In Valparaiso, Ind., Beth Wrobel has been the CEO of HealthLinc, Inc. since 2002. She has moved the organization from a free medical clinic serving adults to a Federally Qualified Health Center (FQHC) providing a healthcare home to all life cycles from prenatal to seniors, with integrated medical, dental, optometry and behavioral health services at six locations, as well as a mobile medical/dental van.
Wrobel’s organization has a challenging, but important role in the healthcare community. At the HIMSS16 conference in Las Vegas earlier this month, she spoke with Healthcare Informatics Managing Editor Rajiv Leventhal about HealthLinc’s successes and challenges as an FQHC, its patient representation, how it’s integrating technology, and more. Below are excerpts of that interview.
Can you explain what HealthLinc does and what is its role in the healthcare community?
HealthLinc is a Federally Qualified Health Center that has been around for about 20 years. It started as a free clinic, like many FQHCs. Our founders were community activists who had done housing and they knew they were getting all of these moms who need places to live, but they discovered that they also needed medical care. So they started HealthLinc. 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, and we treat the patient at the center; we are a Patient-Centered Medical Home. We have been able to grow, and if you think about Lake Michigan, you have the bottom by Chicago, and we basically serve from the Illinois line to where Notre Dame is in South Bend.
Putting the patient at the center is where healthcare seems to be moving towards. How is HealthLinc fitting into this equation?
So 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. My family and I are all patients at HealthLinc, and we used to be the safety net, but I have been saying, what is the definition of safety net anymore? If you’re making $30,000 or $50,000 per year and you have a $500,000 deductible, do you really have insurance? We are looking at that too as our safety net. We are looking at what the patient needs, and that’s where the population manager tool [from Forward Health Group] comes in to see what the patients need and get those resources for them. And it works.
What are the main IT elements at HealthLinc?
We are what I would consider an early adopter of electronic health records (EHRs). We went online in 2008, and I am so thrilled about that. If we just started a few years ago even, we wouldn’t be where we are now. We also highly rely on data. I am a mechanical engineer by trade so I am very process driven. I think that may be different than some groups because I believe that you can’t solve a problem until you know it, and the data will give it to you. We have always had this system called Practice Analytics for the data, and I hired an engineer to write the reports. That is great but it takes time, so we found Forward Health Group and Population Manager. Now, that data is at the fingertips of whomever on the care team, and it allows them to go in themselves; it’s very user friendly. We were lucky enough to have someone else say they want to pilot this and improve community health. You put that data in there, and that’s a big step forward. The next big step is patient engagement.
Are you able to do any predictive analytics on your patient populations?
One of the things about Population Manager is that we 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.
FQHCs have strong patient representation on their boards, and they play a role they might not in other healthcare organizations. What is this like at HealthLinc?
Fifty-one percent of our [board member] patients have to be users of the clinic. We not only have patient representatives but they also represent a wide variety of incomes. For example, we have an eye doctor who almost stopped seeing patients due to patient no-shows. Patients would be charged $20, but they wouldn’t show and not pay the money. So we had a patient suggest to collect the money upfront. If I missed an appointment and lost $20 I would be mad at myself, but in the long run it would not have been tragic. If you are low-income, though, that might mean your kids do not eat for a few days. So they really helped [with the no-shows]. None of our patients get up in the morning and tell themselves that they won’t worry about taking their medications or going to the doctor. There are always those barriers, some people call them non-compliance, but we call them barriers, and finding those will make a difference.
What about HIMSS16 particularly stuck out to you?
I think the significance is seeing so much about population health, and there are some FQHCs looking at this, but not many. We tend to be out at the forefront at HealthLinc, and that’s great, but you also want to see other people doing what you’re doing to confirm that it is right. The other thing I was hoping to see is telehealth, as I think it’s something we will really be relying on in the future. We built an infrastructure at our sites, starting with behavioral health. We have on-site behavioral health, but the hours that we are open [don’t allow us] to have behavioral health at night on every site. Right now we have one site open at night and we do telehealth there. But I want to see what the next thing is that I could be doing with telehealth. And there are challenges there; I think people are afraid of some things involved with telehealth. Indiana has a legislation going on right now about who can do telehealth in the state. Two years ago, I was part of the process to get the rules changed to allow for any telehealth. We had a vision and we told a story. This will help improve the health of our community, and the legislature bought on. We will need more of that, though.