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Care coordinators rely on lagged claims data to manage the administration and cost of care for high-risk patients. But so many things can happen during a 60-to-90-day claims lag, resulting in compromised care. Rising Risk, a feature of our Pings solution, helps providers identify emerging high-risk and multi-visit patients in near real-time and offers a workflow to better manage their care and costs.
Streamline Patient Prioritization and Post-Discharge Follow-Up Workflows
Rising Risk’s features and user-friendly interface make it simple for care teams to quickly identify high-priority patients and enter them into a follow-up workflow. The benefits are measurable and significant.
Together, these features enable care teams to improve patient outcomes and reduce costs in value-based care settings.
Leverage real-time data and predictive analytics to easily identify your rising-risk patient population.
Utilize a risk scoring model that continuously improves with user input through predictive analytics and machine learning.
Implement a proven workflow solution to streamline patient prioritization and care.
Accelerate targeted post-discharge care to successfully enroll patients in care management programs.
Connect with hard-to-reach patients via notifications and in-app SMS contact sharing.
More than a Patient Risk Platform, We Help with a Post-Discharge Workflow
Yes, we provide you with real-time predictive analytics that surfaces high- and rising-risk patients to your care managers. But we also help you with a post-discharge follow-up workflow so you know how to manage prioritized patients.
A typical complex care management workflow asks you to call three times and then send a letter. Here is how Rising Risk helps you accomplish that, all within the platform:
Provide up-to-date contact information with SMS contact cards, helping to increase your chance of contact post-discharge, especially for hard-to-reach patients.
Use a scheduling assistant to quickly and painlessly book future follow-ups.
Set up reminders to follow-up with patients within certain timeframes to adhere to deadlines and value-based care contracts.
Add context notes to care plans for users responsible for the patient, allowing everyone to stay current with the patient’s health.
Track individual patients to increase the likelihood of engaging them at the point of care if phone outreach is unsuccessful.
Leveraging Rising Risk in a Clinical Setting
Consider a state-wide accountable care organization (ACO) that participates in the Federal Advance Payment ACO model and focuses on value-based care. In this arrangement, there is one goal: to improve the quality of care while reducing the total cost of care. It’s no easy task.
One way to make it easier is by leveraging Bamboo Health’ Rising Risk feature to identify emerging high-risk patients. We house and analyze the patient data to accurately identify and surface these patients in real time, while also providing a workflow for next steps in their care, so that care managers and physicians can effectively reach out and put them on a path to preventative care.
Preventative care, along with smoother transitions of care and quicker post-discharge follow-up care, contributes to better outcomes and reins in rogue costs. For the ACO, this can translate to a healthier population, limit the number of high utilizers in their population, and maximize shared savings through the payment model.
Learn how Rising Risk helps identify emerging high-risk patients.