Welcome to HIMSS

This site uses technologies such as cookies to provide a better user experience by personalising content and ads, analysing web traffic and trends, and improving site operations. We may share information about your use of the site with third parties in accordance with our Privacy Policy. By continuing to use this site you agree that we can save cookies on your device, unless you have disabled them. You can change your cookie settings at any time by visiting our Cookie Policy, but parts of our site may not function correctly without them.

Skip to main content
Email

The latest news in Healthcare IT – straight to your inbox.

Home
  • Main Menu
  • Subscribe
  • Topics
    • Video
    • Analytics
    • Artificial Intelligence
    • Cloud Computing
    • EHR
    • Government & Policy
    • Interoperability
    • Patient Engagement
    • Population Health
    • Precision Medicine
    • Privacy & Security
    • Telehealth
    • Women In Health IT

Regions

  • ANZ
  • ASIA
  • EMEA
  • Global Edition
Global Edition
AI & ML Intelligence

Optimus Healthcare ACO boosts performance and payments with AI platform

The accountable care organization has achieved a 10% improvement in quality gap closure, a key measure of network performance that will deliver $1 million in potential incentive payments.
By Bill Siwicki
September 10, 2024
11:36 AM

Dr. James Barr, vice president of physician value-based programs at Atlantic Health System and chief medical officer at Optimus Healthcare Partners

Photo: Optimus Healthcare Partners

Dr. James Barr, vice president of physician value-based programs at Atlantic Health System and chief medical officer at Optimus Healthcare Partners, an accountable care organization within that health system, is very firm when it comes to artificial intelligence and how it is deployed: "Your reason to use AI tools can't be just the need to say we're on the cutting edge."

THE PROBLEM

Within accountable care organizations, the challenge is designing and managing successful AI implementations that solve specific pain points and bring exponential value to physicians and the health status of populations, Barr said.

"Our top two priorities were unburdening the workflows of clinicians and understanding what is unique to each patient," he explained. "Our physicians and care teams were challenged by 'data noise' and poorly organized insights that failed to integrate in existing workflows. We also needed a way to integrate a critical source for insights – the patient.

"In addition to standard data aggregations from EHRs, payer claims, prescription files, lab sources and other inputs, we needed an AI system to continually seek patient input that could empower AI algorithms with numerous date features," he continued. 

"This needs to occur in a manner that strengthens the physician-patient relationship through customized narratives instead of standard un-engaging communications."

Optimus Healthcare Partners wanted AI systems that would wow the patient, understand them better, improve their compliance with care plans, and inspire them toward healthy lifestyle choices. These challenges highlighted the necessity for AI within the Atlantic Health System's accountable care organizations.

Since its inception in 2012, Optimus Healthcare Partners ACO, a part of Atlantic Alliance, the clinically integrated network, has invested in practice transformations, evidence-based protocols, care management structures and measurement/incentive processes that "care better" for patients.

"While the effort has delivered consistent gains, it came at a cost to ACO operations and physician burden, and we still have untapped potential for patient outcomes," Barr noted. "Asking clinicians to forage through EHR tabs or cross-reference chart reminders to identify gaps is cumbersome and inefficient.

"Absent a complete picture of health services utilization, EHR-level clinical data and patient-generated data features, it is difficult to pull forward the right screening prompts, care insights or patient-specific interventions," he added.

Simultaneously, payers were requesting connections to practice EHRs for the same purpose. Optimus realized it could improve the care its physicians provided by leveraging a data platform to connect the diverse set of EHRs and surfacing insights directly within the clinical workflow. It needed to bridge this gap.

PROPOSAL

The AI technologies evaluated by Atlantic Health System ACOs aimed to enhance efficiencies within clinical quality and coding workflows, support robust clinical decision-making, and improve patient access and experience. 

By integrating generative AI tools, Optimus Healthcare Partners ACO sought to automate routine tasks, reducing administrative burdens and allowing healthcare providers to focus more on patient care.

"The technology platforms can longitudinally aggregate patient data from numerous sources," Barr explained. "Then apply AI algorithms to prioritize and deliver critical insights within healthcare visits or interactions. In addition, generative AI can allow back-and-forth conversations with physicians and patients through AI chatbots. This allows real-time access for decision making by physicians and self-management for patients.

"To ensure responsible and ethical use, we planned to implement stringent guidelines and continuous validation processes, focusing on maintaining accuracy, privacy and data security," he continued. "The proposal emphasized educating and guiding team members to navigate AI tools effectively."

Recognizing the challenges in deploying AI, the strategy included identifying existing pain points for clinicians and patients, assessing their adaptability, and establishing transparent quality assurance processes to build trust.

