Carson and his best friend Dr. James Barr, vice president of physician value-based programs and chief medical officer for accountable care organizations at Atlantic Health
Photo: Dr. James Barr
Morristown, N.J.-based Atlantic Health serves New Jersey, Pennsylvania and the New York metropolitan area. The not-for-profit health system offers more than 550 sites of care, including eight hospitals.
The health system includes Atlantic Medical Group, part of a physician enterprise that makes up one of the largest multispecialty practices in New Jersey with more than 1,700 physicians and advanced practice providers.
Joined with Atlantic Accountable Care Organization and Optimus Healthcare Partners, they form part of Atlantic Alliance, a clinically integrated network of more than 2,500 healthcare providers throughout northern and central New Jersey.
THE CHALLENGE
The health system's leaders asked: "Why do we still have uncontrolled diabetics, hypertensives and patients not caring better for themselves?"
Despite the success of the organization's ACO in managing more than 500,000 patients within 11 payer value-based contracts, there remained challenges with overburdened providers and lack of patient engagement.
Initial performance improvement efforts were focused on physicians, providers and practice care teams. Atlantic Health implemented Patient-Centered Medical Home redesigns of primary care and the American College of Physicians Specialty Medical Home Neighborhood.
This was supported by a cloud-based data lake, advanced analytics, RN population health managers, patient case managers, social workers, community health workers and ACO clinical pharmacists. Success followed as the organization elevated its standard of clinical care among the ACO providers and practices, but something was missing.
"For all of our care transformation initiatives over the 10-year journey to value-based reimbursement, the entirety of the quadruple aim – inclusive of patient experience and clinician wellbeing – was of equal importance to financial returns," said Dr. James Barr, vice president of physician value-based programs and chief medical officer for accountable care organizations at Atlantic Health.
"Reaching those goals required understanding that there was still room for improvement in a number of areas, including reducing burnout of providers and practice teams," he continued. "Improving success with clinical management also needed to include methods to understand and manage patient needs and preferences."
Time constraints and cost barriers limited one-on-one personal time during patient visits, limited non-visit patient interactions and restricted the ability to scale population health interventions. Internal analytics then revealed significant numbers of diabetics and hypertensives with persisting poor clinical control.
A new approach would not only support the organization's emphasis on wellness, prevention of disease and restraint on rising risk, it would hopefully reaffirm patients' trust in the providers, practices and health system, Barr added.
PROPOSAL
The key was finding a system to manage numerous pain points without adding burden to providers or increasing staff costs, he said.
"Medical Brain brought an AI-powered clinical management platform that could impact all aspects of care, including providers, staff, and, most important, patients," he continued. "The vendor works by aggregating numerous healthcare data sources including real-time clinical extracts from the EHR patient chart.
"Clinical decision support insights are generated using AI algorithms on 5,000 evidence-based guidelines of care," he added. "These insights are then communicated to providers, practice care team members, and directly to patients via the Medical Brain mobile app."
The mobile app contains an AI chatbot working as an AI digital assistant via secure text communications. Providers are informed of evidence-based care treatment options and can communicate patient needs to practice team members. Patients receive precision care recommendations, education and self-management support.
They can also use the platform 24/7 to evaluate symptoms or ask questions regarding medications or chronic conditions.
The ACO population health goals for the platform included improved patient clinical outcomes (specifically diabetes and hypertension care), improved prevention and wellness (annual wellness visits, cancer screenings, healthy lifestyle choices), and a positive patient experience.
In addition, Atlantic Health looked to unburden providers and practices through the AI chat's ability to buffer in-basket message volumes from patients.
MEETING THE CHALLENGE
Initially, Medical Brain was offered on a voluntary basis to interested ACO practices. Implementation involved automated clinical data extracts from practice EHRs and aggregation of additional data sources. Then meetings with practice providers and care teams identified preferred use cases and workflows.
In parallel, the ACO and Atlantic Health deployed the platform to assist transition of care nurses with readmission prevention of hospital discharged patients.
"The Optimus Healthcare Partners ACO consists of totally independent providers and practices who embraced the technology," Barr noted. "They were attracted to the efficiencies, time savings and impressive patient experiences.
"One provider who isn't shy to criticize ACO activities proclaimed the platform was the best thing we ever did," he continued. "She quickly had more than 800 patients using the mobile app and providing very positive experiences. One patient told their friends to switch providers if they didn't use Medical Brain."
The Atlantic Health ACO is mostly employed or joint-ventured providers using the same EHR. The key implementation challenge for them was identifying which use cases to transition from their EHR patient portal to the new platform. In addition, integration of platform access within the EHR workflows was required.
"As with anything new, physicians and practices will have early adopters, cautious adopters and the wait-and-see groups," he added. "The key for adoption is always in the impact analysis."
RESULTS
Each ACO payer contract has performance goals related to diabetic patient control of their blood sugars (A1c level) and hypertensive patient control of their blood pressure (<140 systolic/<90 diastolic). Once the volume of patients reached statistically significant levels, an impact analysis was performed pre- versus post-Medical Brain patient engagement.
Diabetics' blood sugar control (A1c level) and impact of the platform:
- CMS (Medicare) identifies poorly controlled diabetes as having an A1c>9%. Within Atlantic Health's study, 64% of uncontrolled diabetics using the platform were able to achieve control.
- Those patients who reduced their A1c to "in control" had an average A1c reduction of 3.66 points.
- Among all diabetics starting with A1c>9%, their A1c fell by 2.52 points on average following use of the platform.
- Among patients starting with A1c>8%, their A1c fell by 1.8 points on average following use of the platform.
Blood pressure control and impact of the platform:
- CMS identifies blood pressure control as having a BP of <140 systolic and <90 diastolic.
- Patients starting with average systolic BP ≥160 obtained an average reduction of 34 points following use of the platform.
- Patients starting with average systolic BP >150 obtained an average reduction of 20 points following use of the platform.
- Patients starting with average systolic BP >140 obtained an average reduction of 12 points following use of the platform.
- Patients starting with average systolic BP >130 obtained an average reduction of 5 points following use of the platform.
"As evident in these outcomes, the Medical Brain intervention delivered an impressive impact," Barr said. "This will support thousands of diabetic and hypertensive patients in achieving control, feeling better, and avoiding the numerous comorbidities associated with chronic disease deterioration. It will also assist the ACO in achieving value-based contract quality goals and reduce ER utilizations, hospitalizations and avoidable costs of care.
"In addition to supporting disease management efforts, we evaluated the platform's impact on the volume of patient messages within 'in baskets' of providers and practices," he continued. "Only 6.4% of patient communications with the platform required escalation to providers. The remaining more than 93% were resolved between the AI chat and the patient – a significant time savings and unburdening of the provider and practice."
The sicker the patients, the stronger the buffer is: In the nephrology office (serving chronically ill, medically complex patients), only 1.3% of patient communications with the platform were escalated to the nephrologist, he added.
"Unburdening providers and care teams is critical for improved efficiencies, allowing patient-centered workflows, providing time for listening to patients, and strengthening the patient-physician relationship," Barr said.
"We're now expanding Medical Brain's deployment to all ACO practices as a standard of care for diabetics and hypertensives," he continued. "From there we'll focus the AI-powered clinical assistant on all population health quality metrics including medication adherence. The possibilities grow as we use AI digital assistants to better understand patients, their needs, their behavioral health, their social health and even their spiritual health."
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