Care coordination challenges threaten patients and providers along the care continuum with critical consequences for emergency departments (EDs). As patients struggle to access primary care providers and longitudinal care, increasingly they turn to EDs as a last resort, burdening EDs and leading to potential gaps in care. Providers like the Massachusetts League of Community Health Centers (Mass League) face this ED challenge. Additionally, Mass League must support the diverse needs of their large patient populations despite having insufficient funds dedicated to improving information technology, resulting in adverse impacts on quality, efficiency and cost of patients’ care
The Challenges: Managing a Vast Patient Population
- Increase visibility into ED visits for over 1 million patients with a diverse range of chronic issues
- Improve care coordination across 300 access sites
- Reduce instances where patients visit EDs unbeknownst to their providers
- Address social determinants of health considerations for 52 community health centers (CHCs)
- More effectively manage federal funding for direct patient impact
The Solution: Better Whole Person Care for Over 400,000 Patient Lives
After receiving a federal grant from the Health Resources & Services Administration (HRSA) to support its health centers with improved information technology, Mass League needed a partner to advance interoperability, increase data usage and enhance patient and provider experience. They selected Pings to meet these goals, utilizing real-time notifications sent to care teams when their patients experience care events across Massachusetts. With Pings, Mass League directly improved patient outcomes.
“It’s our job to help our community health centers offer better value-based care. Considering many of their patients lack private health insurance, this is also important to Medicaid. With Pings, care managers can track patients’ journeys across the continuum far better than ever before. This saves the health centers time and reduces costly care gaps while improving the quality of care the patient receives.”
Susan Adams, PMP, VP, Health Informatics, The Massachusetts League of Community Health Centers.
Pings helps monitor over 400,000 patient lives across 13 CHCs, with several more CHCs in the process of implementation. Thanks to the transitions of care data provided by Pings, Massachusetts achieved profound patient outcomes:
- 47% reduction in 30-day readmissions among ED patients
- 20% reduction in 30-day readmissions among hospitalized patients
- 33% increase in follow-up visits for hospitalized patients within 30 days of discharge
Learn more about Mass League’s use of Pings in this case study.
