Definition
A care gap is a difference between the care a patient should receive under clinical guidelines or quality measures, such as a screening, vaccination, follow-up visit, or medication refill, and the care the patient has actually received.
Care gaps are usually identified by matching claims, EHR, pharmacy, and lab data against measure specifications, many of them HEDIS measures. Typical examples include an overdue mammogram or colorectal cancer screening, a patient with diabetes who has not had a recent HbA1c test or eye exam, a missed follow-up after hospitalization, or a lapsed refill. Health plans track open gaps because they feed Star Ratings and value-based contracts, and providers track them for quality programs and patient outcomes.
Care gap closure is the work of getting the missing care done, and most of it starts with contact: reaching the patient, explaining what is due, and scheduling it. Gaps also surface during other calls; in a 2026 quasi-randomized trial of 7,091 high-risk patients (Du et al., JMIR), 40% of completed 48-hour nurse calls surfaced at least one care gap.
Delivery is a common failure point. A care-gap call that is labeled as spam or never answered leaves the gap open, which is how deliverability failure in healthcare converts directly into missed screenings, missed follow-ups, and no-shows. See "Spam Likely" call labeling.
How Consig handles it
Care-gap campaigns are among the outreach workflows platforms run on Consig, alongside reminders, recall, and no-show follow-up. For health plans, Consig's automated outreach is aimed at enabling preventive care, closing care gaps, and lifting the measures that drive reimbursement without increasing headcount.