How Johns Hopkins HealthCare Identified High-risk Patients for COVID-19 Outreach Using the ACG® System

Health plans have experienced an unprecedented need to identify patients most at-risk and vulnerable to complications from COVID-19, take action to manage the underlying chronic disease during the outbreak, and assist with social and medical needs.

Johns Hopkins HealthCare wanted to support their 25,000 Medicare Advantage (MA) plan members at a time of crisis with a rapid outreach initiative. Using the Centers for Disease Control and Prevention (CDC) defined risk criteria to inform the analysis of the Johns Hopkins ACG^® System, the plan quantified the number of patients within the MA population who were at-risk due to a combination of age and underlying comorbidities.

While developing the intervention, the clinical team initiated a number of technical readiness activities to support their outreach. Download the case study for details on all the collaborative steps taken by the health plan, plus findings of their program success.