Closing gaps in care: How 3,500 healthcare practices are using AI-powered insights

The healthcare industry is undergoing a major transformation, driven by artificial intelligence (AI), real-time analytics, and advanced automation. These technologies are being integrated into electronic health records (EHRs), payer systems, and provider workflows to enhance care quality, reduce administrative burdens, and improve financial performance.

Companies like Veradigm, Innovaccer, and MedeAnalytics are leading this shift, helping healthcare organizations close gaps in care, streamline risk assessment, and improve patient outcomes. With the U.S. Centers for Medicare and Medicaid Services (CMS) pushing for value-based care models, healthcare providers must adapt to these new technologies to remain competitive and compliant.

Real-time insights for better care

One of the biggest challenges in healthcare is the fragmentation of patient data, which often leads to care gaps. These gaps occur when patients miss screenings, follow-ups, or treatments, negatively impacting their health outcomes and increasing costs for providers and payers. To address this, companies are embedding real-time insights into provider workflows, ensuring that gaps in care are identified and resolved efficiently.

Veradigm has taken a major step in this direction by integrating gaps-in-care alerts into the EHR systems of more than 3,500 healthcare practices across the U.S. These alerts, generated from national and regional health plans, provide actionable insights to clinicians at the point of care, allowing them to make timely interventions. This not only enhances clinical decision-making but also improves claim acceptance rates and reduces the administrative burden on staff.

“By embedding risk and quality-driven insights into provider workflows, we are fostering a more interconnected healthcare ecosystem that enhances efficiency and improves patient outcomes,” said Jay Bhattacharyya, Senior Vice President & General Manager of Veradigm.

Financial benefits for providers and payers

Beyond patient health, addressing care gaps has a direct financial impact on healthcare providers. Medicare Advantage plans, for example, benefit significantly from improved risk adjustment accuracy and reduced hospitalizations. According to industry estimates, closing care gaps effectively can save healthcare systems billions annually by preventing unnecessary emergency room visits and inpatient admissions.

Veradigm’s AI-driven system also integrates payer incentive programs, allowing providers to earn $100 per addressed patient gap. This additional revenue stream not only improves provider engagement but also encourages more proactive patient management.

AI and automation in risk adjustment and quality

Risk adjustment is a critical component of value-based care models, ensuring that providers receive accurate reimbursements based on patient risk profiles. However, traditional risk assessment methods are often slow and prone to errors, as they rely on manual processes that introduce compliance risks and increase administrative costs.

To overcome these challenges, Innovaccer has introduced its 360-Degree Gap Closure platform, which leverages AI-powered analytics to automate risk assessment. This platform enables payers and providers to identify and close care gaps across various settings, including provider offices, pharmacies, and home-based care.

Additionally, it facilitates seamless data exchange with electronic health records (EHRs), eliminating inefficiencies caused by disconnected systems and improving overall care coordination.

Improving Compliance and Coding Accuracy

As the CMS accelerates the shift toward value-based care, compliance and coding accuracy are becoming increasingly crucial. AI-driven automation is playing a key role in improving coding precision, ensuring that diagnoses and procedures are accurately recorded. This not only helps healthcare providers optimize reimbursements but also reduces the likelihood of audits and minimizes financial losses.

Abhinav Shashank, co-founder and CEO of Innovaccer, emphasized the importance of integrated solutions in addressing these challenges, stating that health plans no longer need to rely on multiple vendors and fragmented tools to close care gaps efficiently across the entire patient journey.

By reducing dependence on manual coding and disconnected data sources, healthcare organizations can lower the risk of compliance penalties, improve financial sustainability through optimized risk-adjusted payments, and enhance patient care by identifying high-risk individuals early.

EHR integrations and AI-powered patient insights

While gaps-in-care alerts and risk adjustment tools are essential, healthcare providers also require comprehensive patient insights embedded directly into their EHRs. This is where MedeAnalytics and Holon Solutions come into play. Their AI-powered patient insights overlay enhances provider workflows by providing real-time data without requiring clinicians to switch systems or search for information manually.

Breaking down data silos with AI

Healthcare providers often face challenges in accessing complete patient histories, as crucial data is scattered across multiple systems. This lack of integration makes it difficult to provide timely and well-informed care.

To address this issue, MedeAnalytics and Holon Solutions have collaborated to develop an AI-powered patient insights overlay that seamlessly integrates with electronic health records (EHRs) without disrupting clinical workflows.

This overlay automatically retrieves and presents essential patient information, including claims history for past diagnoses and treatments, social determinants of health (SDOH) data to identify external factors affecting patient well-being, and real-time care gap alerts that enable providers to take immediate action.

By eliminating the need for multiple logins and manual searches, this technology reduces administrative burdens, allowing clinicians to focus more on direct patient care and improving overall efficiency in healthcare settings.

Enhancing provider efficiency and revenue capture

For healthcare providers, adopting AI-powered insights brings significant benefits. It leads to an 80% increase in gap closure rates, which directly improves patient outcomes by ensuring timely interventions and preventive care. Additionally, providers experience a 5% increase in revenue capture, contributing to greater financial stability. By automating administrative tasks and streamlining workflows, AI also reduces the burden on healthcare staff, allowing them to focus more on patient engagement rather than paperwork.

Steve Grieco, CEO of MedeAnalytics, stated that the partnership with Holon marks a significant advancement in healthcare data management and analytics, improving patient outcomes, enhancing care quality, optimizing value, and increasing revenue for both payers and providers.

The future of connected healthcare

Looking ahead, AI will play an even greater role in predictive analytics, allowing healthcare providers to anticipate health risks before they escalate. Advanced algorithms will soon be capable of predicting disease outbreaks by analyzing population health data, enabling early interventions to prevent widespread illness.

Additionally, AI can personalize treatment plans by examining patient genetics and medical history, ensuring more targeted and effective therapies. Hospitals will also benefit from AI-driven forecasts of patient admission trends, allowing for better resource allocation and improved patient flow. As these technologies continue to evolve, healthcare organizations will be able to enhance preventive care, reduce costs, and ultimately improve patient outcomes.

Insights for healthcare stakeholders

AI-powered gap closure tools enable payers and providers to take a proactive approach to patient care, ensuring that medical needs are addressed in a timely manner. At the same time, electronic health record (EHR) integrations help reduce manual workflows, allowing healthcare professionals to work more efficiently and focus more on patient interactions.

Another key advancement is risk adjustment automation, which enhances coding accuracy and ensures that providers receive the appropriate reimbursements for the care they deliver. Alongside this, real-time patient insights are improving decision-making, reducing unnecessary hospitalizations, and lowering overall healthcare costs.

The future of healthcare relies on AI-driven data, transforming care delivery for a more connected and efficient system. Real-time analytics and automation are reshaping healthcare, improving outcomes for providers and patients alike.

As healthcare continues evolving, embracing AI, automation, and real-time data exchange will be essential for success. Providers and payers who leverage these innovations will not only enhance patient outcomes but also optimize financial performance, improve operational efficiency, and drive long-term sustainability.