Unlocking the triple threat in healthcare

For years, Montage Health was the sole healthcare system in its area, a scenario Dr. Steven Packer, its President and CEO, describes as "both a blessing and a curse." Packer explains, “When you're the only system, you sometimes get really comfortable with what it is you provide. And you realize over time, that geographic isolation only goes so far.”

The entry of competitors to Monterey County, front desk staff turnover rates of 20-30 percent during the pandemic, and a payer mix skewed toward government payers presented challenges. The EHR system helped digitize the work but didn’t focus on automation. There was also a lack of standardization, with different departments using different patient engagement tools, which led to an inconsistent patient experience.

“For appointment reminders alone, we had four different solutions,” says Meg Dingae, Director of Human Experience. “Two of them were in the hospital. And with that, came a really disparate patient experience.”

In 2021, Dingae sought a unified solution, which led Montage Health to Notable. The first project was to unify the system’s patient experience. Within the first six weeks live on Registration and Intake, Montage Health doubled its digital intake completion rate from <20 percent to around 50 percent. Patients who used Notable could check in more than 30 percent faster than those who did not (from 6 minutes to 2 minutes, and sometimes as little as 10 seconds with Notable).

Lines in the waiting room decreased, and front desk staff had more time for interactions with patients. “We’ve increased patient and staff satisfaction at our medical group because of this project,” Dingae says. “Our Press Ganey scores for patient experience before they see the doctor have gone up.”

Following the success with Registration and Intake, Montage Health and Notable continued to identify additional opportunities to use AI to enhance operations and care. 

Proactively engaging patients to get care

Before Notable, Montage Health’s chart review and care gap outreach workflows were time-consuming and limited to specific populations. Dr. Kathleen Chase, Chief Medical Officer, Montage Medical Group, noted physicians spent up to half of a 20-minute appointment searching for past screenings like pap smears, often postponing further research until after the visit. This delay could necessitate additional patient visits for services that could have been provided earlier if the information was accessible.

Montage Health targeted five care gap categories for Notable to support: cervical cancer, colon cancer, diabetic eye exam, breast cancer, and hypertension. Notable automates chart reviews for these categories, identifies care needs, and contacts patients accordingly.

To date, Notable has reviewed over 17,000 charts, pending care gaps for closure through chart review 6.5 percent of the time. For 14.6 percent of care gaps, Notable can address the care gap by automating chart reviews, getting information from patients that is necessary for gap closure, and/or scheduling the patient to come in for their screening to close the gap.

This work has prevented patients from being lost to follow-up. For cervical cancer screening alone, Notable identified over a hundred high-risk HPV patients who had not followed up.

“We really are improving the lives of the patients and our community,” Dingae says. “From a financial perspective, this is helping our medical group meet their quality metrics. And there's no way our medical group had time to manually scrub the charts of 17,000 patients.

Marie Wolf, Director of Collaborative Care Services at Montage Medical Group, agreed there are too many charts to scrub manually. When Notable works well, it’s almost invisible.

“From a front-line clinical perspective, it’s just magic and it just happens,” Chase shares. “I think 90 percent of people have forgotten that we are even using Notable.”

However, the new, more proactive approach is noticed by patients. Wolf sometimes sees patients reaching out to say thank you for the reminder.

Improving financial performance

“I think our relationship with Notable has proven to have opportunities for efficiency built in,” Morgan says. “For example, we've seen a record number of radiology appointments in 2023 and I have the same amount of staff scheduling those folks.

Notable takes the burden off the team and allows them to spread themselves across a greater population. That counts as efficiency and cost savings in my book.” Today, Montage Health can serve more patients without adding more staff.

Altogether, the partnership currently offers an estimated $2 million in annual gross value through revenue capture and cost savings, with that figure growing as new workflows are deployed.

Through the partnership with Notable, there has been a concrete improvement in revenue. “53 percent of patients who walk through our door have already completed their digital registration, payments, or other information online,” Dingae confirms. “We’re improving copay collection prior to patients even walking through the door.

The partnership has positively influenced perceptions of Montage Health. Ferreyra, a HIM Supervisor at Ryan Ranch, noted that in the most recent Press Ganey survey, patients had commented about the ease of accessing care.

“For myself, I think that it's great that Montage is working with vendors like Notable to help make things easier,” she said. “Obviously, there are going to be some roadblocks and stuff like that. But I think it's overall a good perception that we want to make things easier for patients and staff.”

Leveraging AI toward new use cases and opportunities

Notable advocates for starting small with deployments, achieving early results, and iteratively expanding. One example of this approach at Montage Health is our work with referrals, which is initially being used at a few showcase sites.

While work on referrals with Notable is still new, staff are already seeing an impact on their day-to-day jobs. For example, Zulema Cortez Cuevas, Wellness Program Specialist for Aspire Health, saves an hour or 2 per day with Notable that would have been spent transcribing referrals. She can now reach out to more patients and enroll them in the wellness program.

Before Notable, there was a dedicated staff person in the Breast Care Center who transcribed referrals. If that person wasn’t there due to planned or unplanned time out of the office, the work would have to be divided between different administrators in the department.

For the primary care department, the process was more reactive than proactive. “We had quite a bit of a backlog on those referrals,” Ferreyra says. “Notable has helped in that aspect where we don't have to hire an FTE.”

These backlogs can delay patient care. By the time a referral gets processed, patients may be confused about their next step, potentially losing out on the care they should receive. With Montage Health operating at or near capacity, this is especially critical.

“If you just cut the referral work from 14 days to three days, that's awesome,” Morgan tells Notable, referring to Notable’s work with Healthy Together. “I really need help there because we have people waiting.”

If Notable disappeared, “that would be more work for us,” says Jessica Diaz, an Administrative Assistant at Carol Hatton Breast Care Center. As for the Aspire Health wellness program, it would be more difficult to meet their goals.

“I would have to focus on and prioritize transcribing instead of making calls,” Cortez –Cuevas says. “That would probably affect our goals on scheduling and enrolling 30 people per week.” To meet that target, she makes over 75 calls per week.

Early results from Notable’s Referrals work are promising, with more to come as we build for the future. Other in-development opportunities include clinical forms, including the ability to send PHQs, and the ability to validate insurance at an encounter level.

Conclusion

Our analysis shows that using an AI platform for healthcare operations has been a successful strategy for Montage Health. Opting for a unified EHR-integrated platform, Montage Health has streamlined operations across the digital front door, quality and risk, and patient financial experiences, continually exploring new applications.

This complementary approach to the system’s EHR has delivered $2 million in annual gross value, doubled digital intake completion rates, closed 17,000 care gaps, and freed the equivalent of 13 FTEs, with outcomes expanding as new use cases are added.

Notably, these achievements were made without requiring a large HIT or Digital Health lift from Montage Health. “For about 18 months, I was a Digital Health department of one,” Dingae says. “And what was really cool about this partnership is I felt like I had a team with Notable… I got to work with this incredible team every day to roll out this stuff and do it pretty quickly.”

Staff members interviewed in focus groups were eager to share their feedback and experiences with the overall sentiment being a strong desire for further engagement. We extend our gratitude to all contributors for their invaluable insights, which ensure our solutions continue to meet the community’s needs.