USING HEALTH INFORMATION TECHNOLOGY TO IMPROVE CARE

OUTCOMES

HCN BOARD RETREATTONY AMOFAH, MD, MBA, FACP,

CMO, COMMUNITY HEALTH OF SOUTH FLORIDA, INCCMIO, HEALTH CHOICE NETWORK, INC

OUTLINE• The changing health care landscape for CHCs• Traditional patient flow• Time-tested interventions• HIT as a strategy for success– Use of available HIT in our CHCs– Positioning for success with Managed Care, ACO, HRSA

• Inertia– Overcoming inertia

• Take home messages

CHANGES IN EXPECTATIONS OF CHCs

• PAST– CHCs –”only game in town”– Sole Medicaid provider– Focus on patients seen in

our CHCs• Active – 2 visits

– Quantity• # of patients seen• Poverty level• # of A1c done

– Credit for ordering tests– Good old paper– Funding guaranteed

• PRESENT & FUTURE– Competition– Population health

• 1 visit

– Patient engagement in care– Quality + Quantity

• Outcomes

– Health information technology• Initially # with E.H.Rs• Now: E.H.Rs used meaningfully

– Transparency and Accountability

– Pay for performance

THE HEALTH CENTER STRESSORS

FINANCIAL STABILITY

CHC

RISK MANAGEMENT

MANAGED CARE

E.M.R

PROVIDER RECRUITMENT &

RETENTION

SURVIVAL

QUALITY

STAFF TURNOVER

FACILITIES & LOGISTICS

MONITORING AGENCIES

UNFUNDED SERVICES

CORPORATE COMPLIANCE

& AUDITS

GROWTH

PAYROLLANCILLARY SERVICES

PRODUCTIVITY

COMMUNITY ALLIANCES

GRANT FUNDING CODING

UDS

MU

ICD 10

HEDIS PCMH

PAY FOR PERFORMANCE

TRADITIONAL PATIENT FLOW

5

Patient arrives

• Front desk check in• ID verification• Payment collected

Nursing encounter

• Vital signs, BMI, pain scale• Reason for visit• FBS

Provider encounter

• Chronic dis mgmt• Med refills• Labs• Referrals mgmt

Patient discharged

• Apptmt

HEALTH CENTER STRATEGY:WHICH OF THESE INTERVENTIONS?

PCP visit

Specialist Visit

Emergency RoomHosp Visit

Case Management

Capitation Patient Arrangements

DRGs

PCP Gatekeeper

Risk Sharing Arrangements

Pay for PerformanceProvider Report Cards

Telephonic Case Management

Outreach Interventions

Diabetes Education Classes

CoPay Adjustments

Grocery Shopping Sessions

Self Management Support

Pre-visit Planning

Shared Medical Appointments

Health Information Technology Tools

Patient

Bundled Payments

Closed, Limited Panels

Discharge Planning

HEALTH CARE INDUSTRY TIME-TESTED INTERVENTIONS

BEST BANG FOR THE BUCK IN OUR CHCS?

SUPPORT STAFF/CARE TEAM BASED

CARE

PATIENT ENGAGEMENT

STRATEGIES

PRE-VISIT PLANNING

HEALTH INFORMATION TECHNOLOGY

AVAILABLE HIT TOOLS1. E.H.R tools– Forms/Templates – Health reminders– Flow sheets– Pharmacy Benefits Management History (PBM Hx)

2. Patient portal tools– Appointment scheduling– Medical summary– Pre-visit questionnaires

3. Informatics tools: CLEAR dashboard– Quality indicators– Provider report cards– Personalized Care Gap Report

PATIENT PORTAL TOOLSMy Medical Summary

Satisfies Meaningful Use CORE MEASURE 7: Patient Electronic Access

Required fields to display are:• Allergies,• Lab Results,• Plan of Care• Problems,• Procedures,• Social History,• Vital Signs,• Chart Summary• Chart Access

History

PATIENT PORTAL TOOLSRequesting an Appointment

Patient completes all fields in the Request Appointment screen.

Clicks Submit once complete.

Staff reviews message details.

Searches for an open time slot in POMIS.

PROVIDER REPORT CARDS

13

Patient schedules apptmt

Prompted to complete pre-visit

forms

Patient completes pre-visit tests

Arrives for visit

Support staff visit

Provider visit

Patient discharged

Care team reviews planned care visit report and patient’s record for care gaps (Pre-orders tests)

Pre-visit care team phone call

Care team huddle;Review of personalized patient care gap report;Left at front desk for patient

Address care gapsProvide education handouts Commence self mgmt. goal setting

Patient home

Hospital & Specialist visits

Patient homeCare CoordinationPhone Tree Calls

Shared medical visits

CLEAR

CLEAR

HEALTH REMINDERS

PATIENT PORTAL

FORMS & TEMPLATES

Informatics at point of care

CLEAR

HIEPATIENT PORTAL

CLEAR

Appointment request & receipt via portal

Resolve remaining care gapsUnderscore self mgmt. goals

WHAT HAS MADE THESE POSSIBLE?

1. Economies of scale2. Collective brain power3. Collaboration– Across CHCs– With vendors and stakeholders

4. Inherent competitiveness sparked by benchmarking

THE TRADITION OF THE FEUDING GIANTS

Tobacco Cessation Counsel-ing

Childhood Immunization Compliance

HTN - Controlled Blood Pressure

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Community Health of S. Florida

Citrus Health Network

Q-TECH: COMPLIANCE WITH SELECTED UDS MEASURES

POSITIONING FOR SUCCESS

1. Answers to questions– Who are our patients?– Which are at highest risk?– What are their care gaps– What is our current performance?

2. Value in facilitating management of patients in their “white space”

3. Enhanced efficiency of patient visits

REASONS FOR “TECH INERTIA”

1. Insufficient staff2. Too many patients3. Limited patient access to the internet4. Reports inaccurate5. Wrong phone #s6. Competing priorities7. Funding

TAKE HOME MESSAGES

1. “>50% of payments in a few years will be value based”

2. Health Information Technology Tools will be increasingly critical for success– Population health analytics, care coordination

and patient engagement solutions

3. No barriers should prevent HIT utilization maximization

4. Its all about results!

THANK YOU

TONY AMOFAHE mail: samofah@hcnetwork.org