As part of value-based care (VBC) and population health initiatives, health systems are leveraging AI and digital technology to improve quality, engage patients at scale and prevent avoidable utilization to support financial sustainability. These were insights shared at Becker’s 16th Annual Meeting in a session sponsored by Arcadia and Guidehealth titled “Driving Economic Sustainability in Healthcare’s Digital Age.”

This session, moderated by Aneesh Chopra, chair of Arcadia Institute, featured case studies from Rush, Emory and Ochsner by:

• Sidney H. “Beau” Raymond, MD, chief medical officer, Ochsner Health Network (New Orleans)

• Tina-Ann Thompson, MD, executive director, Emory Healthcare Population Health Collaborative (Atlanta)

• Amanda Tosto, RN, associate vice president, operations, Rush University System for Health (Chicago)

Here are three key takeaways from the session:

1. Rush is driving system-wide quality improvements

Rush Health has 5 hospitals, 3,000 providers and 17 value-based care and pay-for-performance contracts. While Rush has about 200,000 patients in VBC agreements, Rush is not currently at “full risk” for any of those patients. Ms. Tosto estimated that just 1 in 50 Rush patients is in any risk agreement.

Even without full risk patients, Rush has prioritized delivering outstanding quality on all key metrics through a clinical integration program that leverages PCP performance scorecards. This quality focus moves the needle for Rush economically because, “We negotiate favorable agreements,” said Ms. Tosto. “We’re able to do that because we can prove we have top-decile quality in measures that are important to our payers.”

2. Emory is using AI agents for patient outreach

For years, Emory Healthcare lagged in primary care and value-based contracts. That began to change in the past few years and now has about 450,000 lives in VBC. By prioritizing care management, Emory has improved on most key quality metrics, especially transitions of care.

However, Emory still had opportunities to improve star ratings on some population health measures, such as blood pressure control. Lacking budget or staffing to have human care coordinators intervene with patients at scale, Emory tested an intervention featuring AI agents to improve blood pressure results. These agents identified themselves as AI agents, asked for patient consent to participate in the program and orchestrated an at-home blood pressure program among about 2,000 patients.

“These AI agents closed enough care gaps to take us from one star to four stars,” said Dr. Thompson. “More importantly, the patients liked it, with 9 out of 10 reporting a positive experience.”

3. Ochsner is preventing unnecessary ED visits through a virtual ED program

Ochsner, in Louisiana and Mississippi, has a payer split of 70% government and 30% commercial, with over 500,000 lives in value-based contracts. For government-pay patients, Ochsner loses money on inpatient admissions, and therefore wants to keep these patients out of the hospital.

Like other health systems, Ochsner provides care management programs for patients with diabetes, hypertension, kidney disease and other conditions. These programs have been successful at decreasing ED visits and hospital admissions.

However, even with these programs and a 24/7 nurse triage line, half of Ochsner’s ED visit were avoidable. This led to the implementation of Ochsner Virtual ED, where a patient speaks with an ED doctor virtually. Not only is this reducing ED visits, but it is routing patients to the most appropriate point of care. “Having an ED doc intentionally keeping people out of the ED, where hospitals traditionally generate revenue, is game changing,” said Dr. Raymond.

Mr. Chopra noted that these case studies describe operating models that support financial sustainability, which is critical given shifting reimbursements, the rise of risk-based programs, and rapidly evolving healthcare policy.

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