How much revenue are we losing from unfilled care gaps?

The average primary care practice with 5,000 attributed lives has $800K–$1.2M in annual revenue sitting in unfilled care gaps. The highest-value gaps: Annual Wellness Visits averaging $250 per visit (40% capture rate nationally), HbA1c screening for diabetics ($45/test, 62% compliance), and depression screening (PHQ-9, $40/screen, 48% compliance). In value-based contracts, each gap closure also improves quality bonuses — creating a revenue multiplier effect.

Care gap revenue operates on two tracks in value-based arrangements. The first is direct: completing an Annual Wellness Visit generates $167–$238 in direct CMS reimbursement depending on complexity. The second is indirect: AWV completion improves HEDIS quality metrics, which determine bonus payments in Medicare Advantage contracts and MSSP shared savings distributions. A practice with 500 AWV gaps is not losing $84,000–$119,000 in direct revenue. It is losing that amount plus the downstream quality bonus degradation, which typically adds 40–80% to the true revenue opportunity.

The five highest-value gap types have distinct closing mechanisms. Annual Wellness Visits require a scheduled appointment — they cannot be closed retroactively with lab data. HbA1c screening requires a visit or standing lab order; practices lose this gap when established diabetic patients have not been scheduled within the guideline-required interval. Depression screening via PHQ-9 takes three to four minutes at any visit and generates quality credit across Medicare Wellness, MSSP, and Medicare Advantage programs simultaneously. Colorectal cancer screening now includes FIT test alternatives to colonoscopy, with 82% patient acceptance when offered proactively at an AWV. Breast cancer screening gaps close through reminder-to-appointment workflows where the conversion step — not the reminder — is the operational constraint.

Care gap dashboards in most EHR and quality reporting platforms display gap count by measure. A practice might see 820 open AWV gaps, 340 HbA1c gaps, and 510 depression screening gaps — and allocate staff effort proportionally to gap volume. This is the wrong prioritization. Dollar-weighted by revenue per closure, 820 AWV gaps at $200 average represent $164,000, while 510 depression screening gaps at $40 each represent only $20,400. The effort-to-revenue ratio differs by 8x.

The quality bonus multiplier is almost never shown in care gap dashboards. A practice operating under a Medicare Advantage contract with a per-member-per-month quality bonus structure may earn an additional $12–$18 PMPM for achieving 4-star or 5-star status. Moving from 3.5 to 4.0 stars on a panel of 2,000 Medicare Advantage members can generate $288,000–$432,000 in additional annual bonus payments — driven largely by care gap closure rates in AWV, HbA1c, and preventive screening measures.

Implement dollar-weighted care gap prioritization. Each open gap should display an estimated revenue value combining direct reimbursement and quality bonus impact. Sort the gap list by dollar value, not by gap type or patient name. This shifts staff outreach effort toward the highest-return closures automatically, without requiring training on reimbursement policy.

Build proactive outreach workflows differentiated by gap type: AWV gaps require an appointment invitation with scheduling link; HbA1c gaps can be closed with a standing order sent to a preferred lab location; PHQ-9 gaps close at any upcoming visit if the tool is embedded in the pre-visit intake. Offering telehealth options for AWV completion increases conversion rates by 25–35% for patients with transportation or work-schedule barriers. Practices that implement dollar-weighted prioritization combined with gap-type-specific outreach typically recover 60–70% of their theoretical gap revenue opportunity within 12 months.