The visit that closes a care gap is the visit that documents a condition.
Quality and risk adjustment are chased by two vendors, two lists and two outreach programs — and they are usually the same appointment. A member with an open screening gap and an undocumented chronic condition needs one visit, not two campaigns. That is the case for calculating measures on the same taxonomy as everything else.
What it does
Alberto calculates the measure set that matters to a Medicare Advantage contract — screenings, diabetes care, medication adherence, care for older adults, transitions, follow-up after hospitalization — from the claims, lab, pharmacy and eligibility data already on the platform, on the published specifications and value sets, versioned by measurement year.
Measure rates roll up to the contract, the published cut-points are applied, and the rating is projected early enough to act on. The per-measure gap list comes back as a worklist — member, measure, what would close it, and which visit already scheduled could.
What it does not replace
Your certified auditor. The calculation engine is what vendors sell; the audit is what the regulator recognizes, and those are different things. Keep the auditor. Replace the engine — and get a feedback loop tight enough that a projection in April still has time to change the number in December.
Why it belongs here and not in another contract
Because a care gap and a suspect condition share a member, a provider and a visit, and only a platform that holds both on one taxonomy can put them on one list. Nobody should pay two vendors to chase the same physician for the same patient. That is the compounding this site keeps talking about, in its most literal form.
A care gap and a suspect condition are usually the same appointment. Chase them once.