MEETING THE CHALLENGE

The Optimus ACO uses four AI system vendors to meet the challenges within population health. Optimus invested in vendor Innovaccer to connect the disparate EHRs of independent affiliated physicians, allowing critical data aggregation that improves quality of care and produces AI care insights, Barr explained.

"The platform pulls this EHR data and organizes and curates it with claims, pharmacy, lab and other data sources to identify gaps in care," he said. "When the EHR patient chart is opened by a clinician, the InNote system prompts the clinician to review and close any open quality gaps and evaluate the assigned HCC coding opportunities.

"If questions arise, with one click, the clinician can open Patient360 to see a summary of recent or upcoming visits, labs, specialist-ordered testing and/or procedures, and social determinants of health indicators, which reduces the burden of follow-up and saves them time," he continued. 

"Initial impact analysis reveals a 10% improvement in quality gap closure, a key measure of ACO network performance, and a 16% improvement in coding and documentation accuracy."

At Optimus Healthcare Partners ACO, the greatest satisfaction for physicians is time savings.

"Previously, physicians had to search in the EHR to cross-reference specialist notes and confirm if patients were up to date on preventive and chronic condition screening goals," Barr explained. "Now, with Innovaccer's AI, notes are automatically scanned for updates at the point of care, enabling physicians to focus on their patients, and this can save up to 30 minutes per day.

"To promote adoption, Optimus trains physicians one-on-one and uses performance incentives to reward practices for building new workflow habits," he added. "Peer-to-peer training, complemented by webinars and on-site coaching as necessary, also supports this effort. Finally, the vendor's population health analytics system helps generate provider scorecards and payer reports, enabling clinicians to monitor their performance."

In addition to Innovaccer, the Atlantic Health System-aligned ACOs are using AI algorithms to support evidence-based care adherence, and generative AI to produce customized narratives with patients, enhancing patient access and improving patient experience via 24/7 access to a secure AI chatbot.

"Behavioral health, pharmaco-analytics for medication management and prescriptive analytic tools are other AI systems in place," Barr noted. "We have received tremendous feedback from clinicians, practices and patients. When used correctly, AI provides one of the strongest vehicles we've seen for positive change."

RESULTS

All interventions and innovations within the ACOs involve an impact analysis. Optimus Healthcare Partners ACO has standard KPI metrics such as quality gap improvements, patient experience surveys, clinician and care team experience surveys, utilization of ER/hospital admissions/readmissions, and costs of care.

Additional metrics such as adoption, engagement and unique clinical outcomes are added specific to the use cases where the AI tool is deployed.

Using Innovaccer's platform and suite of population health management systems, Optimus has achieved a 10% improvement in quality gap closure, a key measure of ACO network performance that will deliver $1 million in potential incentive payments, and achieved a 16% improvement in documentation accuracy, Barr reported.

"The use of a secure AI chatbot platform has buffered more than 90% of patient messages to physician practices," he said. "This delivers a significant reduction in their daily burden. Initial quality outcomes and compliance with recommended screenings also have improved through AI chatbot outreach, education and reminders to patients.

"We look forward to additional KPIs as results are evaluated," he continued. "The excitement of physicians, care teams and patients already is evident. A perfect example is a patient's conversation with their physician stating they are recommending everyone should switch doctors unless their physician has similar AI tools."

ADVICE FOR OTHERS

For healthcare provider organizations considering the adoption of AI technology, it is crucial to start with a clear understanding of the specific problems that need to be solved and ensure the AI systems are tailored to address these challenges directly, Barr advised.

"Engage all stakeholders, including clinicians, care teams and patients, early in the process to identify pain points and assess their readiness for new technologies," he said. "Transparent communication and education are key to building trust and ensuring broad acceptance across the organization.

"In addition to these steps, healthcare organizations should be proactive in the establishment and enforcement of AI governance and guidelines," he continued. "While governmental oversight will occur, we in healthcare should demonstrate our ability to fully understand the complexities of AI and regulate its use responsibly within our frameworks."

Continuous validation and monitoring should be integral to the implementation process to maintain high standards and adapt to emerging challenges, he added.

"Lastly, set clear metrics for success, such as improvements in workflow efficiency, patient satisfaction and cost-effectiveness, and regularly review these metrics to ensure the AI technology delivers the desired outcomes," he concluded.

Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

Topics: 
Accountable Care, Artificial Intelligence

More regional news

Patient does a virtual care consult

Castlight Health intros virtual urgent care for members

By
Mike Miliard
April 18, 2025
HIMSSCast logo

HIMSSCast: Should every healthcare organization have an AI strategy?

By
Mike Miliard
April 18, 2025
Nurse checks tablet to communicate on shift

Zoom launches agentic AI-powered mobile comms for frontline staff

By
Andrea Fox
April 18, 2025
Want to get more stories like this one? Get daily news updates from Healthcare IT News.
Your subscription has been saved.
Something went wrong. Please try again.

