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Healthcare Informatics Innovator Awards: First Place Winning Team: Yakima Valley Farm Workers Clinic

March 19, 2015
by Mark Hagland
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Can a physician organization that serves an underprivileged population make it in a managed care-driven environment? The Folks at Yakima Valley prove it can be done

About 150 miles away from the glamour and hip chic of Seattle, the Yakima Valley lies in the heart of Washington state’s agricultural and viticultural heartland, with apple, peach, and cherry orchards, bell pepper and corn fields, and vineyards, stretching as far as the eye can see. It is a very blue-collar region, and the Yakima Valley community includes many migrant workers, some of them undocumented, and many uninsured or underinsured.

Caring for about 130,000 area residents annually, the Yakima Valley Farm Workers Clinic (YVFWC) embraces its community, while its senior executives, led by CEO Carlos Olivares, have been working furiously to optimally serve their community in ways that acknowledge the perpetually straitened healthcare budgets involved. Indeed, they recognize that there will never be an abundance of resources available to serve the Yakima Valley patient population, 90 percent of whom fall below the poverty level.

That’s why Olivares and his colleagues at the Toppenish-based YVFWC, which encompasses 26 outpatient care sites, 1,400 staff, and 95 physicians and allied health professionals (52 physicians and 43 nurse practitioners and physician assistants; in addition, about 100 behavioral therapists are on staff), have had to create invention out of necessity, in order to optimally care for their hardworking, underprivileged population.

The key to enabling Olivares and his colleagues to optimally serve this community, after 35 years of effort? In a word, data, says Olivares. “Typically,” he says, large organizations look at their future, and begin to analyze data they already have, and then they say, ‘What do we want to do five years from now?’ That level of strategy is much more difficult to successfully pursue in small organizations that don’t have the data systems the larger ones have.” What’s more, he says, “We cannot continue to ask our providers to work harder, see more patients, document more, and improve patient care. We need to tap into our data to help them make the right patient care decisions, faster, and with greater accuracy.”

As a result, Olivares and his colleagues have invested heavily in IT, building a robust data warehouse that encompasses data from more than 10 sources; developed a comprehensive set of clinical reporting tools that integrates directly into the clinical workflow of the organization and provides physicians and other clinicians with dashboard-based indicators for chronic care management; and have outsourced data analytics management to a vendor partner (the Burlington, Mass.-based Arcadia Healthcare Solutions), resulting in the freeing-up of time and intellectual energy on the part of senior YVFWC leaders to focus on IT and data strategy instead of core system maintenance.

Carlos Olivares

The results of the appropriate infusion of data into care delivery processes have been diverse—and beneficial to the organization both clinically and financially. For example, providing the organization’s physicians with real-time data-driven dashboards has helped those doctors to successfully achieve clinical outcomes goals across a wide variety of measures around diabetes, asthma, and prenatal care, and around the avoidance of ED visits and hospital admissions. And as a result, Olivares reports, “By achieving all the measures on the risk-based contracts we have, we received $1.6 million in differential payments last year.” What’s more, he notes, “It took us 18 months to get Level 3 recognition from NCQA [the National Committee for Quality Assurance]; we were accredited early last year. By achieving the Level 3 NCQA recognition, we generated $3.50 PMPM [per member per month], which translated into $3 million in incentive payments from our payers,” who include Medicaid managed care and some commercial health plans.

Data-driven care delivery has not only been profitable for the organization; it has also positively changed the way in which physicians work, reports Ross Ronish, M.D., YVFWC’s chief medical officer. “Physicians are trained to be pattern recognizers, and there are some strengths to that, but one of the weaknesses of it is that what is in your mind as a provider is what you’ve last seen,” he says.  “So if you ask physicians how they’re doing with their patients in general, they’ll look at their most recent patients, and will be wildly wrong. So using IT to provide a current picture for physicians will help tremendously.”

Russ Ronish, M.D.

Dashboards are essential to helping physicians to dramatically improve their clinical outcomes and efficiency in a resource-straitened environment, Ronish says. What’s more, their use helps all clinicians to work at the top of their license, he adds. “For example, we use behavioral health consultants, or BHCs, who work within our medical clinics, and who help providers to identify when psychosocial conditions are affecting patients and their outcomes, and  helping to address things when, say a PCP is tempted to call a patient non-compliant,” he says. BHCs actively analyze the patient record for narcotic use patterns, and benefit from being able to draw from medical, behavioral, and other data, drawn into the same systems. In one recent case, he notes, a BHC was able to clarify that middle-aged male patient was not non-compliant in taking his medications, but rather, suffering from a personality disorder, the clear identification of which necessitated a new medication management strategy. Having dashboards in place to analyze the use of narcotics for chronic pain makes such interventions possible, he emphasizes.