The December scramble

The first week of December. The payer's year-end list shows 1,100 open care gaps. Four care managers split it up and start dialing. Half the phone numbers are wrong. Most of the patients on it haven't been in all year.

Picture a primary care group with 9,000 patients on value-based contracts. Each month it is paid a set amount for each patient, whether they come in or not. It also earns shared savings when its patients cost less than expected. Its quality score decides how much of those savings it keeps. The score depends on closing care gaps: screenings, checks and follow-ups. Payer lists arrived a month late and were checked by hand. Care managers spent 120 hours a week working spreadsheets. Gaps were found after the visit, when the patient had already gone home. At year end the team rebuilt the data to prove work it had already done. It closed 55% of its gaps and earned $300k in shared savings.

What SBK rebuilt

SBK mapped how a patient on the list becomes a closed gap and a paid bonus. The misses were worth $600k a year in savings the group never collected. They came from three places: patients never reached, gaps missed in the room, and care the payer never saw. The rebuild loads payer lists automatically and flags new patients the day they arrive. Outreach runs by priority, so care managers call the high-risk patients first. Open gaps show up at check-in, and the clinician closes them in the room. The data goes to the payer as care happens, not in a December scramble.

What moved

Gaps closed by December rose from 55% to 82%. Eight in ten patients were seen in the year, up from six. Hours on lists fell from 120 a week to 35. Shared savings tripled, from $300k to $900k. December became a normal month.