Mayfair Internal Medicine is a medical group that has served the Denver area since 1996. The practice, which serves 3,000 patients, was an early adopter of electronic health records (EHR) systems, moving away from paper records years ago.
“Our providers have always been pioneers and they’ve instilled that into our team and into the overall culture of our office,” says Tiffany Martin, who has served as Mayfair’s office manager since 2008. Martin says their practice “jumped on the bandwagon right away,” implementing eClinicalWorks EHR and demonstrating 90 days of meaningful use within the first year of eligibility.
“Over the years, we kept learning about and joining other innovative programs. When we heard about Colorado Care Partners value-based contracts, we knew we wanted to be a part of it,” she says. Participation in the APM opened the door for Mayfair to access additional free or low-cost resources and incentives – including services offered by Contexture – to help track and report on required milestones like quality improvements.
In fall 2018, Mayfair joined Contexture’s Notifications pilot program, which sends batched or real-time notices about patient ED visits, hospital admissions or discharges. Within the first year, the practice had begun seeing an overall decrease in alerts, primarily due to improved care coordination efforts.
“We’re now able to go in and look at ED and hospital discharges and reach out to patients with a phone call within two business days of discharge,” Martin says. “We’ll call and say, ‘I noticed you were in the ED, did you know you can call us first?’ Or, ‘I see you went to the ED for a UTI, let’s talk about the difference between urgent and emergency care.’”
Contexture Notifications solution has also been an effective tool to improve overall care coordination, Martin says. “We had a patient who went into the ER and was admitted to the hospital, where she ended up having a toe amputated, but we never received a discharge summary. Upon discharge, she had trouble managing her medications and was not set up with home health care services,” she says. “Because of Notifications, we were able to intervene, reconcile her medications, get her home health, and ultimately, we saved her a readmission.”