Top Story

Nurse checks tablet to communicate on shift
Zoom launches agentic AI-powered mobile comms for frontline staff

Most Read

How UCHealth is reducing fall injuries with AI-enhanced risk modeling
2025: AI enhances personalized care; caregiver experience in the spotlight
Frontera launches with $32M in seed funding
Korea University Medical Center pursues brain, heart AI development and more briefs
Roundup: AI and cloud tackle cyber risk and improve workflows
HIMSSCast: Fundamentals of data governance - lessons from UNC Health, part 1

Research

White Papers

More Whitepapers

Telehealth
Create secure, connected omnichannel communications
Telehealth
Let us guide you to HIPAA compliance
Cloud Computing
How a cloud communications platform puts connection at the center of care

Webinars

More Webinars

Analytics
Standby Eligibility and Claims Solutions: Diversify Your Risk & Ensure Business Continuity
Interoperability
Nursing Leadership, Operational Innovation, and Emerging Technologies with AONL
Artificial Intelligence
Loving the AI Revolution: How Automation is Humanizing Healthcare and Improving Provider Well-Being

Video

Ilir Kullolli, Stanford Medicine Children's Health_Las Vegas skyline Photo by halbergman/E+/Getty Images
HIMSS-ACCE working together to advance digital health
Vik Bajaj, Foresite Labs_Medical research Photo by Edward Jenner/pexels.com
Healthcare research is being affected by federal budget cuts
Priyanka Jain, Evvy_Hand holding sample vial Photo courtesy of Evvy
How one women's health startup tests fertility outcomes
Keisuke Nakagawa, UC San Diego Health_Las Vegas skyline Photo by halbergman/E+/Getty Images
Can technology help bring the human touch back to medicine?

More Stories

Lee Kim, HIMSS_Las Vegas skyline Photo by halbergman/E+/Getty Images
Past year's data breaches often stemmed from remediable cybersecurity gaps
Cathy Menkiena, Health Catalyst_Las Vegas skyline Photo by halbergman/E+/Getty Images
Innovative – and useful – tech is key to empowering care teams
Sameer Sethi of Hackensack Meridian Health on AI
Hackensack Meridian Chief AI Officer on the intersection of business and technology
Doctor checking and tracking information on a computer
HHS updates regulatory guides for the safe use of EHRs
Sameer Sethi, Hackensack Meridian Health_Computer neural network concept Photo by dan/Moment/Getty Images
Chief AI Officer on becoming one and working with the C-suite
Businessperson signing piece of paper
White House releases guidance on federal AI use and procurement
Dr. Ateev Mehrotra of Brown University School of Public Health on telehealth policy
Brown University policy expert talks about the future of telehealth flexibilities
Micky Tripathi, former HHS acting chief AI officer
Former National Coordinator headed to Mayo Clinic, reports say
Home

More News

  • MobiHealthNews
  • Healthcare Finance News
  • Healthcare Payers News

Newsletter Signup

HIMSS25 European Health Conference & Exhibition
HIMSS25 European Health Conference & Exhibition
Get ready for knowledge-sharing, all the latest innovations, and in-depth demos with Europe's most influential healthcare community.
10 - 12 June, 2025 | Paris
Learn More
AI in Healthcare Forum
AI in Healthcare Forum
The HIMSS AI in Healthcare Forum cuts through the hype to showcase real-world examples illustrating the transformative potential, and realistic challenges of AI application across the care continuum.
10 - 11 July 2025 | New York
Learn More

Footer Menu

  • About
  • Advertise
  • Reprints
  • Contact
  • Privacy Policy

© 2025 Healthcare IT News is a publication of HIMSS Media

X

Topics

  • Video
  • Analytics
  • Artificial Intelligence
  • Cloud Computing
  • EHR
  • Government & Policy
  • Interoperability
  • Patient Engagement
  • Population Health
  • Precision Medicine
  • Privacy & Security
  • Telehealth
  • Women In Health IT

Career

  • Events
  • Jobs
  • Research Papers
  • Webinars

More

  • About
  • Advertise
  • Contact
  • Special Projects
  • Video

Regions

  • ANZ
  • ASIA
  • EMEA
  • Global Edition

The Daily Brief Newsletter

Get daily news updates from Healthcare IT News.

Search form

Top Stories

Nurse checks tablet to communicate on shift
Zoom launches agentic AI-powered mobile comms for frontline staff
HIMSSCast logo
HIMSSCast: Should every healthcare organization have an AI strategy?
Vik Bajaj, Foresite Labs_Medical research Photo by Edward Jenner/pexels.com
Healthcare research is being affected by federal budget cuts