Alliance for Health Reform Briefing:

1
Community Health Centers and HIT Driving
Innovation in the Patient-Centered Medical Home
Alliance for Health Reform Briefing Medicaid
and Health IT
Presented by Judith Featherstone MD,
FAAFP Medical Director HealthPoint August 1, 2011
2
Health Centers Today

• Today, Health Centers serve as the health care
  home for more than 20 million patients
  nationally, including
• 1 in 7 Medicaid beneficiaries
• 1 in 7 uninsured persons
• 1 in 3 individuals in poverty
• 1 in 7 rural Americans

Includes patients of federally-funded health
centers, non-federally funded health centers or
Look-Alikes
3
HealthPoint Your Community Health Center

• HealthPoint is the largest CHC in the 14th
  largest county in the US.
• 12 Clinics 7 medical, 4 dental, 1 school-based
• Patients 62,542, Visits 210,865
• Medicaid, Medicare and Public Insurance- 55
• Uninsured 37
• In addition to primary medical and dental care,
  services include
• Prenatal care and delivery
• Complementary and alternative medicine including
  naturopathic medicine, acupuncture and nutrition
  counseling
• Behavioral health
• Pharmacies in all clinics

4
HealthPoint Patients
Patient race/ethnicity
Patient income by Federal Poverty Level
Patient by insurance
5
Health Centers and HIT National Perspective

• Nationally, three quarters of all health centers
  are now on the road to adopting integrated health
  information technology systems.

6
HealthPoint Perspective

• 2005 Electronic Health Record/ Practice
  Management Adoption
• 2007 Quality of Care Outcomes Reports
• 2007 Immunization Data Interface with the State
  Registry
• 2008 Population Recall Reports
• 2008-11 Templates for Behavioral Health, MSS,
  Homeless care
• 2008 Electronic Prescribing
• 2010 Internal Pharmacy System Integrates with
  EHR,
• 2010 Electronic Dental Record Integrates with
  EHR,
• 2011 Billing from EHR
• 2011 Future Patient Portal, HIE, Enhanced
  Reporting and Decision Support

7
Challenges to Adopting Health IT

• Equipment
• Staff training
• Provider use
• Reassignment of Medicaid HIT Incentive Payments

8
Opportunities for Health IT Support

• Medicaid HIT Incentive Payments
• Health Center Controlled Networks
• Primary Care Associations
• Regional Extension Centers

9
Health Centers and HIT National Perspective

• Health centers use Health IT in varied ways to
  meet the needs of their patients, for example
• Telehealth patients, including those in rural or
  remote areas, can see a provider for
  screenings, behavioral health encounters, remote
  eye exams, and chronic disease management.
• Referral Tracking the record, patient history,
  medication and Rx plan follows the patient across
  health center sites and other health care
  providers.
• Personal Chronic Care Management electronic
  records notify providers and patients when its
  time for a check up or check in.

10
Innovations at HealthPoint

• EHR
• Specialist guidelines for referrals built into
  EHR.
• Coordination of EDR and EHR
• Tracking referral completion
• Managing for quality of care outcomes
• Reports on health disparities to target community
  approaches.

• Other
• Video interpretation
• Mobile phones for health reminders
• Website with links to mobile applications for
  healthy living.
• Telepharmacies

11
Health IT Improving the PCMH

• Patient Experience
• Time of visit activities
• Invite in for individual visit or group with
  cohort.
• Coordinate with specialists, ER and hospital,
  decrease redundant work.
• Decision support built in for referral
  appropriateness, referral preparation, evidence
  based testing.

• Population Care
• Outreach to patients due for health maintenance
  services
• Outreach to patients with chronic diseases which
  are uncontrolled or due for monitoring.
• Reports can guide us in setting up appropriate
  systems such as community health workers for new
  immigrant populations.
• Develop interventions targeting obesity based on
  our reports including language and ethnicity.

12
Health IT Improving the PCMH

• Patient-Centered Medical Home
• Six standards align with the core components of
  primary care
• 1)Enhance Access and Continuity
• 2)Identify and Manage Patient Populations
• 3)Plan and Manage Care
• 4)Provide Self-Carte Support and Community
  Resources
• 5)Track and Coordinate Care
• 6)Measure and Improve Performance
• Health IT is vital to meet these standards.