ThedaCare conducts 900+ automated care gap outreaches in 3 months

How a leading population health organization saved its staff 350 hours of manual work in care gap outreach

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Use case

Care gap outreach



Community size served


The challenge

One of the more administratively burdensome tasks in healthcare is outreaching to patients with open care gaps. Failing to close care gaps in a timely manner can result in missed diagnoses or unnecessarily costly or invasive treatment later on, leading to worse clinical outcomes, increased healthcare spending, and lower performance on value-based care contracts.

In keeping with their mission to increase access to quality care, ThedaCare leveraged intelligent automation to advance its population health initiatives, starting with care gap outreach. Using Notable, ThedaCare can automate care gap detection, outreach, and scheduling so a patient can book a visit with their provider immediately after a care gap is identified. With this technology, patients can also interact with the system remotely by providing important data that helps their provider know where they are in their care (e.g., home blood pressure measurements or information about previous screening exams).

The solution

Notable’s digital assistants are helping ThedaCare close care gaps at a faster rate by automating patient outreach. How it works:

1. Notable ingests a list of patients with open care gaps based on Epic recommendations and/or care gap reports.

2. Notable’s digital assistants automatically outreach to those patients via text and/or email, based on the consumer preference.

3. Patients authenticate through Notable’s web-based app and complete a form unique to the relevant care gaps for that patient, either scheduling an appointment for the recommended care or indicating that the care gap has already been closed.

For patients who indicate they have already completed the care needed to close the care gap, Notable will collect the needed information and document the care gap closure in the EHR. Additionally, Notable automatically surfaces a list of patients who have scheduled, opted-out, screened-out, and/or completed a procedure (like a mammography screening or MAWV) in the last 12 months to ThedaCare’s team. Notable’s digital assistants have performed thousands of automated care gap outreaches, closing more than 900 care gaps (26% from scheduled visits, 74% from patient-reported information), and scheduled hundreds of patients for recommended office visits. Manual outreaches for this same population would have otherwise required support staff to spend an estimated 350 hours calling patients.

These automated outreach campaigns enabled ThedaCare to connect with roughly 3X patients than would otherwise be possible using manual methods. Approximately 30% of patients who received a Notable outreach started the care gap closure process -- ThedaCare estimates that 10% of patients typically answer the call during past campaigns.


"By leveraging intelligent automation to automate repetitive, manual tasks like care gap outreach, we can develop efficient workflows that can be tailored based on the unique needs of each of our patient populations. Notable gives us the insights we need in order to ensure patients receive the exceptional care they need, right when they need it."

Mark Thiel
VP of Primary Care


Mark Thiel
VP of Primary Care

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