This article appears in the February 2012 issue of HealthLeaders magazine.
Millions of dollars continue to flow from Washington, DC, to communities across the country in the form of grants to so-called Beacon Communities, intended to serve as pilots and role models for how health information technology can be used to improve quality and care coordination. The federal government announced recently the award of $220 million to another 15 communities, and earlier recipients are reporting that the money can make a difference.
The Beacon grants can provide the necessary capital for improvements that many healthcare providers have on their wish list, the recipients say, but the money doesn't necessarily make the job easy.
Hawaii received a $16.1 million Beacon grant in May 2010 and used it to form the Hawaii Island Beacon Community with the goal of improving the health of the Hawaii island residents through implementation of healthcare system improvements and interventions across independent hospitals, physicians, and physician groups and in partnership with public and private health insurers. Engaging patients in their own healthcare is also a primary focus, says Susan B. Hunt, MHA, Beacon grant project director and CEO of HIBC.
Hunt says healthcare access is a significant challenge for the people of Hawaii County, also known as the Big Island. This population is served by 395 physicians, which is approximately 33% fewer physicians than is estimated to adequately serve the population. This shortage affects nearly all specialties, and patients experience long waits for an appointment to see a healthcare professional, particularly in primary care and specialty care.
Native Hawaiians between the ages of 19 to 35 are more than five times as likely as non-Hawaiians to be diagnosed with diabetes. Between ages 36 and 64, native Hawaiians have a rate of diabetes that is more than twice that of others.
The HIBC program involves a consortium of organizations and agencies including Hawaii County, the University of Hawaii at Hilo College of Pharmacy, health plans, associations, hospitals, clinics, physicians, and community groups—with CEOs and other top leaders from those organizations actively participating. The HIBC is also working with the Hawaii Health Information Exchange, which includes a regional extension center that will provide technical assistance in achieving meaningful use and qualifying for Medicare or Medicaid incentives, and coordinate efforts among vendors, electronic health record resellers, and consultants.
About 35% of the funds are being spent on helping providers improve the care coordination of patients with chronic disease, 22% is used for health information exchange to achieve a better assessment of the patient and reduce the repeating of information, and 9% for community wellness. For the community wellness component, HIBC has requested applications for mini-grants called HEAL, for Healthy Eating and Active Living, that focus on changing behaviors involving nutrition, physical activity, and tobacco use prevention.
"We've had a tremendous level of interest in the mini-grants," Hunt says. "It's exciting to see that level of interest in making the community healthier."
Another 8% of the funds go to subject matter experts in health IT and other pertinent fields, 16% is used for infrastructure at the University of Hawaii College of Pharmacy, and the other 10% goes to the Beacon operations such as staff, utilities, and travel.
The Hawaii consortium is finding that the community's relatively small size is an asset, allowing the consortium to build momentum more quickly than might be possible for larger communities, Hunt says.
"We have 195 primary care physicians that are moving toward meaningful use, and 76% of our physicians have EHRs in their practices," Hunt says. "That's a pretty good number for a small rural area."
One physician has attested to stage 1 meaningful use and several more are close, Hunt says. HIBC also is aiding physicians with creating a medical home approach, using care coordinators to help physicians set a new standard for tracking patient progress and facilitating improvements around the healthcare system, Hunt explains.
"Care transition is a very important piece of this," she says. "The strategy is to try to standardize the discharge process so that no matter what hospital you go to on the island, you can expect the same kind of approach to discharge planning, education, medication reconciliation, and patient engagement."
Success will be measured with a number of metrics, Hunt says, including three clinical metrics for diabetic and cardiovascular disease patients—A1C levels, blood pressure, and lipid levels. Other metrics include preventable readmissions within 30 days and reductions in ambulatory-sensitive emergency department visits. The Hawaii consortium is just getting under way with measuring those improvements.
HIBC has learned already that having a major health insurer on your side can be a great benefit when coordinating Beacon efforts. Hawaii Medical Services Association is part of the consortium, and Hunt says a key contribution from the insurer is helping providers link Beacon-initiated improvements in patient care and coordination to performance improvement payments from third-party payers.
"As we get better at achieving our goals, those payments continue to come and the incentive to participate in the change process continues to grow," Hunt says.
The Beacon grants also are beginning to yield good results in Rhode Island, says Gary Christensen, COO and CIO for the Rhode Island Quality Institute, which involves 28 primary care practices, 220 providers, and approximately 275,000 patients.
Care transitions are a major focus for RIQI, which received a $15.9 million grant from Beacon in May 2010. With a multidisciplinary board similar to the Beacon program in Hawaii, RIQI is using Beacon funds to focus on four objectives:
- Enhance the quality of care provided to patients with diabetes by encouraging adherence to nationally recognized, evidence-based guidelines and the patient-centered medical home model.
- Reduce preventable hospital and ED use.
- Reduce the impact of tobacco use on the health of the state's population.
- Reduce the impact of undiagnosed, untreated depression through increased screening.
The state, with RIQI's leadership, has implemented an HIE system called currentcare, which provides a secure electronic network enabling providers to access and share patients' health information and collaborate more effectively. Beacon funds were used to enhance the HIE and make it more beneficial to physicians, Christensen says.
"A lot of times doctors don't even know their patients went to the hospital or the emergency department, and that's one reason Rhode Island ranks 47th in the nation for 30-day readmits—in a bad way," Christensen says. "We know that if there is follow-up after discharge, you can reduce the likelihood of readmit, so our HIE is linked to hospitals in the state and we get a feed of their admit/discharge/transfer info regularly."
The HIE monitors that feed and, for patients participating in currentcare, generates a message to the doctor with a continuity of care document to update him or her on the patient's visit. The HIE then initiates the follow-up care workflow, with no effort expended by the hospital, Christensen says.
All of that happens through a secure Internet application that allows providers to share protected health information, he says, and RIQI encourages physicians to use that platform for sharing data from the patient's EMR every time they make a referral to a specialist or otherwise communicate about an individual's care.
Beacon funding also was used in Rhode Island to build an infrastructure that collects performance data from practices, then feeds that information back to providers to apprise them of their progress in meeting RIQI's quality goals—individually, and relative to how their colleagues are doing.
"The metrics we needed to be able to measure for reporting purposes turned out to be one of our important interventions," Christensen says. "Doctors are a competitive bunch, and shining a light on actual performance has generated a lot of interest in improving the numbers and getting better in the rankings."
The Beacon projects from RIQI are helping Thundermist Health Center, headquartered in Woonsocket, RI, to "refine and further develop tools and concepts that are key to the success of that model," says Chuck Jones, president and CEO of the private, nonprofit community health center. "The level of integration and information sharing with healthcare partners would be very difficult without it," he says. In addition to benefitting from RIQI's Beacon funding, Thundermist, a level 3 patient-centered medical home, also received a $100,000 grant from Beacon to support its side of the IT structure that facilitates more communication among providers.
"The Beacon project has supported Thundermist's efforts to implement expanded access to primary care through limited-scope, on-demand visits," Jones says. "In addition, the project has helped to address emergency room and urgent care utilization through patient education, improved sharing of real-time hospital data, and connecting of patients to Thundermist's patient-centered medical homes."
This article appears in the February 2012 issue of HealthLeaders magazine.