HEDIS Care Gaps

Overview

The Sanitas HEDIS Care Gaps dashboard provides a comprehensive and interactive overview of quality performance metrics across various organizational levels within Sanitas. Designed to support population health initiatives and care management efforts, this dashboard visualizes performance on key HEDIS measures, highlighting gaps in care and tracking progress toward organizational targets. It is also a tool to prioritize patient outreach and identify high-value activation opportunities.

The primary view on each tab aggregates data by chosen org level and care gap category, offering detailed metrics including the number of opportunities, the number met and unmet, the resulting HEDIS rate, and comparisons against goals. The goals are provided by Florida Blue periodically throughout the year and are based on peer-practice performance.

The presentation of data on each tab is catered to specific audiences (e.g., Executives, Operations Managers, Providers). Color-coded indicators and region-specific breakdowns allow stakeholders to quickly identify areas of underperformance, enabling data-driven decision-making and targeted interventions to improve patient outcomes and close care gaps.

This dashboard defaults to showing only Active Patients on the current payer roster.

Metrics Overview

The charts and tables included in this tab are:

  • Trend

  • Details

  • Profile Metric – Refers to which geographic or organizational level you want to see the aggregate statistics per HEDIS measure. The dashboard defaults to Region—use the Profile Metric picker on the page to change the default to the desired level of interest.

  • Care Gap – Specific HEDIS measures tracked (e.g., Breast Cancer Screening, Diabetes - A1C).

  • Opportunities – Total number of patients eligible for a specific HEDIS measure.

  • Met – Number of patients for whom the measure was satisfied (closed gap).

  • Not Met – Number of patients for whom the measure remains outstanding (open gap).

  • HEDIS Rate – Proportion of met opportunities over total opportunities (Met ÷ Opportunities).

  • Max Goal (EOY) – Florida Blue peer performance benchmark that Sanitas aims to achieve by the end of the year.

IMPORTANT: Max Goals are moving targets. Florida Blue changes the values periodically relative to peer performance. If peer practices are doing better, the goals will be raised.

  • Expectations Status – Indicator showing whether the current performance is "Below" or "Meets" expectations based on the goal thresholds.

  • Region / County / Center – Geographic or organizational filters that can be applied to the data.

  • Open Counts per Patient – Distribution of patients by number of open care gaps (e.g., 1, 2, 3, etc.).

  • Provider Managed – Patients that have been seen and are attributed to a provider panel. This mirrors the provider scorecard rules for patient inclusion in a provider's care gap closure performance.

  • Current Quality Measure File – the latest measure year/month that has been received from the payer. New files are usually loaded the first week of the month for the previous month.

  • Current Roster YearMo – the latest roster that has been received from the payer. New files are typically received on the 10th of the month and fully propagated in the system by the 15th.

Tabs Overview

Summary

This tab contains a high-level view of performance at various geographic and demographic levels for executive management to compare performance across the organization.

At the top of the page are the following two charts which are not subject to the dimension filters of State, Region, County, Facility, and Provider:

  • Open Counts per Patient

  • Hedis Rates to Targets

The following tables and charts are impacted by dimension filters:

  • Performance Summary

  • Breast Cancer

  • Cervical Cancer

  • Colorectal Cancer

  • Controlling HBP

  • Diabetes A1C

  • Diabetes Eye

  • Diabetes Kidney

  • Mental ED

  • Hedis Rate by Age

  • Hedis Rate by Gender

  • Hedis Rate by Age and Gender

Patient Details

This tab contains similar information to the Summary tab, but by default only includes seen patients (Provider Managed = Yes). Providers can come here to see the details behind the care gap closure metric in their Provider Scorecard. Providers may also utilize the controls to download their priority patient lists for targeted outreach to help them meet/exceed their performance goals

The tables included are:

  • Performance Summary

  • Patient Details

Data Waterfall

A detailed view for the Sanitas Quality Team to reconcile differences between the payer (Florida Blue) files and this dashboard.

Tables included in this view are:

  • Full File Count

  • Keep Florida

  • Measure Year

  • Keep Current Year

  • Active Roster for this Year

  • Keep Active this Year

  • Facility State

  • Keep Florida and Non-Seen

  • Care Gap Measures

  • Keep Core Gaps

  • Final Count (Default View is Set to Current Roster)

  • Final Count - Market Segment

  • Final Count - Seen vs Not Seen

  • Final Count - Closed Gaps

  • Final Count - Seen vs Closed Gaps

  • Final Count - Measure Date Details

Historical

This tab contains a view that contains monthly snapshots of Hedis data displays summarized data by month.

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