What a care gap is

With no deadline there is no gap. An order from two weeks ago and one from fourteen months ago look identical on a pending list, and only one of them is a problem. Each type of service needs its own window, and the provider is the one who sets it.

What is the denominator of a care gap?

It is the question that comes up in every meeting where a percentage is shown. A patient can leave one consult with an imaging study and several blood tests: counting that as one order or as six changes the result. Either convention works as long as the denominator is declared before the figure is put on screen.

A gap closes with care delivered, or it gets explained: the patient had it done elsewhere, the physician cancelled it, the patient chose not to go through with it. A pending item with no explanation is unfinished work, and it piles up quietly over quarters.

US plans run the count under a standard name. HEDIS, as defined in federal regulation, is the performance measure set NCQA develops and maintains, covering effectiveness of care, access and availability, and service use.

The indicator serves both economics. The fee-for-service provider reads revenue that never happened; the capitated one reads clinical risk building up. We publish the full methodology in how we measure, including the completion rate that comes out of it.