Healthcare organizations are being asked to assume more and more financial risk for their patients’ health, with limited insights into the nonclinical factors contributing to that risk. Now more than ever, clinicians must understand the non-clinical factors that influence, and often determine, a patient’s health outcomes. As organizations expand their approach to population health management, one thing is certain, they cannot underestimate the importance of identifying social risk and building partnerships with community agencies and social services to address this risk. Whether this means identifying high-risk patients with a stratification model based on non-clinical factors or enabling a meaningful conversation about social vulnerabilities between the doctor and patient, providers can leverage AI and Machine Learning technology, along with non-traditional activated data sets to impact the health of their populations and win at Value-Based Care.
Nathan Riggle is the Division Director of Analytics at MercyOne Population Health Service Organization (PHSO). In this role, Nathan manages analytics, data, and IT work that supports the care management and population health initiatives at the organization. He is also leading and supporting multiple PHSO strategic initiatives, which strive to help the organization grow and succeed in the ever-changing healthcare industry. Additionally, he serves as a member of MercyOne IT Steering Committee, helping to drive all organizational IT projects and implementations. Prior to joining MercyOne PHSO, Nathan worked for 8 years in analytic consulting with the management consulting firm ZS Associates, and as an internal consultant at Principal Financial. Nathan Riggle received his bachelors in mathematics and economics from Creighton University and did his Master’s in Business Administration from the University of Chicago Booth School of Business.
Emily Fletcher is the Ambulatory Care Program Manager at MercyOne Population Health Service Organization (PHSO). She leads the integration of Health Coaches, Social Workers, Pharmacists, and Community Health Workers into the medical home to positively impact consumer experience and patient outcomes. Emily received her Bachelor’s degree in Socio-Political Communications from Missouri State University and a Master’s degree in Public Health from the University of North Texas Health Science Center. She completed her practicum with the Centers for Medicare and Medicaid Services in Dallas, Texas. Emily started at MercyOne in 2010, working in oncology research for five years before joining the PHSO in 2016. She served a two-year term as Vice Chair of the Institutional Review Board. Emily’s goal is to create a health care environment where all patients have the same opportunity to be healthy. Addressing health-related social needs through the community health worker program is a key strategy in accomplishing this goal.