Case Studies: High Risk Patient Outreach

Published: September 24, 2020
Countries: United States
Language: English
Types: Population Health
Settings: Health Plan

Marathon Health is a leading provider of onsite and nearsite employer health centers. By leveraging the Johns Hopkins ACG System, Marathon Health was able to offer outreach and options to individuals identified as a higher risk of contracting or experiencing complications as a result of COVID-19.

Marathon Health was able to create their own customized algorithm using ACG System risk markers including age, gender, chronic conditions, probability of hospitalization, and predicted costs.

This case study outlines how Marathon Health utilized the ACG System to identify high-risk patients, the interventions utilized to reach these patients and the outcomes of this initiative.


Health plans have experienced an unprecedented need to identify patients most at-risk and vulnerable to complications from COVID-19, take action to manage underlying chronic disease during the outbreak, and assist with social and medical needs. Johns Hopkins HealthCare (JHHC), the managed care division of Johns Hopkins Medicine, developed a rapid outreach initiative to support their 25,000 Medicare Advantage (MA) plan members at a time of crisis.

Using the Johns Hopkins ACG System, JHHC quantified the number of MA patients with a combination of age and underlying comorbidities and deployed outreach efforts to contact these patients.

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