HCC Gap Closure at Health System Scale

Health system ACOs managing 50,000 or more attributed lives have, in most cases, invested meaningfully in analytics infrastructure. Population health dashboards identify every patient with a chronic condition documented in a prior year that has not been coded in the current data submission. The RAF impact per patient is calculated. Prioritization by dollar value and coding deadline is built into the tool. The gap list exists, is accurate, and is refreshed regularly.

The gap list does not move by itself. For patients who have upcoming appointments, the workflow is manageable — pre-visit documentation briefs need to reach the care team before the visit. For patients who do not have upcoming appointments, the problem is more fundamental: the patient needs to be brought in before the year-end coding window closes, and that requires a two-way contact that identifies the barrier, schedules the visit, and confirms it.

Across a 50,000-life population, the number of patients who qualify for HCC recapture without a scheduled visit in the next 60 days can run to several thousand. At that volume, manual outreach from coordinators already managing active caseloads is not a realistic path to year-end closure. The RAF leakage accumulates in proportion to the gap between the worklist and available outreach capacity.

ZynGap identifies and prioritizes HCC documentation gaps across the attributed population — ranking by RAF dollar impact, coding deadline proximity, and patient-level EHR and claims history. For patients with upcoming appointments, pre-visit documentation briefs are generated and routed to the care team before the visit. For patients without upcoming appointments, the Preventive and Quality Activation Agents run outreach to bring them in.

The outreach is two-way. The agent identifies the reason the patient has not been seen, addresses scheduling barriers, and books the appointment through ZynSchedule. ZynReminder follows up with patients who agreed to schedule but have not yet confirmed. Every step is tracked — how many gaps were identified, how many patients received outreach, how many visits were scheduled, and how many conditions were documented at the encounter.

For health system ACOs where RAF score accuracy drives shared savings distributions, closing the documentation gap before year-end is the most direct lever on financial performance. The platform tracks completion — not just identification — so year-end reconciliation reflects work that actually happened.