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Artificial Intelligence at Work: Cone Health Reduces Mortality Ratio for Improved Patient Outcomes

Key takeaways:

  • Cone Health partnered with Premier’s Advisory Services team to develop a strategy to improve O/E mortality outcomes representative of its patient population.
  • The health system redesigned processes and leveraged the PINC AI™ CareScience Risk Calculator technology to identify opportunities for improvement.
  • As a result, Cone Health improved clinical documentation specificity and coding accuracy – resulting in improved O/E mortality outcomes reporting.

For many healthcare organizations, the ongoing goal of improving patient outcomes and accurately capturing the severity of the patient populations they treat requires the strategic application of actionable data.

Against this backdrop, coding accuracy and documentation forms the cornerstone of calculating a meaningful mortality observed-to-expected (O/E) ratio, a critical metric in assessing the effectiveness of healthcare initiatives.

Unlock the Power of Data with Artificial Intelligence

Without precise and reliable data, healthcare organizations risk misinterpreting their performance and missing out on valuable insights that can drive meaningful transformation.

What’s more? Artificial intelligence (AI) is playing a pivotal role in unlocking the power of data to enhance outcomes reporting in healthcare. Analyzing a wealth of patient data, AI can rapidly identify correlations, trends and risk factors that contribute to mortality outcomes.

Cone Health, a not-for-profit health system serving North Carolina, recognized this vital connection and embarked on a mission to harness the potential of its data and analytics. “Our primary objective was around reducing the mortality ratio. We are always striving to be a top decile health system and do the right thing for our patients,” said Emily Paula, Director of Quality Informatics at Cone Health.

The health system turned to Premier’s Advisory Services team for support in developing a strategic plan to more accurately report its mortality O/E.

Early on in its journey, Cone Health encountered a prevalent healthcare industry hurdle: the lack of robust mortality data and technology that provides insights into risk adjustment variables impacting outcomes. Plus, the implementation of a collaborative clinical documentation improvement (CDI), coding and quality department process was hindering its ability to accurately capture the appropriate mortality O/E.

To bolster its progress, Cone Health needed a concurrent/pre-bill solution that could accurately and efficiently analyze mortality O/E across all facilities, with the aim to pinpoint improvement opportunities. The health system utilized PINC AI™, Premier’s technology and services platform, to implement new processes and operations for accessing and analyzing actionable, high-quality mortality data.

Risk Adjustment is Key

Cone Health harnessed the power of the PINC AI™ CareScience Risk Calculator technology, with its AI-enabled capabilities, to delve deep into their data and identify clinical factors that play a key role in each patient's risk adjustment.

Risk adjustment is vital for factoring in the severity of patients' conditions and determining the coding and documentation that most accurately reflects the severity of patients. This method serves as the foundation of Cone Health's strategic approach to mortality improvement and collaborating between the physicians, CDI, coding and quality department personnel for a comprehensive approach to managing quality outcomes.

With the PINC AI™ CareScience Risk Calculator, Cone Health gained the ability to more easily scrutinize data and pinpoint specific clinical variables that influenced risk adjustment on a per-patient, concurrent and real-time basis.

“We use Risk Calculator to input patient data each month, encompassing our mortality cases. Then, we check what the expected mortality was and learned how to adjust for risk,” said Jessica Thomas, a Quality Nurse at Cone Health. “It’s about helping our physicians provide more comprehensive documentation, guiding our coders in identifying relevant codes and collaborating with our CDI team. The solution and data are enabling our teams to ask the right questions for better risk adjustment. We’ve really learned a lot about what affects expected mortality with the Risk Calculator tool.”

Moreover, with the PINC AI™ CareScience Risk Calculator, Cone Health had the ability to compare clinical groups, assess internal performance, benchmark against external standards and identify areas for improvement.

“With this new process, we took time to connect with our physicians and explain why we were making changes – they needed to be closely involved, understand the rationale backed by comprehensive, accurate and actionable data. We also tapped into the expertise of our skilled coders, forging strong relationships to harness their coding knowledge, and similarly; we fostered connections with our CDI team. It’s not something that happens overnight for anyone; it requires breaking down silos, collaborative efforts, trust in the data, and a mutual effort to better understand and leverage each other’s roles and skillsets,” said Laurie Freeman, a Quality Nurse at Cone Health.

Cone Health was also able to utilize the PINC AI™ CareScience Risk Calculator tool to enhance electronic medical record (EMR) findings and help educate clinicians and coders about the impact clinical documentation has on quality outcomes.

“We emphasized to our clinicians the vital need to thoroughly document all aspects of a patient's condition. While they may have a clear mental picture of the patient and their situation, it’s important to translate that into detailed documentation within the medial records,” said Thomas.


Cone Health’s engagement with Premier led to a comprehensive review, standardization and enhancement of the accuracy of coding and clinical documentation specificity, marking a significant step forward in the health system’s pursuit of improved quality outcomes.

Through Advisory Services support and AI-enabled technology, Cone Health successfully transformed intricate mortality data into practical, comprehensive insights for both clinical and coding teams. These insights are valuable for continuous improvement, and ultimately raising the standard of patient care.

Additionally, the health system improved its clinical documentation and mortality O/E ratio – and as a result – ascended to the top decile in terms of mortality outcomes.

“Let me give an example: one of our facilities is now at a .93, surpassing their stretch goal. This accomplishment stemmed from ongoing collaboration and building trust in the process,” said Paula. “We remained committed to using the Risk Calculator, reviewing charts, refining documentation specificity and correcting coding. The remarkable outcomes highlight our dedication to patient well-being and survival, and they fuel our motivation to continually elevate our standards.”

Cone Health’s accomplishments demonstrate the power of using AI to leverage data quickly and effectively – and implement standardized practices across all facilities to achieve high-quality patient care. By extracting actionable insights from a vast pool of healthcare data, AI is transforming mortality outcomes reporting into a dynamic and proactive process that can help save lives.

“We’ve got this never-ending curiosity that keeps us looking for improvements. Partnering with Premier and using tools like the Risk Calculator ensures that the narrative we portray about our patients through documentation truly reflects the great care we deliver,” said Freeman.

Learn more about mortality improvement with PINC AI™.

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