IPHCA Focus on Quality Webinar Series Health Center Investments in Enabling Services Associated with Better Health Outcomes IPHCA Focus on Quality Webinar Series March 13, 2019 - Albert Ayson, Jr., MPH, Senior Program Manager, T/TA Rosy Chang Weir, PhD, Director of Research

Objectives Identify the role of enabling services in supporting various initiatives such as clinical quality improvement, practice transformation, social determinants of health, and value-based payment. Explain the importance of enabling services data collection and documentation as a means to increase access to care, improve health outcomes, and promote health equity for your patient populations. Describe the updated Enabling Services Data Collection (ESDC) standardized protocol and how AAPCHO's training and technical assistance resources can help expand an ESDC initiative in your own community health centers. 1 2 3

About AAPCHO The Association of Asian Pacific Community Health Organizations (AAPCHO) was formed in 1987 to create a national voice to advocate for the unique and diverse health needs of AA&NHPI communities and the community health providers that served those needs. National association of 34 community health organizations serving more than 600,000 Asian Americans, Native Hawaiians, and other Pacific Islanders (AA&NHPIs). Dedicated to improving the health status and access of these medically underserved communities Bureau of Primary Care (BPHC) funded National Cooperative Agreement (NCA) to provide training and technical assistance to health centers

About AAPCHO www.aapcho.org The Association of Asian Pacific Community Health Organizations (AAPCHO) was formed in 1987 to create a national voice to advocate for the unique and diverse health needs of AA&NHPI communities and the community health providers that served those needs. National association of 34 community health organizations serving more than 600,000 Asian Americans, Native Hawaiians, and other Pacific Islanders (AA&NHPIs). Dedicated to improving the health status and access of these medically underserved communities Bureau of Primary Care (BPHC) funded National Cooperative Agreement (NCA) to provide training and technical assistance to health centers www.aapcho.org

AAPCHO’s Enabling Services Accountability Project Pilot PARTICIPATING CENTERS: Charles B. Wang Community Health Center (New York, NY) International Community Health Services (Seattle, WA) Kalihi-Palama Health Center (Honolulu, HI) Waianae Coast Comprehensive Health Center (Waianae, HI) *Acknowledgement: New York Academy of Medicine (NYAM) , National Association of Community Health Centers (NACHC), et al.

AAPCHO’s Enabling Services Accountability Project Pilot (cont.) Develop standardized enabling services (ES) data collection protocols Describe utilization of ES at health centers Evaluate the impact of ES on health access, outcomes, and utilization of primary care Disseminate findings to health centers and policymakers to guide effective resource allocation Facilitate research and expansion opportunities to other health centers and networks Goals

AA&NHPI-Serving Health Centers & Enabling Services (UDS 2017) Source: 2017 Uniform Data System. Bureau of Primary Health Care. HRSA, DHHS.

Enabling Services are foundational to Clinical Quality Improvement Source: AAPCHO & NACHC White Paper on “Highlighting the Role of Enabling Services at Community Health Center: Collecting Data to Support Service Expansion & Enhanced Funding.” 2010

Enabling Services are foundational to: Practice Transformation Source: NCQA Introduction to PCMH. Available at: www.ncqa.org

Enabling Services are foundational to: Social Determinants of Heath NEEDS DATA Standardized data on patient social risk/barriers (PRAPARE) RESPONSE DATA Standardized data on interventions (ES + others) Acknowledgement: PRAPARE partners at National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association.

Enabling Services are foundational to: Value-Based Care Source: Healthify Blog - “The Critical Role of SDoH Data in Value-Based Contracts.” March 12, 2019

Importance of Enabling Services

What are enabling services and why are they important? Enabling Services: Non-clinical services that are provided to health center patients that promote, support and assist in the delivery of health care and facilitate access to quality patient care Case Management Interpretation Services Health Education Transportation Eligibility Assistance

ES address patients’ multiple needs Source: Commonwealth Fund

ES addresses patients’ multiple needs Source: Commonwealth Fund

Investment in ES is Associated with Better Health Outcomes (2008) Source: HRSA BPHC Uniform Database System (UDS) 2008

Investment in ES is Associated with Better Health Outcomes (2015) Source: HRSA BPHC Uniform Database System (UDS) 2015

ES Investment & Utilization Source: The Health of AA&NHPIs Served at Health Centers, 2015 UDS. AAPCHO.

