The Real Cost of Care Gaps — And How to Eliminate Them with Digital Nudges
Care gaps, the periods between doctor visits when patients often fall off track, cost employers, TPAs, and patients a significant amount each year. These gaps result in missed treatments, poor outcomes, and increased costs across the board. But digital health tools like Cix Health are changing that. The consequences are far-reaching, extending beyond individual patient outcomes to impose substantial, often hidden, costs across the healthcare ecosystem. For employers, this translates into lost productivity and increased absenteeism. For TPAs, it means higher claim volumes and strained resources. For care managers, it represents a constant battle to keep patients on track with limited touchpoints.
The truth is, what happens—or doesn't happen—between doctor visits is often where the real battle for health is won or lost. Missed appointments, unmonitored recovery periods, and a lack of adherence to care plans not only represent missed opportunities for better health but also actively contribute to a cycle of escalating costs and deteriorating conditions.
The Hidden Drain: Unpacking the True Cost of Care Gaps
Care gaps quietly drain billions from the system. Hospital readmissions are a prime example—often preventable, yet extremely costly. Patients confused about discharge plans or medications frequently end up readmitted.
As Sherry, a pharmacist, explains: "The doctors may stop meds in the hospital and start new ones that are duplicate therapy. They're taking their old meds plus their new discharge meds, and a couple of days later, they are back in the hospital. Adverse med event. Happens frequently."
Without timely guidance or follow-up, patients often default to the ER. These visits are expensive, avoidable, and emotionally draining. Courtney, a caregiver, shared how her father's short hospital stay spiraled into six weeks of complications due to a lack of visibility and communication:
"I have no visibility into what's happening." This lack of visibility and coordinated follow-up is a hallmark of care gaps that can lead to such escalations. It's a sobering reality that a significant percentage of Medicare patients, approximately 20%, are readmitted within 30 days, resulting in billions of dollars in annual costs, with a substantial portion of these readmissions being preventable.
Chronic conditions demand consistent care, but care gaps disrupt that rhythm. A missed check-in or lapse in medication can turn manageable conditions into emergencies. David, who lives with Type 1 Diabetes, shared: "I hurt every day, all day. I wouldn't wish this on my worst enemy." His struggle underscores the daily burden of chronic illness, where consistent support can make a monumental difference in quality of life and prevent costly complications. The cost isn't solely measured in dollars spent on claims; it also includes lost productivity, presenteeism, and employee turnover.
Bridging Care Gaps: The Power of Proactive, Personalized Engagement in Digital Health
The key to mitigating these costs and improving outcomes lies in transforming how we approach patient support outside the traditional clinical setting. This is where the concept of "preventive engagement" becomes paramount. Instead of reacting to crises, we must proactively guide and support individuals throughout their health journey. This is where innovative "digital care coordination" platforms are making a profound difference.
Cix Health helps employers, TPAs, and care teams eliminate these costly gaps. Through smart, personalized digital nudges, members stay engaged between appointments and out of the hospital.
Key Results
Up to 50% lower readmission costs with Cix Health's recovery tracker
63% member interaction rate (vs. 17% industry avg)
ROI up to 315% for enterprise clients
How It Works: Personalized Nudges, Consistent Support
Cix Health achieves these outcomes through a sophisticated yet user-friendly approach.
Smart Nudges & Reminders – Real-time prompts for meds, self-care, and follow-ups. Robin, a patient managing chronic conditions, states, "I love being able to take my meds from my watch," and finds notifications most helpful. She adds, "I like having a place to manage all my meds; it's my own version of my health record." Kelly, another patient, found the app invaluable when she left town and forgot a prescription, saying, "Using the Cix Health app, she was able to look up her medicine and request a refill."
Track Adherence & Progress – Patients and caregivers monitor care plan completion. Jacob, a caregiver, notes, "The medicines feature is most helpful. He believes our app has helped him focus on what medicines his cousin is taking as well as the dosages." This continuous stream of information is invaluable.
Proactive Alerts – Escalations flag risks early for timely intervention. This proactive "post-discharge management" is crucial. Douglas, a Chief Medical Officer, emphasizes the problem of transitioning care: "Transitioning care from hospital to home/facility is a large problem... If one breaks, it all breaks." Cix Health aims to mend these breaks.
This proactive support system enhances human interaction, ensuring providers are more informed and effective.
Benefits of Digital Care Engagement for Employers, TPAs, and Care Managers
For Employers: Cultivating a Thriving, Productive Workforce. A healthier workforce is more productive.
By providing employees with a tool like Cix Health, employers can:
Reduce Absenteeism and Increase Presenteeism: When employees like David, who endure daily pain, or Karen, who struggles with stress-induced conditions ("I couldn't turn my mind off"), receive better support, their ability to be present and engaged at work improves. It's understood that around 70% of total healthcare costs are driven by lifestyle and chronic care conditions, areas where Cix provides significant support.
Support for stress, pain, and chronic care leads to higher productivity: Empowering employees to manage their health yields better long-term outcomes and contributes to a more positive and productive work environment.
Better retention through compassionate care benefits: Investing in employee well-being is a powerful tool for employee retention. Supporting employees like Janet, a caregiver who felt that "self-care takes a backseat," can improve morale and reduce turnover.
For TPAs: Enhancing Plan Efficiency, Compliance, and Member Satisfaction TPAs seek to improve plan efficiency and member satisfaction. Cix Health helps by:
Cut unnecessary claims and ER visits: Significantly reducing costly readmissions (up to 60-70% lower costs) and ER visits directly impacts plan spending. As Sherry, the pharmacist, highlighted, preventing medication errors post-discharge avoids costly adverse events. The platform's high engagement and retention rates (a 54% 90-day retention rate) contribute to more consistent and effective plan utilization.
Boost retention and engagement (54% 90-day rate): Members who feel consistently supported are more satisfied. Ray, a user, found the app a "Huge plus" when it helped him find cheaper medication for his wife. The platform's ability to simplify care navigation and centralize health tools improves the overall member experience.
Improve plan efficiency and HEDIS scores: Effective "post-discharge management" and chronic care support contribute to better adherence, which is foundational to improving quality scores and meeting compliance metrics.
For Care Managers: Amplifying Impact and Focusing Expertise Digital nudges act as a force multiplier for care managers:
Scale touchpoints with automated check-ins: Support more patients effectively. Becky, a pediatric nurse, spends much of her day on the phone with insurance companies, stating, "That's just not what I went to nursing school for. I want to be doing patient education." Cix can automate routine follow-ups, freeing her from direct patient education.
Refocus energy on high-acuity patients: Automated systems handle routine check-ins, allowing care managers to focus on complex cases.
Access real-time recovery data for faster decisions: Recovery alerts and patient-reported data provide early warnings.
The Future of Care is Connected and Proactive
The era of reactive healthcare is proving too costly. The opportunity to improve outcomes and manage expenses lies in proactive, continuous, and personalized support. Digital nudges, intelligently applied, are a fundamental shift. Cix Health is designed to "keep people out of the hospital" and "empower members to take control of their health."
By addressing missed care, reducing readmissions, and supporting the management of chronic conditions, solutions like Cix Health are helping to build a more resilient, efficient, and patient-centered healthcare system. For employers, TPAs, and care managers, embracing these tools for "preventive engagement" and "digital care coordination" is not just an option but a necessity. The cost of inaction is too high.
The time to close care gaps is now. Cix Health helps you reduce costs, prevent readmissions, and empower members to manage their health every step of the way.
Ready to see Cix in action? Book a demo and join the Employee Wellness Revolution.