial concerns, or sometimes aren’t sure about what to do next for their healthcare. Our team makes it a priority to help individuals and families in Chester County identify gaps in their healthcare so that we can close them and reduce gaps in care going forward.

What are Gaps in Care in Healthcare?

Ideally, healthcare should be an ongoing process for everyone. Tracking health history, monitoring disease risks, and managing health conditions are all ways that healthcare providers support their patients. When there is a difference between the healthcare a person should receive based on their age, overall health, and any existing diagnosis and the healthcare they actually receive, we call that a gap in care.

Gaps in healthcare happen for a combination of reasons, and patients should never feel like they did something wrong when they do not take the next step for screenings, follow-up appointments, or specialist referrals. Sometimes, there are barriers like costs, a misunderstanding about their doctor’s recommendation, or insurance confusion that prevent a patient from moving forward. Clinical gaps in care come up when patients don’t have a primary care provider (a healthcare practice that they see regularly) to support their ongoing needs.

Where Do Care Gaps Come From?

Healthcare gaps are incredibly common, and it does not mean that you did something wrong. These things tend to just happen, and in fact, there might be several causes behind your own gap. Do any of these sound familiar?

  • You don’t have a regular doctor or healthcare provider who you see for routine physicals or sick visits.
  • You changed jobs and no longer have insurance, or you don’t know how your new insurance works.
  • You have had trouble understanding healthcare providers in the past because you don’t speak the same language, and you are frustrated by the confusion.
  • You aren’t sure what a healthcare visit, screening test, bloodwork, or specialist referral will cost out of pocket for your insurance co-pay or without insurance at all, so you don’t want to schedule the appointment.
  • You completely forgot to schedule bloodwork or a follow-up appointment, and now you worry it’s too late.
  • You moved to a new county or state and don’t know how to get back on track with healthcare providers in the area.

Knowing how to identify gaps in care is important for both healthcare providers and patients so they can work together to avoid them in the future. 

Examples of Gaps in Healthcare

What does a gap in care look like for the average patient? For many, it’s as simple as one missed appointment. But that one missed appointment or screening can quickly lead to more. These are some examples of what that looks like:

  • A woman over 40 visits her women’s healthcare provider for a routine visit, where she receives an order for a mammogram. She forgets to make the mammogram appointment, then worries that she did something wrong and decides not to schedule her next annual exam.
  • A Type 2 Diabetes patient gets behind on scheduling his bloodwork, creating a clinical gap in his HbA1c test records with his primary care provider.
  • A teen and her parent receive a referral for behavioral health services, but they can’t find time in their schedule to connect with the provider.
  • A family moves to Chester County from another state, and they are not sure when their child last received vaccines. They do not remember the name of their previous provider and can’t complete the paperwork to enroll their child in school.
  • An adult with a family history of colorectal cancer is unaware of the hereditary risks, does not mention the cancer in the health history questionnaire, and misses a timely screening for the disease.
  • Following routine bloodwork, a patient receives a call from the healthcare provider reporting high cholesterol that they want to monitor. Feeling healthy and not wanting to make any changes, the patient decides not to schedule a new appointment or follow through on updated lab work.

These examples of gaps in care are just a short list and do not cover all the ways people can miss out on important healthcare. Think about your own healthcare experience and whether or not you have gotten behind in appointments, screenings, or bloodwork. If you have, then you are experiencing a gap in primary care.

What is Gap Closure in Healthcare?

Gap closure in healthcare is the simple process of figuring out what care should have been received and working to make it happen. Healthcare providers are invested in helping patients reduce gaps in care, which means that patients should not feel guilty or embarrassed about reaching out for assistance.

Most of the time, closing the healthcare gap is as simple as scheduling an appointment, writing a new prescription or order, or connecting with a referral provider. If you know you are in a healthcare gap right now, the first step you can take is to reach out to your care team.

How Do Providers Identify Gaps in Care?

With electronic health record systems (EHRs), it has become much easier for healthcare providers to identify gaps in care and work with patients to close them. Some EHR systems generate reminders for overdue care, which your healthcare team can see on their internal system. You may also be able to see the reminder if you have access to an online patient portal.

