Baptist Health South Florida operates an extensive healthcare network comprising 11 hospitals, ambulatory facilities, urgent care centers, and emergency departments across four counties.
The organization focuses on improving health outcomes through its Population Health Service Organization (PHSO), which coordinates and integrates healthcare services.
One key component of this initiative is the Baptist Health Quality Network (BHQN), a clinically integrated network that unites primary care physicians, specialists, and hospitals to deliver patient-centered, high-quality care.
Before implementing population health management technology, Baptist faced significant challenges in managing patient health effectively. The primary issue was fragmented patient data across multiple provider organizations and electronic health record (EHR) systems.
This fragmentation hindered a comprehensive view of the patient’s health status, care history, and ongoing needs. Additionally, the lack of interoperability and a unified data platform made it difficult to identify high-risk patients, track care gaps, and coordinate care efficiently across the network.
Manual processes for risk stratification and predictive analytics were inadequate, making it challenging to identify patients at risk of health deterioration or high utilization. The absence of real-time insights and actionable data led to inefficiencies, duplicated services, and missed opportunities for early intervention.
Moreover, the lack of advanced communication tools and a centralized care management system hampered patient engagement and care coordination, affecting the organization’s ability to meet the Triple Aim of improving patient experience, enhancing population health, and reducing healthcare costs.
To address these challenges, Baptist proposed implementing a comprehensive population health management technology. This technology would integrate patient data from multiple provider organizations and EHR systems into a centralized, interoperable platform.
The technology also offered advanced risk stratification and predictive analytics to accurately identify high-risk patients and predict potential health deteriorations. Real-time analytics and dashboards would provide actionable data for both network leadership and providers, enhancing decision-making, reducing inefficiencies, and facilitating early interventions.
The solution involved a combination of technologies: Cerner HealtheIntent (Oracle Health Data Intelligence), Innovaccer’s InNote, InCare, and InGraph, Salesforce’s Salescloud, and a remote patient monitoring system.
Cerner’s HealtheIntent served as the foundation, aggregating data from various EHR systems and payer claims into a unified data warehouse, providing a holistic view of the patient population.
Innovaccer’s platform added advanced analytics and machine learning algorithms to generate actionable insights, while Salesforce managed patient interactions and outreach efforts.
Despite the robust implementation of these technologies, Baptist still faced challenges such as data integration issues, alert fatigue among care teams, and patient adoption of remote patient monitoring tools. However, the integrated system showed significant improvements.
Innovaccer’s InNote system increased coding gap closure rates by 7%, and the HUB model, leveraging HealtheIntent, improved care coordination and management.
The implementation led to a 17% increase in annual wellness visit completion rates for Medicare populations, a 9% improvement for commercial populations, and significant improvements in transitional and chronic care management revenue capture.
Cervera advised other healthcare provider organizations to prioritize a system-wide population health strategy, secure executive buy-in, and engage physician leadership for successful adoption.
She emphasized the importance of having appropriate teams and resources, focusing on interoperability, scalability, and patient engagement features, and fostering a culture of continuous improvement and clinical standardization. Implementing population health management technology requires ongoing optimization and support to fully realize its benefits.
