IBM Case Studies Population Health Management Platform Anchors Arch Health’s Approach to Lowering Hypertension
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Population Health Management Platform Anchors Arch Health’s Approach to Lowering Hypertension

IBM
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Arch Health Partners, a multi-specialty group with over 90 providers at 13 locations in San Diego County, was facing a challenge with its hypertensive patient population. The group's hypertension statistics were below their expectations, and they were struggling to improve the health of these patients. The first step in driving better outcomes was identifying at-risk patients from within a large and growing patient population, which proved to be a more difficult challenge than originally expected. As the organization continued to grow, managing clinical data and improving quality scores became increasingly difficult due to manual processes. The organization realized that to increase the quality and frequency of patient engagement, they would need to automate some of their processes.
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Arch Health Partners is a multi-specialty group with more than 90 providers at 13 locations in San Diego County. In 2014, it was named a top-performing physician organization for the fourth consecutive year by the California Integrated Healthcare Association. With physicians’ offices and urgent care locations spread across San Diego, Poway, Ramona, San Marcos and Escondido, California, the organization is a prime contributor to the health and well-being of the citizens of San Diego County. Arch Health Partners takes its responsibility very seriously, which is why there was heightened interest in hypertension after participating in the American Medical Group Association (AMGA) annual conference in 2013.
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Arch Health Partners initiated an eight-week population health management pilot using the Watson Health platform to identify and engage patients with out-of-control hypertension. The automation capabilities of Watson Health’s population health management platform allowed Arch Health Partners to build a faster, easier, and more accurate patient registry. This helped drive patient engagement and improve outcomes. The pilot program used a combination of automated and personal calls made by health care providers to help close care gaps in hypertensive patients once they were identified. The Watson Health platform was used to generate automated outreach to the patients to contact their physician at Arch to make an appointment. If there was no response after three attempts, the information would be handed to a medical assistant to make a personal follow-up call.
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The Watson Health platform allowed Arch Health Partners to automate registry building, patient outreach, appointment reminders and other repetitive, labor-intensive tasks so clinicians could focus on care. The platform was also used to extract clinical data directly from their electronic medical records (EMR) system on-demand, in real time, and then identify the patients who were out of control. This made building the patient registry faster, easier and more accurate. The platform also gave the team an opportunity to measure their progress with the overall population. A dashboard made it easier to monitor how many of the identified patients had been contacted, how many had made appointments for blood pressure checks, labs or physicals, and whether their blood pressure was under control – or at least trending in the right direction.
In-control hypertension population increased from 63 percent to 77 percent in six months
Medicare star rating increased to 4.5 stars
Medicare Patient Assessment Survey score jumped 8 percentage points to 90th percentile on question about whether patient receives reminders from physician’s office
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