Case Study: La Maestra Community Health Centers identifies 453 at‑risk patients and cuts missed opportunities with i2i Population Health (i2iTracks)

i2iTracks Population Health Management Platform is Helping LMCHC Shift from Missed Opportunities to Proactive Care Managemen

La Maestra Community Health Centers (LMCHC), a San Diego-based nonprofit serving more than 65,000 low-income and immigrant patients since 1990, needed a scalable way to identify patients at risk for cardiovascular disease as part of its Million Hearts® efforts. Conventional EHR reporting left gaps and missed prevention opportunities that the care team wanted to close.

By implementing the i2iTracks Population Health Management Platform, LMCHC instantly identified 453 patients due for hypertension screening; proactive outreach found 26.2% were hypertensive and the clinic reduced missed opportunities from 67% to 59% within months—an improvement the team says has translated into lives saved and more efficient, data-driven care.

La Maestra Community Health Centers

Sonia Tucker

Quality Improvement Director