Closing the Care Gap: How Datapro’s AI Automation Helped a Health Network Prevent Missed Preventive Care

Overview:
A large hospital network with over 800,000 patients was losing millions annually due to missed preventive care actions, mammograms, A1C tests, statin prescriptions. Existing systems failed to catch these lapses in time, leading to late diagnoses, emergency interventions, and reimbursement penalties.

The Challenge:

• Patient data scattered across multiple EHR systems and formats
  
  
• Care gap rules (USPSTF, ADA, CMS) complex and hardcoded into legacy tools
  
  
• Manual chart reviews were slow and expensive
  
  
• No way to proactively engage patients based on real risk
  
  

The Datapro Approach:
Datapro worked with the network’s clinical innovation team to build an AI-enabled care gap detection and outreach platform.

Step 1: Intelligent Data Ingestion
We deployed a cloud-native pipeline to ingest:

• Structured EHR data (diagnoses, labs, prescriptions)
  
  
• Unstructured clinical notes via NLP
  
  
• Claims data and social determinants (e.g., missed appointments, ZIP code risk scores)
  
  

Step 2: AI-Powered Care Gap Detection
We trained models using clinical ontologies and guidelines to detect:

• Missed preventive actions (e.g., overdue colonoscopy)
  
  
• Non-adherence to chronic care plans (e.g., insulin refill gaps)
  
  
• Risk escalations (e.g., uncontrolled hypertension + missed visit)
  
  

Unlike traditional rule engines, our system handled nuance from real-world data and adapted to new guidelines automatically.

Step 3: Personalized Patient Outreach
We built an engagement layer with patient-specific insights:

• Risk-based prioritization: Which patients to contact first based on predicted benefit
  
  
• Channel optimization: Email, SMS, EHR portal based on prior engagement
  
  
• Actionable nudges: e.g., “You missed your A1C test, click here to schedule near you”
  
  

Results:

• Closed over 35,000 care gaps in the first 9 months
  
  
• Reduced manual review time by 68%
  
  
• Increased patient adherence by 19% via personalized nudges
  
  
• Improved HEDIS scores and CMS star ratings, leading to increased payer incentives
  
  

Why It Worked:
Datapro brought together data engineering, clinical AI expertise, and user-centric design. We didn’t just build dashboards, we built intelligent systems that acted on data in real time and integrated into existing clinical workflows.