3 Ways AI Can Enable Health Systems to Achieve the Quadruple Aim

The healthcare industry's enduring quest to achieve the Quadruple Aim — improving population health, enhancing the patient experience, reducing costs, and improving care team well-being — often feels like an elusive goal. 

In fact, although value-based care first went mainstream in the early 2000s, fee-for-service models remain the most dominant payment model in the U.S., according to a 2023 AMA Policy Research Perspectives report.

So, what will it take for high-value healthcare to take permanent hold?

Advances in AI-powered automation offer health systems new tools to address the barriers, such as administrative burden, complex, disparate data, and care gaps, that have long held them back from achieving the promise of the Quadruple Aim. Specifically, Notable’s AI platform can automate tasks and work queues with EHR-integrated AI Agents. Pre-visit chart reviews, clinical forms, clinical trials, prior authorizations, risk adjustment coding, payment collection, care gap identification and closure, and more can be executed and automated within Notable’s AI-powered platform. 

To illustrate how AI can enable health systems to achieve the Quadruple Aim, let’s explore the successes of Security Health Plan, Marshfield Clinic Health System, and Presbyterian Healthcare Services. Each organization presented at Noteworthy 2024, Notable’s annual executive retreat for healthcare leaders and changemakers, and shared real-world examples and outcomes of their value based care journeys. 

1. Reduce Overall Healthcare Costs While Ensuring Quality Care

Security Health Plan is a not-for-profit health maintenance organization sponsored by the Marshfield Clinic Health System. The organization primarily supports rural communities in Wisconsin. 

During the panel, Krista Hoglund, CEO of Security Health Plan, discussed the challenges of reducing overall healthcare costs while ensuring quality care for their 220,000 members. Hoglund shared that the organization struggled with risk adjustment and quality scores but launched a multifaceted approach to address these challenges. 

This includes establishing a system committee that combines the expertise of the health plan and the provider side to create shared accountability. Security also used Notable’s AI Agents to streamline provider workflows and documentation and improve the accuracy of disease burden documentation. This led to the identification of an additional 2,800 chronic health conditions and generated an estimated $5.4 million in annual savings. 

“We know that risk adjustment and quality have a financial impact, but that's not why you should do it. The reason why health systems should focus on risk and quality is that, ultimately, it's about ensuring the right care for the patient. When we care for patients' conditions to their fullest specificity and identify and close their care gaps, there is a meaningful financial and patient impact, and we’ve achieved the goal of reducing overall healthcare costs while ensuring quality care," said Hoglund.‍

2. Navigate Complex, Disparate Data to Find Focus

Roxi Foreman, Vice President of Marshfield Clinic Health System, also touched on the organization’s joint effort with Security Health Plan to improve the quality of care and enhance patient outcomes. 

“This was a strategic initiative with shared ownership between our health plan and health system CEOs. Although we had leadership rally support from the disparate groups across the system, we still needed the disparate data. We needed a way to refine the data to understand what we should focus on first, what are our gaps, and how we should go from here. We needed to get the right data in place, and when we did that, it really transformed our work,” said Foreman.

Marshfield’s robust network of hospitals and clinics leverages automation in clinical and revenue cycle operations. Implementing AI tools allowed providers to easily navigate complex data, avoiding the lengthy process of sorting through cluttered patient charts, faxes, PDFs, chart notes, and problem lists from across the system to pinpoint pertinent diseases.

The result: Marshfield Clinic Health System saw a 6.4 percent increase in complete and accurate documentation of persistent HCC codes. The Marshfield organization captured 7,000+ additional conditions annually – putting the organization on track toward its annual redocumentation targets.‍

3. Standardize Work to Supercharge Productivity 

For Michael Montoya, Vice President of Primary and Urgent Care Services at Presbyterian Healthcare Services, when he thought about the opportunity to achieve the Quadruple Aim, improving quality performance and patient experience was a top priority. 

“We're chasing stars in HEDIS metrics and HCCs like everybody else – playing whack a mole. Sometimes, it feels like you improve on two of the metrics, and you erode on three of them. Then you have staff turnover and workforce changes,” said Montoya. “I thought, ‘this is just so inefficient,’ I have to find a way to standardize how we do work.”

During the panel, Montoya shared that Presbyterian now leverages Notable’s AI platform to standardize work and eliminate administrative burdens.

Presbyterian uses AI Agents to text patients, confirm appointments, or reschedule. While the patient experience has been significantly more efficient and positive, the impact on health system staff may be even greater.  

“Standardization has been huge for our completion rate, and we’ve been able to close a lot more care gaps,” said Montoya.

The tight coordination between Presbyterian’s care delivery system and health plan has also led to inspiring outcomes in quality performance. To date, with Notable, the health system has closed thousands of care gaps by facilitating thousands of incremental patient visits, all while saving over 25,000 hours of staff time annually. 

Achieving the Quadruple Aim with AI

The successes of Security Health Plan, Marshfield Clinic Health System, and Presbyterian Healthcare Services illustrate the immense potential AI offers to health systems striving to achieve the Quadruple Aim. As technology continues to evolve rapidly, healthcare organizations leveraging AI Agents to address these areas will find themselves not only closer to achieving the Quadruple Aim but also well-positioned to lead the way in quality, innovation, and patient care for the years to come.