Why do we need to collect standardized data? Source: Center for Care Innovations. Available at: https://www.careinnovations.org/resources/building-a-data-driven-culture/

How do health centers benefit? Assist management to allocate resources more effectively Better understanding of ES (volume, time, etc) to improve efficiency and effectiveness Practice Transformation (i.e. PCMH recognition) Payment reform efforts Enabling services staff were interested in showing how their services impacted patients’ health Enabling services staff were willing to provide information about their work Enabling services staff were involved with improving data collection processes "The data allows our managers to better assign staff and evaluate those activities which staff participate in. For example, we will look at the outcome of sessions like nutritional counseling and the impact on patient health status”

How does the community benefit? Provides general overview of health center programming Highlight diverse needs of community and their challenges Comprehensive data Model for other organizations within the community Increases capacity to carry out research/programs to benefit community "The data from the project shows that our health center provides a great many services to patients and the community” "The project demonstrates that enabling services are the core of what makes quality care for our patients“ "We enjoyed meeting and joining forces with other health centers to show that enabling services are valuable to our vulnerable populations”

Local Health Center Examples Waianae Coast Comprehensive Health Services (Hawaii) – used ES data to support reduction in ER utilization. Received better funding from local health plan by submitting ES data. Valley Wide Health Systems (Colorado) – worked with Colorado Medicaid office for per member per month (PMPM) for care coordination staff Charles B. Wang CHC (New York) – reallocation of resources to hire more care coordinator or case managers. Also, led to more Medicaid eligibility assistant for enrollment and eligibility. Acknowledgement to Waianae Coast Comprehensive Health Services, Valley Wide Health Systems, and Charles B. Wang CHC for their contributions. Image Source: Wikipedia.

Key Takeaways Data Stewards Data Systems Data Driven Culture Develop the data collection system upfront.  Do you have internal or external support to collect and manage this type of data? Data Systems Increase buy-in for continuous workforce training and supporting a data-driven culture Data Stewards Use data to inform ES interventions for clinical or SDoH outcomes, operational changes, overhaul care delivery, etc. Data Driven Culture Acknowledgement: Contra Costa Health Services – Elizabeth Hernandez

IPHCA Conference & Interactive Session Preview: Enabling Services Data Collection (ESDC) Case Studies WHY DO WE NEED TO COLLECT DATA?

Activity using AAPCHO’s Enabling Services Data Collection Toolkit (2017) Visit: http://enablingservices.aapcho.org

Old vs Old ES Categories Revised Categories Code Case Management Assessment (CM001) Social Services Assessment SS001 Case Management Treatment and Facilitation (CM002) Case Management CM001 CM Referral (CM003) Referral- Health RF001 Referral- Social Services RF002 Financial Counseling/ Eligibility Assistance Financial Counseling/Eligibility Assistance FC001 Health Education/Supportive Counseling *Individual *Group Health Education- Individual (one-on-one) HE001 Health Education- Small Group (2-12) HE002 Health Education- Large Group (13 or more) HE003 Supportive Counseling SC001 Interpretation IN001 Outreach OR001 Inreach IR001 Transportation Transportation- Health TR001 Transportation- Social Services TR002 Other OT001 Old vs

Questions to consider 1 What are some examples of ES your health centers provide? 2 What is your experience with Enabling Services data collection (ESDC) at your organization? 3 What resources do you need to start or expand an ESDC initiative? 4 What would having ES data do for you/your health center? 5 Identify one project where having ES data can benefit your health center.

Resources Visit AAPCHO’s Enabling Services homepage at: http://enablingservices.aapcho.org/ E-mail the AAPCHO Training & Technical Assistance (T/TA) team at: training@aapcho.org Visit the PRAPARE website at: www.nachc.org/prapare

Thank you! Contact Info: Albert Ayson, Jr., MPH Senior Program Manager, Training & Technical Assistance AAPCHO aayson@aapcho.org Rosy Chang Weir, PhD Director of Research AAPCHO rcweir@aapcho.org