Annual wellness visits, also called well checks or physicals, allow your healthcare team to review your health history and see what bloodwork, screenings, or vaccines still need to be done. Healthcare providers like LCH have care coordinators on staff who know how to identify gaps in care so that they can be resolved with patient education and proactive scheduling.

Gaps in Primary Care: Why a Regular Provider Matters

Having a consistent primary care provider is one of the best ways to reduce gaps in care for patients. When patients are able to access care for a variety of healthcare needs from a team of providers, all the dots get connected, and that patient’s healthcare picture looks much more complete.

A health center like LCH, that has an integrated approach to patient care, gives patients a homebase for all of their healthcare needs. Even when we refer patients to specialty care for their specific condition or healthcare need, our records continue to track the information so that we can review how patients are doing with the other care provider. When we identify a gap in care, we can address the issue quickly and help our patients get back on track. By reducing gaps in primary care, we find it much easier to close gaps in every other area of care for our patients.

Why Do Care Gaps Matter to Patients?

If you know that you have gaps in your healthcare right now, it’s important to understand that resolving them is the best choice for your health. When you keep up with routine healthcare, your providers are able to assess your current health and potential risks for medical conditions or diseases. Although it can be upsetting to receive a diagnosis or be sent for more testing, early treatment helps you maintain your health and save money in the long run.

Start by scheduling a wellness visit. From there, your healthcare provider can help you close any healthcare gaps with preventative care, early treatment, screenings, and follow-up visits to manage and improve your health.

Gaps in Mental Health Care: A Frequently Overlooked Area

Gaps in mental health care are unfortunately common and can be even harder to overcome than gaps in primary care. Individuals with mental health issues like depression, anxiety, ADHD, and other diagnoses that disrupt daily functioning often find it difficult to keep up with healthcare.

Quality mental healthcare offers treatment plans, supportive follow-up, and referrals to behavioral health providers that can genuinely improve patient outcomes. Because LCH offers integrated behavioral health services in our West Grove location, we are able to get patients plugged into mental health services quickly and affordably. Our sliding-scale fee discount program prevents finances from ever being a barrier to accessing necessary mental health care.

How to Start Closing Your Own Care Gaps

Closing your healthcare gaps, and reducing care gaps in the future, is very manageable. Once you get back on track, you’ll feel like you have a lot more tools to stay in control of your health.

Step 1. Find out what kind of care you are due for by asking your current provider for a summary, visiting your online patient portal, or calling your primary care provider. If you don’t have a provider right now, contact us at LCH to schedule a first appointment.

Step 2. Schedule your annual wellness visit. This is the single most effective way to close a healthcare gap for yourself or a member of your family. If you have medical insurance, including Medicaid or Medicare, your annual well check is covered at no cost to you.

Step 3. Follow up on referrals, screenings, bloodwork, and scheduling your next appointment. If you made the first call and have not heard back to get an appointment scheduled, call them again.

Step 4. Be honest with your provider. If you missed a screening, never scheduled a follow-up or specialty care appointment, or you could not afford to fill a prescription, your care team can help. There’s nothing to be embarrassed about; just reach out and let us know what happened so we can support you.

Step 5. Connect with a care coordinator. If navigating primary care, specialty care, or mental health care for yourself or a family member is overwhelming, we are here to help. LCH offers care coordination as a standard service so that our patients can stay up to date with all of their healthcare needs.

How LCH Helps Patients Close Gaps in Care

As a Federally Qualified Health Center that has been serving Southern Chester County for over 50 years, LCH defines good care as providing the resources patients need in order to maintain healthy lifestyles. Gap closure in healthcare is our priority because it’s what is best for our patients and our community.

If you know you have a gap in your healthcare, or you have gone a long time since your last appointment, please reach out to our team. You do not have to have all the answers about your gaps in care. We are always accepting new patients and will work with what you do know to catch up with the right care for your needs. At LCH, we accept private insurance, Medicaid, and Medicare. We also offer an affordable sliding-scale fee program so that you can receive excellent healthcare even without insurance. We offer primary care and social assistance services in English and Spanish at all three of our convenient locations in Oxford, Kennett Square, and West Grove. Our West Grove location is also home to LCH pediatrics, dental, behavioral health, and women’s healthcare offices. Whether you need a new healthcare provider or you just want to make sure you don’t have any gaps in your current healthcare, please make an appointment at the LCH location nearest to you. 

LCH Health & Community Services