Rising Rising is an advanced care management feature of the Pings platform that helps care teams to easily identify emerging high-and rising-risk patients, streamline post-discharge care, and improve patient patient communication- all within the clinical workflow.
In this article we will review:
Rising Risk Overview
Care coordinators rely on lagged claims data to manage cost of care for high-risk and rising-risk patients. Much can happen during the 60–90-day claims lag, resulting in delayed intervention, missed care opportunities, and avoidable costs.
With Rising Risk you can identify your rising risk cohort in real time, conduct targeted post-discharge follow-up, connect with hard-to-reach patients using SMS contact sharing to help improve patient outcomes.
To identify your rising risk cohort, Bamboo Health collects data on patients, as outlined below, and evaluates their "care coordination burden" using a predictive model. Patients who exceed a certain score are displayed in the product. Scoring is updated daily and the following data is included:
| Hospital Utilization Data |
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| Demographics |
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| Geographic Data |
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| Diagnosis Data |
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| Insurance Data |
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Rising Risk is only available to facilities that have purchased our enhanced offerings. To learn more, contact your Bamboo Health Account Manager!
Rising Risk Key Definitions
- Rising Risk: A Patient who has experienced a significant increase in hospital care in the last 60 days and who may become a multi-visit patient in the future.
- Multi-Visit Patient: A costly and vulnerable patient who experiences high levels of hospital care over a long period of time (180+ days).
- Readmission Risk: When we detect that a patient has experienced a readmission in the last 60 days.
Patient Case Lifecycle
The Patient Case Lifecycle allows you to move patients throughout to document your post- discharge follow-up activities, capture patient level notes to ensure continuity of care, and improve efficiency and quality of patient outreach workflows. The lifecycle statuses include:
- Triage: Patients in this stage are those whom we think could benefit from expedited follow-up, but whom you may not yet have contacted.
- Follow Up in Progress: This stage is the core of the workflow – move patients here when they are relevant for your workflow, and you are in the process of contacting them.
- Tracking: Once your outreach to a patient is complete, you may want to passively track them and be notified when they have an additional hospital event so that you can attempt to engage them.
- Complete: Once your outreach to a patient is complete and you no longer need to track the patient, move their card here.
- Not Necessary: Move patients here if they are not relevant to your workflow.
Moving Patients Through the Patient Case Lifecycle
Patients initially appear on the Triage page. To move them through the Patient Case Lifecycle and update their status, follow the steps outlined below:
- Navigate to the Move To button
- Select the appropriate status to move the patient to
3. Click Save
4. This will remove the patient from the Triage tab and move them to the selected tab.
Adding Follow Up Actions
Utilize the Follow Up Actions feature to schedule and sort patients that you are not ready yet to action on!
- Click the Add Follow-up Action button.
- Select the date and time you wish to follow up
- Click Add
- This will move the patient to the Follow Up In Progress tab
Sending a Contact Card
- Click Send Contact Card on the Rising Rising patient card
- Upon clicking the link, a modal will pop up with the patient's name, birthdate, age, gender, and telephone numbers:
- Once a phone number is selected, you can click Save
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An alert will appear at the top right indicating that an SMS was sent and should be logged with the date. The icon will also update to reflect that the SMS was sent
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If no mobile phone numbers are available for the patient, the modal will be greyed out. An alert will be displayed asking you to contact your Organization’s Administrator to update your roster with a practice phone number.
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Rising Risk FAQs
| How often do the patients update on the Triage tab? | Once a Day |
| Will patients drop off after a certain period of time? | Patients will stay on for 30 days on the Triage tab; they will stay on the other tabs indefinitely |
| Can I filter on the Rising Risk tab in the same way I do on the Ping Feed/Patient Roster tabs? | Not at this time. The goal of this product is to help proactively make recommendations of a small subset of your patient roster based on our inputs. |
| Can I send an SMS contact card more than once? | Not at this time. This may become an update in the future! |
| What if none of the options for “Complete” and “Not Necessary” match what happened? | At this time, other can be selected |