Unlocking the triple threat in healthcare

How Epic-based Montage Health delivers better care and does so more efficiently

$2M

Annual value from revenue capture and cost savings

11%

Reduction in no-shows

2.8%

Increase in point-of-service cash collections

13

FTEs capacity created

solutions deployed
Registration and Intake, Referrals, Care Gap Closure
EHR
Epic
employed providers
3,000
Market
Monterey Peninsula

Study in brief

Over the past two years, Notable and Montage Health have partnered on Registration and Intake, Referrals, and Care Gap Closure. Through a detailed study, we’ve assessed the tangible benefits of this partnership.

The partnership yields Montage Health an estimated $2 million in annual gross value through revenue capture and cost savings. This result shows how an AI platform can improve financial performance and operational efficiency. Montage Health had already transitioned from analog to digital with its EHR implementation, and adding AI and automation unlocked further benefits.

No-show rates dropped by 11 percent with automated appointment reminders and the ability to confirm or cancel digitally, boosting resource utilization.

The point-of-service cash collections rate has increased by 2.8 percent. When patients complete their digital pre-registration, they can digitally pay their co-pays and prior balances before arriving at the appointment. These more user-friendly processes are essential for the organization’s financial sustainability.

The partnership also freed up the equivalent of 13 full-time employees (FTEs), allowing resource reallocation to higher priorities. This equates to a 3–6 percent improvement in operational labor efficiency across Montage Health’s ambulatory footprint of approximately 300 FTE staff.

Ultimately, using an AI platform has allowed Montage Health to grow its patient volumes without adding more staff. The collaboration between Notable and Montage Health demonstrates AI and automation's power to significantly improve healthcare delivery.

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. 

Highlights
2X

Digital intake completion rates in six weeks

537

Hours saved within 6 weeks

30%+

Faster check-in with Notable

91%

Patient satisfaction in the first six weeks

“Closing care gaps provides better health for patients. Traditionally, we would have people combing through charts to find these things. That takes time. And that time has now been redirected. I could find both cost and efficiency savings there,  improved charge capture, and a healthier patient. So that's a real triple threat. Love it as a CFO. Love it. My CEO loves it. We all love it.”
Matt Morgan
CFO
Highlights
17,000+

Charts automatically reviewed in the first year

14.6%

Total care gap closure rate

100+

Patients with high-risk HPV sent for follow-up

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.

Breakdown of financial impact

In the breakdown below, the dollar value is listed as a range from our low-end estimate to our high-end estimate where the exact dollar value is unknown. These numbers have been validated with Montage Health.

Revenue capture

Reduction in no-shows and late cancellations

From appointment reminders and confirm/cancel
$518–$633k

Point of service cash collections

2.8% POS rate improvement, supported by the option to digitally pay copays, prior balance, and pre-payment
$340k

Care gap closure

From Notable’s initiatives to close 5 care gaps
$143–$175k

Cost savings

Staff time savings

Efficiency gains have allowed staff to reallocate hours to more valuable tasks
$801–$978k

Vendor replacement

Using one platform across the system has allowed Montage to cut down on vendors
$71k

Reduction in cost to collect

Streamlining the payment process for patients has led to more efficient collections
$55–$67k

Crafting a better experience

Patients often face challenges in accessing care, from working adults struggling to call during business hours to parents juggling paperwork and children in waiting rooms. A digital system must cater to all, including first-time healthcare consumers and seniors.

The partnership with Notable aids accessibility and equity, offering Spanish outreaches and reducing manual burden related to referrals and scheduling for Montage Health’s Healthy Together program, a Population Health program that addresses nutrition and food insecurity. This patient-centered approach has achieved a 96.8 percent patient satisfaction rating.

Digital pre-registration rates soared from less than 20 percent with Epic eCheck-in to over 50 percent, thanks to the solution’s ease of use. Liliana Madrid, a Director with Montage Medical Group, praises her firsthand patient experience of Notable: “From a patient standpoint, that has been fantastic.”

Because all communications are branded as Montage Health, most patients don’t realize they’re interacting with external technology, which Amy Susemihl, Assistant Director of Patient Access, describes as “seamless.”

Every time a patient completes their digital intake through Notable, Notable requests feedback, and then uses this feedback to improve the experience. For 96.8 percent of patients, this feedback is mostly positive:

“I like that I could do this on my phone and didn’t have to have the papers to sign at the office”

“Pre-filled forms, few questions, and check boxes made it convenient and quick”

“Easy access, easy to navigate — THANKS!”

“I could easily use my cell phone. Small discrete bits of info asked on separate screens. Clear language. I could easily upload a pic of my card without leaving app”

“It was an easy process to fill out online once I used the link and went through the process. Most was already correct and I did not have to change much on it”

“I like that I could do this on my phone and didn’t have to have the papers to sign at the office.”

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.”

Supercharging the workforce

Before Notable, there were often more administrative tasks to be done than people to do them. Using Notable to automate these manual, burdensome tasks helped Montage Health create 13 FTEs worth of capacity, equivalent to a 3–6 percent operational labor efficiency given approximately 300 FTE staff involved in these operational tasks.

Montage Health’s operations team has been able to repurpose staff effort toward more valuable tasks, such as focusing on patient communications rather than transcription. All of this was accomplished without adding a large volume of work for Montage Health’s HIT department to deploy and maintain.

These time savings allowed Montage Health to create a better and more streamlined experience. Previously, patients were sometimes dissatisfied with their experience before they even got to the doctor. There were long lines in the waiting rooms and patients were frustrated with delays and having to wait. Now, lines in the waiting room have substantially decreased, improving both staff and patient satisfaction.

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.

Method

This study employed a mixed-method approach to assess the impact of Notable's technology solutions on Montage Health's operations over the past two years. The research was conducted over two months, January and February 2024, integrating both qualitative and quantitative methodologies to provide a comprehensive understanding of the technology's effectiveness and areas for improvement.

Quantitative Analysis

The quantitative component of the study involved an in-depth analysis of data extracted from Montage Health’s EHR, industry baselines, and Notable’s databases. This analysis was used to evaluate Montage Health’s performance in key operational areas.

Metrics such as check-in times, referral times, and percentage of care gaps closed were analyzed to quantify Notable’s impact on improving healthcare delivery and administrative efficiency at Montage Health.

Qualitative Analysis

The study’s qualitative aspect was conducted through three focus groups comprising a total of 14 participants. These participants were selected from various departments, practices, and roles within the Montage Health network to ensure a diverse representation of perspectives on Notable's technology. Four sites of care were represented, as well as representation from the executive level, back-office staff, and Aspire Health.

The focus groups were structured around three of Notable’s solutions deployed at Montage: