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How an FQHC Uses Technology to Accelerate a Population Health Initiative

   May 24, 2016

A new breed of population health solutions enabled an eight-clinic network in Indiana to implement a quality improvement program and determine how to reach at-risk patients sooner.

At first glance, the terms "population health" and "Federally Qualified Health Center" do not seem to go together. FQHCs are still considered part of healthcare's safety net, while population health is still not a widespread phenomenon, even at better-capitalized healthcare institutions.

And yet, here and there, population health, and the technology enabling it, have arrived in the safety net. One such arrival occurred at HealthLinc, an eight-clinic network in northwestern Indiana.

Last year, HealthLinc served 28,000 patients who logged 107,000 visits across medical, dental, behavioral health and optometric services. An early adopter of EHRs since 2008, last year HealthLinc received more than $83,000 in U.S. Health Resources and Services Administration (HRSA) grant awards.

That money funded a study of HealthLinc's 11,000 Medicaid patients to see which patients were struggling most with diabetes, hypertension and related chronic diseases. The next challenge was to determine how to reach these patients better, and implement screenings sooner. Employee incentives end up playing a role there.

The Greenway EHR HealthLinc used wasn't going to be enough technology to do the job.

The organization turned to one of a new breed of population health solutions, this one from Forward Health Group, whose PopulationManager garnered one of KLAS's early awards in the population health category.

In addition, HealthLinc is using The Guideline Advantage, a quality improvement program developed in 2011 by The American Cancer Society, American Diabetes Association, and the American Heart Association.

This program also meshed nicely with HealthLinc's patient-centered medical home efforts.

As it turns out, the CEO of HealthLinc has a background in mechanical engineering. "Now I'm reengineering healthcare," quips Beth Wrobel. PopulationManager provides a tech assist to get the population health data to her team of nurses, medical assistants, and other health coaches, she says.

As HealthLinc expands its population health efforts, it is focusing initially on those with multiple chronic conditions, but gradually expanding to those with fewer such conditions, and even drilling into social determinants of health, such as lack of transportation, or the presence of food deserts around the patient's own home.

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"What we're planning to do is take that to the payers, and show them we're a better deal, and maybe you need to support me with a community worker," Wrobel says. "You can't solve a problem until you know it. Until you can start to see those numbers. We are just now picking which of our payers we want to go after."

It's not that doctors and nurses are entirely on their own with the aforementioned technology at HealthLinc. "We have a quality director who is a doctor who has her Master's of Public Health," Wrobel says. "I've hired an engineer to do the data analysis."

An indicator of the importance of health coaches comes out of HealthLinc's behavioral health clinic, where some of best population health outcomes are actually happening early on. "They have peer counselors," Wrobel says.

"If we say that Sam needs to get his labs, and he needs to walk 30 minutes three times a week, they make sure Sam does that."

In Indiana, almost all Medicaid patients are in managed care programs. "We've got a lot of Medicaid," Wrobel says. But she highlighted a disconnect between certain unnamed Medicaid payers, whom she declined to name, and the quality objectives HealthLinc aspires to meet.

"I would get a check, and here's your quality bonus. I go, what was that for? And they go, we'll give [quality feedback] to you in about six months."

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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