It was great to read the excellent interview that HCI Managing Editor Rajiv Leventhal conducted with Beth Wrobel at HIMSS16 and published yesterday.
Wrobel, the CEO of HealthLinc, Inc., a federally qualified health center (FQHC) in Valparaiso, Indiana, met with Leventhal while both were participating in the annual HIMSS Conference, held in Las Vegas earlier this month. In the interview, Wrobel shared with Leventhal some of the challenges and opportunities facing her organization in northwest Indiana.
As she noted of her organization, which has existed in some form for over 20 years, “We grew to a FQHC in 2006 and that was our springboard. We started as a safety net provider, and now we have medical, dental, behavioral health, optometry and an onsite pharmacy. So it’s become pretty immense,” she said, “and we treat the patient at the center; we are a Patient-Centered Medical Home.” And what does putting the patient at the center mean?
“So,” Wrobel said, “we make sure that we never start with “the patient will do this.” Instead, we work with them to find out what they need to do and find those resources for them. If they need transportation, we work with them; if we have a diabetic and their hemoglobin a1c is out of control, we work on behavior changes, and we find a pharmacist who can work with them on their medications. So that’s different, and I think we are the way healthcare is going to be delivered if we [want to] change these out-of-control costs and achieve the Triple Aim.”
I have to say, I found that to be a very important statement, particularly in light of Wrobel’s additional explication of how she and her colleagues are proactively doing health risk assessment on their patient population and working with rising-risk patients to head further health issues off at the pass. As she noted, “[W]e can do Venn diagrams, and right now we concentrate on the people in the center, but now we want to look closer at the people who may have diabetes, but maybe they don’t have hypertension or depression yet, and try to work with them. The next step for us, and we have been working with Forward Health Group on this, is that we don’t get claims data today. Once we can get that—and we are also working on a project on social determinants— and start putting it all together in that system we will be able to say, ‘Oh my gosh, look at these high utilizers, they are the ones who said they have no transportation,’ so maybe we develop a system to help them. Once you get the data, you can do root cause analysis, which is something I like and know from my engineering training.”
And there you have it. This is exactly the kind of work that leaders at patient care organizations of all types need to be doing; and Beth Wrobel and her colleagues are already moving forward into it at HealthLinc in Valparaiso. They’re not yet “there,” of course. They’re only planning on the time when they will have access to claims data that they can marry to clinical data from their electronic health record (EHR), for example.
But this leveraging of data to build population health risk assessment processes and to fuel proactive care management, is incredibly important. And it’s not surprising that it’s taking place at progressive FQHCs like HealthLinc, whose leaders and clinicians are deep in the trenches of caring for vulnerable populations. Of course, it is inherently in the interests of the leaders of FQHCs to do everything possible to proactively care for the health of the populations they serve, given the extremely limited financial resources they have at their disposal. On the other hand, isn’t that entirely the point, anyway?
The reality is that U.S. healthcare is moving into a new phase, as it shifts from the old fee-for-service and discounted fee-for-service reimbursement systems and into more of a value-based set of payment systems. And the leaders of all types of patient care organizations will be under pressure as never before to move forward proactively to take care of high-risk and rising-risk patient populations. That will especially be true as the U.S. healthcare system moves ever closer to global capitation.
And the very fact of the leaders of FQHCs having become skilled at working with meager resources to care for their populations, will mean that they will be more practiced in leveraging scarce resources to effect major changes in care delivery and care management, compared with their counterparts in more richly resourced patient care organizations.
In addition, as a whole, FQHCs have proven skilled at quickly and efficiently implementing EHRs and other clinical information systems and applying them to the most pragmatic uses possible, again, because they have not had the luxury of delay in their implementation.
And finally, the vulnerable populations that FQHCs have been caring for, for decades, are some of the populations with the most challenges around the social determinants of health: they include homeless and near-homeless patients, and by definition, a majority of poor or near-poor patients. So connected-health resources must really work at a practical level, if they are to help those patients, because they largely lack the personal resources to engage in the kinds of personal workarounds that more middle-class patients might be able to engage in. In other words, the smartphone that the care manager at an FQHC provides to a disadvantaged patient in order to enhance patient engagement and care management, has got to work in the context of that patient’s day-to-day life, because that patient likely will not be able to afford to provide her or his own alternative to it.