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How AI can help improve quality scores


How AI can be used to activate patients to make important wellness appointments, such as cancer screenings.

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As federally qualified health centers (FQHCs) continue moving towards value-based care models, it’s important to consider how tools and tactics can help improve patient outcomes and quality scores. One such technology is artificial intelligence (AI), which can be used to activate patients to make important wellness appointments, such as cancer screenings.

AI has evolved significantly in recent years, becoming more in-depth and reliable – and facilitating a wider range of capabilities. FQHCs can take advantage of those advancements to make their data work for them in a powerful way, such as activating patients to schedule appointments that may improve their health outcomes and drive improved quality scores. This application of AI can support an organization’s delivery of chronic care, immunizations, screenings and other necessary services without expending undue resources or overwhelming already short-staffed clinics.

While the options are plentiful and growing, the following are three ways FQHCs can begin to leverage AI to drive improved outcomes in the near term.

Outreach to highest-risk patients

Most providers today are reporting quality metrics to stakeholders and insurance companies. FQHCs have the added burden of reporting to their primary grant funder, the Health Resources and Services Administration (HRSA).

One of the most vital ways to move the needle on HRSA quality measures is by proactively bringing in the highest-risk patients and taking care of their needs first. AI takes the guesswork out of predicting and identifying the individuals who might have conditions or a history that puts them at a higher risk of certain conditions, such as breast cancer or heart disease.

Through data analysis and machine learning, AI can accurately predict the needs of patients up to a year in advance, send educational materials, appointment reminders, and personalized communications to help drive disenfranchised individuals to the care they need. All of this can be measured and reported succinctly as well, giving further insights into the effectiveness of a campaign and the impact it has on patient outcomes to appointment volume to star ratings and quality measures..

Make the best use of inventory and provider time

Many FQHCs deal with a higher demand for services than they can effectively meet. In some cases, an FQHC may be the only provider in the area, or the single provider accepting Medicaid payments. At the same time, clinics across the board are struggling to keep sufficient providers on staff. If those challenges aren’t enough, a recent Kaiser Family Foundation survey found that many FQHCs have physical constraints, with no ability to expand in order to serve a broader audience.

With limited potential appointments, FQHCs must prioritize which patients to see when. Using AI, healthcare systems can identify which individuals require urgent screenings or care that should not wait. Data filtered through an AI platform can also keep patients on track for annual wellness visits for Medicare patients or those with chronic conditions. The available appointments that are left can then be used for less time-sensitive care.Prioritizing patients in this manner helps save resources and improve medical outcomes.

Become the provider of choice

FQHCs have a responsibility to serve all members within their communities, not only those who may not have access to other sources of healthcare. Particularly in urban areas, providers must meet the needs of a broad range of patients, insured and uninsured, those with chronic conditions and a younger, healthier population. Attracting a variety of patients helps to increase reimbursements and ensure financial stability.

Using AI to analyze patient needs, communicate individually and preserve resources creates an environment where staff and patients alike can thrive. And that is a healthcare system that will become competitive with private providers. As quality scores improve and experiences are shared, FQHCs will no longer be seen as only a safety net clinic, but a high-quality, comprehensive care unit with so much to offer.

FQHCs have faced a litany of challenges over the last few years, from a global pandemic and evolving technology to staffing shortages. AI won’t solve all of these problems overnight, but this tool is a great place to start as providers look for more patient engagement, better healthcare outcomes, more efficient use of limited resources and a more sustainable financial model.

Alan Tam is chief marketing officer at Actium Health.

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