A booked visit is not a closed care gap

Define completion before contacting anyone

Start with the measure or care need your team is working on. Agree eligibility, exclusions, the relevant time period, and the evidence required to record completion. Those definitions need to come from the responsible clinical and program teams.

This article is an administrative planning example. It does not define measure specifications, coding requirements, or clinical recommendations.

Follow one illustrative wellness-visit request

Your approved list identifies a member who may be due for a visit. The team confirms eligibility and permission to contact them. During outreach, the member says mornings are difficult and asks about afternoons.

After a suitable time is agreed, the scheduling system confirms the appointment. That is a booking milestone. The gap remains open until the evidence specified by your program supports closing it.

• Eligible for outreach: reviewed against the current list.
• Contacted: the conversation and next action are recorded.
• Booked: the appointment is confirmed in the scheduling system.
• Verified: the required completion evidence has been reviewed.

Keep unanswered questions visible

A member may be unavailable, need transport help, or prefer to speak to their care team. Record the administrative next step and the responsible person. Don’t convert these situations into a completed status simply because outreach occurred.

Clinical questions and documentation decisions stay with qualified staff. Decide how requests reach them and how unresolved handoffs are reviewed.

Build the business case from separate measures

Review eligibility counts, contact attempts, people reached, bookings, verified completions, and staff effort as separate figures. Use consistent definitions when comparing your starting point with a pilot.

If you estimate financial impact, state the costs and assumptions and check for overlap between benefits. A change in bookings alone does not establish savings or better clinical outcomes. Use the pilot to learn where the process helps and where patients still need personal support.