Castell reduces average daily chart time from 4 hours to 1 hour

How the value-based care health services company is using intelligent automation to review charts and identify opportunities for care gap closure

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Patients served

900,000

Employed providers

860

EHR

Cerner

Use case

Chart review

The challenge

Like many health systems, Castell grappled with how to manage its own staffing shortage amidst growing administrative workloads. Rising administrative costs and workflow inefficiencies can jeopardize the ability of health systems to deliver timely, quality care. These challenges exist for VBC organizations like Castell, who rely on highly-trained care coordinators to provide ongoing support to providers for tasks like chart review and member outreach.

Prior to Notable, Castell Care Coordinators would start their day by logging into iCentra Cerner EHR, and clicking into each and every patient chart to determine if the patient’s insurance was considered a VBC payer. If the payer qualified, the care coordinator moved to the recommendations field within the chart, which contains medical history like date of last mammogram, colonoscopy or diabetic A1c. Depending on the recommended time frame of a service or procedure (for example a colonoscopy should be done every 10 years), the care coordinators search for that documentation, toggling between different filters to locate keywords, dates and repeat recommendations for care. At times, they would have to request records from other health systems which can take hours or days to fulfill. Simultaneously, the care coordinators were running their “immunization workflow” through the Utah Statewide Immunization Information System which requires a manual upload of immunization records.

On average, Castell care coordinators were reviewing approximately 100 charts per day to validate the presence of care gaps. Each chart review required around three minutes of manual point-and-clicking in the EHR, not including the review of scanned reports, faxes, and attachment uploads within each chart, or the phone calls needed for outreach to each patient. These manual tasks prevented care coordinators from operating at the top of their license and focusing on the most complex subset of patients who needed their assistance.

The solution

Since deploying Notable’s care gaps solution, Castell care coordinators are able to review the charts of 3,362 additional patients each day. How? Notable’s bots or “digital assistants” are able to perform the work that would otherwise require an additional 34 full time care coordinators and take more than 190 hours to complete.

By leveraging intelligent automation to correctly identify interval follow-ups and reconcile missing data, Castell’s care teams can be more proactive in the way they engage with patients and as a result, save more lives. In addition to improving care for patients, care coordinators can avoid excessive outbound calls, and reduce the data entry required from staff before and after every visit.

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"Notable’s Intelligent automation platform enables us to utilize data in a meaningful, actionable way. For example, we now have a streamlined way to collect and report patient information, which is typically a major barrier for operationalizing VBC. For so long, our care coordinators were mired in paperwork and data entry. Now, Notable surfaces the right data at the right time to eliminate the many minutes per patient they would normally spend fact-finding in the EHR.”

Dave Henriksen
VP Clinical Operations at Castell

Dave Henrickson_Castell

Dave Henriksen
VP Clinical Operations at Castell

Notable impact

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Closing care gaps faster, without disrupting existing workflows

Using Notable, Castell can identify and close care gaps faster, with more accuracy, and without disrupting their pre-existing process. By digitizing what they were already doing manually, care coordinators no longer need to click into every single chart to determine gaps in care. Instead, Notable’s digital assistants:

  1. Remotely log in to the Cerner EHR
  2. Filter to patients in value-based care contracts
  3. Scan the patient’s chart for care gap recommendations
  4. Search for scanned documents, procedure reports, and clinical notes that are sufficient to fulfill due/overdue care gaps 
  5. Use optical character recognition (OCR) to transcribe images into text, and then parse the text for meaningful data (e.g. name and date of procedure, recommended follow-up interval)
  6. Present the appropriate data to care coordinators
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Making value-based care a reality

The healthcare landscape is constantly changing to meet challenges such as aging populations, emerging technologies, and the escalating cost of care. According to a 2019 study, approximately 15% of the healthcare leaders polled reported that accessing patient information was a challenge for providers when transitioning to a VBC model. VBC-focused organizations like Castell are using innovative technology like intelligent automation to set the new standard in healthcare. 

Technology and analytics is fundamental to the Castell model, specifically the use of digital tools that address virtual care, patient experience, and social determinants of health. With Notable, Castell has the agility to elevate and scale its VBC capabilities without having to re-tool existing internal processes. By adding intelligent automation to its technology platform, Castell can empower its providers to take a more holistic approach to managing the health of their patients.

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