Every year, value-based care organizations swarm at the same thing in Q4: the gap report comes out, and the team sprints to determine which gaps are actually care gaps versus which ones are gaps in documentation.

In some ways, the care gaps might be easier to close: call a patient, ask them to show up for an onsite follow-up or screening, they do, and the gap is closed: payment secured.

The documentation gaps, which often appear as care gaps, show up when an organization cannot see that a patient actually received care because the records aren’t available. In this case, access to the documentation can easily close the gap.

But these gaps exist because patient records sit outside the HIEs, and standing up a chart chase team is labor-intensive and expensive.

My colleague, Scott Tarlow, built a voice AI agent to handle one step of the chart chase process: identifying the right route for a request, including a faxed HIPAA authorization form. One data point he shared about building the agent stands out: roughly 30% of call time is spent on hold or IVR. Then you start to factor in the follow-up calls to check on record status, and the $27.30/ hour salary for Medical Record Specialists [1], and collecting a single chart starts to look expensive and time-consuming.

This is because it’s not just the single phone call. It’s the two other phone calls before the records are faxed over. It’s getting the faxed records from the document queue, identifying the patient they’re matched to, and then finding the right information among a 30-300 page chart. Each of these steps takes time, persistence, and a skilled operations process to accurately close documentation gaps.

But it’s worth it.

The value of complete gap closure for each program speaks for itself.

Industry examples suggest that moving Star Ratings from three to four could be worth around $575 per member [2], and that recaptured HCCs could be worth from $1,000 to $7,000 per year [3]. A 0.10 increase in RAF on a monthly base rate of $1,200 is worth $120 per member, per month. The funding is out there, and so are the charts, but they have to end up in the same place to capture payments. This year, CMS will spend more than $13.4 billion on Medicare Advantage quality bonus payments in 2026, but the share of enrollees in plans that qualify for the quality bonus program has fallen from 75% to 68% year-over-year (the lowest since 2018)[4].

Medicare Advantage plans can now receive higher payments for patients with certain chronic conditions, but those diagnoses need to be documented each year. Couple that with CMS’s announced expansion of audits from roughly 60 contracts annually to all eligible contracts, and the opportunity and burden of proof are equally important [5].  If a plan cannot produce records supporting a diagnosis, CMS can recover the related overpayment.

So where does that leave us? The health information exchanges?

Exchanges tend to work fairly well  inside the network. Our study found larger hospital systems were the most likely to have extensive records available digitally. The trouble is on both ends of that sentence. One cardiologist we interviewed estimated that even with Care Everywhere, in 50% to 60% of cases his staff were still chasing records simply not on the exchange, because the independent PCP, the freestanding imaging center, and the practice that closed when its physician retired are not in anyone's network.

But health information exchanges are incomplete solutions because health data returned is often systematically inconsistent with the receiving system OR trapped in PDFs and CCDAs. One analysis by our team showed that curation consolidated 50%+ of the data retired by digital queries. These data are incredibly hard for an organization to query without incredibly high token costs.

Exchanges solved access between large systems. They did not solve the long tail, and they did not solve usability.

The Year-End Gap Sprint

Measurement year 2026 closes December 31. That is roughly ten working weeks, and the last two count for less than they look, because provider offices run skeleton staff through the holidays. A 14-day chase started in mid-November does not land.

So here is a direct offer instead of a demo.

Send us your highest-value patients and we will retrieve their records, online and offline, as a risk-free pilot.

We query every digital network and chase the offline sources no exchange reaches, then return records indexed for your EHR plus structured data your quality and risk teams can work immediately. One leading value-based care organization receives records in an average of 25.6 business hours against a 14-day legacy baseline, so you will know what is retrievable and what it is worth in days, not months.

But the ten weeks are not the real reason to do this.

Ten weeks from now, one of two things will be true. Either you closed what was closeable and enter 2027 with a clean longitudinal record on the patients who drive your economics, or you enter 2027 the way you entered this year: chasing the same documents, for the same measures, at the same cost.

Start your Year-End Gap Sprint