- The Portland Clinic was getting piecemeal notifications about emergency department (ED) visits by its patients, which was causing gaps in treatment at the hospitals as well as in follow-up care at the clinic.
To help fix the problem, the clinic turned to Collective Medical’s EDie technology, which collects data from ED visits by patients, notifies providers about the visits, packages the data with insights, and delivers that information to providers in real-time.
“We started using it at a basic level looking at our high-risk patients who were under care management to see if they had gone to the hospital and putting in care recommendations for those patients. So, we were able to communicate with the hospital on those high-risk patients,” explained Jill Leake, population health manager for The Portland Clinic.
The Portland Clinic is Oregon’s oldest, private, multispecialty medical group. It has more than 100 physicians and clinicians and six locations serving communities in the Portland metropolitan area.
In 2015, Portland Clinic conducted a pilot program with Providence Health Plan, which resulted in a 13 percent drop in ED visits by the pilot group within one year using Collective’s EDie technology.
“Providence Health Plan was making follow-up calls to our patients. We thought this was confusing to patients, was not efficient, and didn’t improve care. We felt that primary care being more involved with those calls would result in better outcomes,” Leake told HITInfrastructure.com.
“We did a pilot looking at a baseline period where both Providence and Portland Clinic were reaching out to high-utilization patients, those who had three or more ED visits in 90 days. Then, by having just The Portland Clinic do the outreach, this resulted in a 13 percent drop in ED visits compared to the baseline,” she said.
“Since then, our relationship with Collective has really evolved. We are doing a lot more data digging with Collective. We are better able to identify the high-risk, high-utilization patients and making sure they receive the help they need,” she related.
“We identify every patient that goes into the hospital and call them after the visit to make sure they understand what happened to them, have the medications they need, and get follow-up appointments with their providers,” she said.
Leake noted that all the hospitals in Oregon and Washington use the Collective EDie technology.
“We are using the Collective data for community collaborative work in Portland. We work with hospitals, health plans, and specialists to make sure we are coordinating care appropriately, reducing duplication of care, and communicating with high-risk, high-utilization patients.”
The Portland Clinic is a member of the Portland Coordinated Care Association (PCCA), a network of independent medical groups that pool resources to help lower costs, improve quality outcomes, and improve the patient experience. The association is made up of over 400 physicians and 20 care facilities across the Portland metro area. Of the 400 physicians, more than 130 focus on primary care.
PCCA has been a leading in the community collaboration work in which The Portland Clinic participates. The core members of the PCCA use Collective’s EDie technology.
“The biggest game changer about Collective is that it provides aggregated data across our entire patient population so we have a good picture of what is happening with health plans and hospitals in the region,” Leake said.
“For us to tell them, here is our entire group of patients and we want information on these patients and only these patients. That is huge. That is very different than any other data collection method that we’ve used. We can communicate back to the hospitals. So, there is an open line of communication for us,” she concluded.