New Orleans is a city with history painted in all shades, from the glamorous and the decadent to the tragic. It also has a population beset by widespread poverty and poor health status; and both of those challenges were intensified by the devastation wrought by Hurricane Katrina in 2005.
One organization that had for years been working to improve the health of New Orleanians is the Louisiana Public Health Institute, a not-for-profit public health institute established in 1997, whose mission is “to promote and improve health and quality of life in Louisiana through diverse public-private partnerships with government, foundations, community groups, academia and private businesses at the community, parish and state levels.” That mission has only become more pressing and important in the post-Katrina environment.
Not surprisingly, the LPHI’s leaders leapt at the chance to participate in the federal Beacon Communities program; and under the leadership of Anjum Khurshid, M.D., director of the LPHI’s Health Systems Division, and Maria Ludwick, an associate director in the Health Systems Division, LPHI applied for beacon community status, and was awarded with a federal grant, under the aegis of the Crescent City Beacon Community (CCBC) initiative. There are a lot of elements to what Khurshid and Ludwick and their colleagues are doing both at CCBC and at LPHI, its animating organization; but the bottom line is a massive effort to improve the health status of the entire New Orleans metropolitan area, through what is essentially an initiative to create a metro area-wide patient centered medical home (PCMH) model.
Armed with Beacon community status, which was granted to the CCBC in April 2010 (CCBC is one of the 17 Beacon communities nationwide), and with initial funding of $13.5 million over three years (ending this April), Khurshid, Ludwick, and their colleagues moved forward with a very purposeful mission. “We identified two areas that we wanted to work on” as a Beacon community, Khurshid reports. “First, we wanted to demonstrate the capability of quality improvement at the community level; and we also wanted to make long-term investments in the healthcare system, because we knew that three years wasn’t enough to do everything—but it was enough to set up a foundation that would create a patient-centered, accountable, community-wide focus for care, irrespective of whoever the payer is.” Indeed, Khurshid says, “That’s the issue for a lot of communities; we’re spending a lot of money on healthcare, but we don’t necessarily think of the population as a whole, and we don’t think of healthcare as a common good that is shared by everyone. So the Beacon funding helped us to do that.”
One particular area of intense focus is improving communications between and among clinicians and administrators in all the settings of care in the community, from physician offices and clinics to emergency departments to inpatient hospitals. Khurshid and Ludwick note that such communications have historically been fraught with gaps and problems. But the CCBC initiative is funding the deployment of care managers, who are working with the 160 physicians staffing 20 federally qualified health centers (FQHCs) in the metro area. And those care managers are making use of two critical IT elements to improve communications: a community-wide health information exchange (HIE) sponsored by the LPHI/CCBC, and the deployment of electronic health records (EHRs) by physicians at all 20 FQHCs, which are currently serving a population of more than 250,000 local residents, many of whom are Medicaid recipients or are uninsured.
“Previously,” Khurshid says, “if a patient was visiting a primary care physician [PCP] in a community clinic—and we’ve made sure the primary care clinics are the focus of our activity here in New Orleans—usually, when that patient had seen any other physician for specialty care or ED visits, there actually was no mechanism for informing the PCP of hospitalization or ED visits or specialty care visits.” Now, the community-wide HIE is ensuring that clinicians receive that information.
“In addition,” Ludwick reports, “we’re working on the processes within the clinic on how to manage that communication, and how they work that into the care plan with the patients. So it’s more than just the exchange of the information; we work with the care managers on care management.”
Within that context, the leaders of the CCBC have regularly gathered stakeholder group leaders together to further enhance such processes. For example, Khurshid reports, “We have the community partners, who come together as a workgroup, and who discuss the protocols they follow in their clinics; some of the protocols are obviously evidence-based.” What’s more, he adds, “We can use clinical decision support systems to help us ensure that these guidelines are followed, since we can track processes to make sure we’re following the guidelines. And that’s where EHRs can be supportive.”
PHYSICIAN COLLABORATION, EHRs: FOUNDATIONAL
Of course, none of this would be possible without the intensive participation of physicians, including physician leaders in the community like Eboni Price-Haywood, M.D., M.P.H., the co-executive director, CMO, and CIO of Tulane Community Health Centers (TCHC), the constellation of federally qualified health centers that is the core physician organization collaborating with the LPHI/CCBC on its community-wide patient-centered care initiative. Price-Haywood and her fellow physicians and clinic leaders have been working with LPHI since 2007, beginning with the winning of a primary care access stabilization grant in the wake of Hurricane Katrina; and Price-Haywood in particular has been at the forefront in leading her physician colleagues to implement EHRs in order to participate in community-wide care and transitions management.
"In terms of moving forward towards population health management, one of the initial ideas was HIE optimization, and implementing the medical home; and obviously, all those things are connected, including to meaningful use,” Price-Haywood notes. “So we came up with a sub-project initially to look at NCQA’s [the National Committee on Quality Assurance] 2011 standards, and basically creating a crosswalk between those standards and the software’s capabilities. You need to determine what your workflow will be in that system, and if the system has deficiencies, you need to change those.” Price-Haywood has helped lead her colleagues at TCHC adopt the EHR from the Birmingham, Ala.-based SuccessEHS.
A COMMUNITY-WIDE VISION
Thinking community-wide about care management and population health is one of the defining elements of what the LPHI, CCBC, and their collaborating organizations, including the TCHC, are doing these days. But what makes this collaboration worthy of Innovator Awards recognition is the combination of vision and scope on the one hand, and the successful leveraging of healthcare IT to achieve those visionary goals, on the other.
In the end, LPHI’s Khurshid says that four key steps must been taken in order to successfully leverage healthcare IT to support community-wide initiatives like this one. First is to engage physicians at the very outset, “and ask them what functionality they want. Then you go in and search for the best solution.” Second, he says, is “achieving the goals that have been set by the users.” Next is “working with the same partners on the processes that will make sure that the information created and the technology implemented can be used in a meaningful way. The final step is to measure things,” and to plow that measurement back into continuously improving clinical performance.
Only time will tell exactly how much of the vision of this initiative will ultimately be fully realized; what’s clear even now, though, is that strategically thinking visionaries like Anjum Khurshid, Maria Ludwick, and Eboni Price-Haywood will inevitably find ways to improve the health of their communities. ◆