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"Modernizing gaps in care programs: How lab data proactively prepares health plans for CMS Star ratings, HEDIS success and cost control"

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Health plans are under growing pressure to improve quality metrics, contain rising costs, and achieve stronger CMS Star and HEDIS performance. This white paper explores how lab data can serve as a foundational asset in modernizing gaps in care (GIC) programs, transforming them from reactive compliance exercises into proactive engines of financial and clinical success.

By delivering real-time visibility into member health, lab data enables early identification of at-risk populations, more accurate coding for optimized reimbursement, and targeted interventions that improve outcomes while reducing costs. Case studies demonstrate the measurable impact of lab-enabled strategies, including improved risk adjustment, enhanced quality scores, and millions in revenue gains.

The paper also examines the risks of inaction—fragmented care, missed diagnoses, and costly late-stage disease management—while outlining best practices for integrating lab data into GIC programs. With scalable outreach tools such as at-home test kits, automated engagement, and EMR integration, lab data supports member-centered innovation and operational efficiency.

Ultimately, lab data is more than a reporting tool; it is a strategic lever for sustainable growth. Health plans that adopt lab-enabled GIC programs can achieve measurable improvements in quality, compliance, and cost control, securing a competitive edge in today’s value-based care landscape.

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