HealthFebruary 06, 2018

Improving population health at Triad HealthCare Network

Thanks in part to Emmi programs, a major provider organization in North Carolina has raised its game on population health metrics, yielding a $10.7 million shared savings payment from Medicare’s Next Generation ACO program.

Triad HealthCare Network (THN), based in Greensboro, N.C., an accountable care organization comprised of a network of six hospitals and 1,200 physicians, improved its scores on quality measures such as mammography screening rates, fall risk assessments, and flu vaccinations. It also improved outcomes for 30-day and 60-day readmission rates for select patient populations, something Medicare is paying close attention to.

It achieved these results after deploying a series of Emmi programs for prevention and transitions of care. An article recently published in Healthcare Informatics explains how THN achieved these goals.

Tonda Gosnell, THN’s population health project manager, says the ACO is “aiming towards hitting high marks on all 33 metrics” that it is required to report. The challenge is obtaining data from the many independent physicians groups that are not part of the ConeHealth parent system, and reconciling data from the more than 30 different electronic medical record platforms. “The EmmiPrevent® tool, across all those various providers and various EMRs, helps us to really burrow down and get to the metrics that we’d like to achieve, all while driving patients back to appropriate care,” Gosnell says.

Fall risk assessment is a critical metric for Medicare patients. THN found that there was a lot of discrepancy among its providers as to how well and how frequently they were assessing patients. Using an EmmiPrevent campaign, THN launched an initiative to call more than 7,000 patients late last year. It achieved a 51% patient engagement rate.

“By collecting the information based on responses from patients and returning that information to primary care providers so they can act upon it,” Gosnell says, “we were actually able to move the needle from the 80th percentile of that CMS metric to the 90th percentile.”

EmmiPrevent offers customized, interactive call campaigns that inform patients about screenings, visits, and procedures. The calls motivate patients to have some sort of preventive service, such as to get their flu shot or get their mammogram.

“We’ve had incredible work in that area,” says Elissa Langley, chief operating officer for THN. “We’ve been able to move the needle and actually increased our numbers. When we first started out we had about 2,500 calls and now we’re up to over 100,000 calls a year. It’s been an invaluable tool in terms of helping us to close some of those gaps for our metrics.”

Hospitals and physicians groups have found that these campaigns not only help them achieve better population health results, but also increase patient engagement and raise revenue. Call campaigns for such programs as Medicare Annual Wellness Visits help doctors fill their schedules and gain more insight into their patients’ actual health status.

To learn how EmmiPrevent can help your organization meet its population health management and quality improvement goals, contact us.


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