Surface the right member while there is still time to act.
Burse™ evaluates each member prospectively against the applicable measure criteria. Members who qualify for the denominator are checked for exclusions and evidence that the standard of care has already been met. When an actionable opportunity remains, Burse can place it on the worklist a configurable number of days before the member-specific due date or measure-window expiration.
Is the member in the denominator?
Evaluate the member against the applicable prospective measure criteria to determine whether the measure applies.
Is this still an actionable opportunity?
Determine whether the member is excluded or whether available evidence already shows the applicable standard of care has been met.
Bring the opportunity forward at the right time.
Use the member-specific due date or measure-window expiration and the client's configured lead time to determine when the opportunity enters the worklist.
Turn the open opportunity into action.
Give the responsible team the member context, goals, Intake work, Follow-Up work, outreach, and provider coordination needed to address the gap.
Show why the gap exists—and why the care is appropriate for this member.
Burse™ gives the user the evidence behind the prospective opportunity so they can understand why the gap is open and what action is appropriate before they act.
Member meets the prospective denominator criteria and no qualifying screening evidence is currently available.
- Eligible age / measure criteria
- Applicable clinical history
- Existing claims or clinical evidence reviewed
- Exclusions evaluated
Turn each open gap into measurable, member-specific work.
For each prospective opportunity, Burse™ uses the measure, member data, and available evidence to generate the goals, Intake tasks, and Follow-Up tasks needed to move the opportunity toward resolution.
Define the intended outcome
Connect the opportunity to the member-specific outcome the workflow is trying to achieve and define what success should look like for this member.
Act on what can happen now
Confirm the current status, assess available evidence, coordinate outreach or scheduling, communicate with the member or care team, and assign accountable work.
Return verification when it is due
Bring unresolved work, future verification, provider follow-up, or evidence review back to the responsible user when action or time has passed.
Completing the task is not the same as closing the gap.
Quality operations need both states. Operational work records what the responsible team did; qualifying evidence determines whether the applicable gap-in-care criteria were actually satisfied.
The operational work was completed.
The responsible user completed the required outreach, assessment, scheduling, coordination, documentation, or follow-up activity.
Qualifying evidence shows the measure criteria were satisfied.
Claims, pharmacy, laboratory, or clinical evidence demonstrates that the applicable gap-in-care criteria have been met. Gap closure is based on evidence—not simply completion of the assigned work.
Keep the opportunity moving until qualifying evidence closes the gap.
Burse™ keeps prospective opportunities visible as accountable work, with the member context, next action, follow-up, and closure state available to the users responsible for moving them forward.
Bring the prospective opportunity onto the worklist at the configured time.
Show why the gap is open, the relevant evidence, and the appropriate action.
Assign outreach, scheduling, provider coordination, documentation, or other required work.
Return unresolved work or future verification when due.
Resolve the gap when qualifying evidence demonstrates the applicable criteria were satisfied.
Coordinate the work needed to address the gap.
Where enabled, teams can also text members and securely message PCPs and specialists through workflows integrated with the provider's EHR.
See the difference between an open opportunity, completed work, and verified closure.
See how Burse™ turns quality opportunities into accountable workflow.
Walk through prospective member-level opportunity identification, evidence, configurable worklist timing, outreach, Follow-Up, task completion, and verified gap closure.