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."
I asked Wrobel if she bristles at being called part of the safety net.
"When we started, we were a free clinic," she says.
"When I started there, 14 years ago, we were about 90% uninsured. Once we became an FQHC two years about, we were about 42% uninsured. Between the Affordable Care Act and now the Healthy Indiana plan, we dropped to about 18% uninsured by the end of last year."
The number continued to drop in January, to 14%.
HealthLinc also has a grown base of commercially insured patients. In fact, HealthLinc now deals with 100 separate payer plans, some of which might only have a handful of enrolled patients.
Multiply those delays in quality feedback from payers by 100 and you have the need for a FQHC such as HealthLinc to manage its own population health – to understand what is working and what is not.
And yet, many safety net organizations are just waking up to their own potential. Even organizations such as the National Association of Community Health Centers, where Wrobel is active, are just now promoting the virtues of population health to its membership.
As far as ROI, even before the results of the HRSA grant work are in, Wrobel believes the organization is close to break even, even as the full fruits of the work with PopulationManager have yet to be seen.
"HRSA gives us a quality bonus every year, and then the payers do," she says. "Last year, ours increased [to] about $170,000. Our costs last year were $162,000 for the people and the systems. And some of this I would have had to have anyway."
In future years, as HealthLinc can negotiate shared savings with its payers, it can start making much more money than the mere $45 or so it currently receives for a typical office visit, Wrobel says. "We're probably six months away from being able to show that," she says.
The last element that will boost population health performance: Incentives for every patient-facing employee which make sure that some of the tools now in place actually get used by staff. "We incentivized every employee, from the front desk person making $12 an hour up to my docs, based on a lot of indicators," Wrobel says.
"About 30% of the bonus is based on quality outcomes, and it was based on each site. Because we got more money and we got patients in and things like that, the average employee got a 4% bonus last year."
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Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.