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Turning actionable data into meaningful care

Healthgram software helps one hospital’s clinic staff identify and better engage its highest-risk subset.

"Being able to prioritize outreach based on biometrics is critical in focusing our clinical and coaching efforts in a time-efficient manner." - Hospital Director of Health Management

The Outcome

  • Healthgram software used comprehensive data to stratify patients by risk level
  • Clinicians used this data to prioritize outreach and create personalized action plans
  • Real-time EHR system tracks patient progress and risk levels
  • Clear and actionable reporting allows clinic staff to adjust focus as needed

The Client

  • Industry: Hospital System
  • Employees: 4,000+
  • Location: Georgia

The Challenge

A multidisciplinary team manages this southeastern health system’s onsite clinic with a focus on improving health and controlling costs. When they noticed they weren’t engaging highest-risk employees, they turned to Healthgram software for a data-driven strategy to balance the scale.

The Solution

As with most employee populations, those with chronic conditions were the primary drivers of plan cost for the hospital. We set out to help the hospital’s clinic staff identify and better engage this highest-risk subset.

Using our software, we aggregated the hospital’s biometric data, labs, screening values and claims into a comprehensive view of patient health, and then stratified the population by risk level.

“It ensures that we are focusing our efforts on the highest-risk patients,” says the company’s clinician.

For example, when data show an increase in abnormal A1C values, the team is able to make diabetes management a priority, and knows exactly who to engage.

Today, the hospital uses Healthgram software to run the following health management programs: one-on-one health coaching, weight management, condition- specific outreach, cardiopulmonary rehab and tobacco cessation.

The company’s clinician relies on Healthgram software to plan long-term initiatives and let her team know when to shift focus, knowing that the needs of the workforce continuously evolve.

“Healthgram reports help track all phases of the process to work towards our goals,” she says.

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