A Test Without a Conversation Is Just a Number

By Jessica Ganchrow Senior Director of Operations, ComplexCare Solutions

Most A1C gap closure programs are built to document a test - not to change what a member does with it. Here's why the conversation that follows a result matters as much as the test itself.

Every measurement year, health plans invest significant resources in closing the glycemic status gap - outreach campaigns, provider incentives, member reminders. A meaningful share of that investment closes the gap on paper. It may not close it for the member.

Not because members don't care about their health. Not because plans aren't trying. But because the system designed to close the gap was built around an assumption that frequently turns out to be false: that a member who receives a lab order will follow through on it.

They often don't. Research from the Diabetes Study of Northern California (DISTANCE) shows that one in seven patients (14%) fails to complete lab work even after receiving a provider referral. That's a significant leak in your gap closure strategy before a single result is even generated.

And even when they do, the conversation that should follow the result often doesn't happen at all.

The Gap Behind the Gap

The GSD (Glycemic Status Assessment) measure tracks whether members with diabetes had their glycemic status assessed during the measurement year and whether their most recent result fell within an acceptable range. It's one of the higher-weight gaps in the current HEDIS (Healthcare Effectiveness Data and Information Set) framework - and one of the most consistently difficult to close at scale.

Part of the challenge is access. Lab referrals require a physician visit to generate them, and often a separate trip to complete them. For members navigating transportation barriers, work schedules, or competing health priorities, that's two friction points too many. The gap doesn't stay open because the test is hard. It stays open because the path to getting it done is harder than it looks on paper.

But access is only half the problem.

Research consistently shows that a significant portion of people with diabetes don't fully understand their A1C result - what it measures, what their number means, or what they should do about it. A study published in Diabetes Care found that only about 25% of people with diabetes could accurately recall their last A1C value or describe its meaning. A separate study found that in a cohort of patients with poor glycemic control, 90% overestimated how well their diabetes was managed - and limited understanding of results was associated with weaker self-management behaviors.

When a result is just a number, nothing changes for the member. That's the gap most programs aren't designed to address.

In other words, the test gets done, the result gets generated, the gap technically gets documented - and nothing changes for the member.

That's the gap behind the gap. And it's the one that most gap closure programs aren't designed to address.

What Closing a Gap Actually Requires

A hemoglobin A1c result is a number. What it becomes - a motivation to change behavior, a prompt to adjust medication, the beginning of a real conversation about a member's health - depends entirely on what happens in the moment it's delivered.

That moment is narrower than most programs account for. A result communicated through a patient portal, or relayed by a nurse over the phone days after the test, lands in a completely different context than a result explained in plain language by a clinician sitting with the member - someone who can answer questions, connect the number to the member's specific situation, and clarify what it means for their care going forward.

The distinction is worth naming. There are two fundamentally different ways to close a GSD gap, and they produce different outcomes.

1. Gap capture treats the A1C test as a specimen collection event. The gap gets documented. But when a result is abnormal and no one explains it to the member in real time, the window for intervention has often closed by the time the data reaches the provider. The requirement is satisfied. The member's trajectory may not change.
2. Clinical closure treats the A1C test as a consultation event. The result is delivered and explained the same day, in plain language, by a clinician sitting with the member - at the kitchen table rather than in a portal notification - connecting the number to their specific situation and what they should do about it. The gap closes on paper and for the person.

Most gap closure models were built for gap capture. They weren't built around the moment that makes a result matter.

This is the problem ComplexCare Solutions was designed to solve.

The Test and the Conversation, Together

CCS's approach is built on a straightforward premise: the test and the conversation must happen together.

In-Home Assessment: For members reachable through a home visit, a CCS Advanced Practice Clinician collects the specimen on-site and produces a point-of-care result - no lab, no waiting. The care conversation happens in real time, while the member is engaged and present.

Mail-In Kit: For members who are harder to reach - those in less densely populated markets, those who decline in-home visits, or those who prefer to complete testing on their own terms - CCS's mail-in A1C kit extends the same reach without the same access barriers. The kit doesn't arrive alone: CCS's clinical engagement team follows up to ensure results are explained and next steps are clear. The collection mechanism is different. The clinician-led engagement is not.

What's consistent across both models is the recognition that a test result, on its own, is insufficient. The value is in what gets built around it.

The Flexibility Health Plans Need

No single delivery model works for every member population. Dense urban markets and rural markets have different access dynamics. Members who actively participate in their in-home assessments have different needs than members who consistently opt out. End-of-measurement-year gap closure looks different than a full-year outreach strategy.

CCS works with health plan quality teams to configure the right combination of in-home and mail-in delivery based on membership density, existing program infrastructure, and gap closure targets. The goal isn't to maximize one model, but to ensure every member in the eligible population has a viable path to getting tested, getting their result explained, and getting connected to the right next step.

For Medicare Advantage plans, GSD is a triple-weighted HEDIS measure - CMS assigns this weight because glycemic control is a leading indicator for vision loss, kidney failure, and cardiovascular events. A meaningful decline in GSD performance can be the single factor that moves a plan from 4 Stars to 3.5 Stars. For Medicaid populations, it addresses one of the chronic condition monitoring gaps members most consistently defer. In both cases, the value of closing the gap isn't just the HEDIS credit - it's what the conversation that follows the result makes possible for the member's ongoing care.

A Different Standard for Gap Closure

Health plans have spent years optimizing for test completion - getting the lab order in, getting members to follow through, getting the result documented before the measurement year closes. Those are real and important goals.

But the members whose results land in a portal they don't check, who receive a number they can't interpret, who never have a conversation about what their A1C means or what they should do about it - those members had their gap closed on paper. Their health trajectory may not have changed at all.

CCS's standard for gap closure is different: the test is done, the result is explained, and the member leaves the interaction knowing something they didn't know before - and understanding what to do with it. That's what makes a result matter. And that's the standard your quality program should hold.

Frequently Asked Questions

What is the HEDIS Glycemic Status Assessment (GSD) measure?

The GSD measure tracks whether health plan members with diabetes had their glycemic status assessed during the measurement year and whether their most recent A1C result fell within an acceptable range. It is one of the higher-weight gaps in the HEDIS framework and one of the most consistently difficult to close at scale.

Why do A1C gap closure programs often fail to improve member outcomes?

Most gap closure programs are built around test completion, not member understanding. Research shows that a significant portion of people with diabetes cannot interpret their A1C result or translate it into behavior change - meaning the gap closes on paper while the member's health trajectory stays unchanged.

How does clinician-led point-of-care A1C testing work in in-home health assessments

A CCS Advanced Practice Clinician collects the specimen during the in-home visit and produces the result on-site - no lab referral, no separate appointment. The clinician delivers and explains the result the same day, in plain language, connecting it to the member's specific situation and next steps in their care.

How does closing the GSD gap affect CMS 5-Star Rating performance for Medicare Advantage plans?