1. 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

2. 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

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

4. 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

5. 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.

6. 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

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

8. 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

9. Enabling Services are foundational to: Practice Transformation
Source: NCQA Introduction to PCMH. Available at:

10. 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.

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

12. Importance of Enabling Services

13. 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

14. ES address patients’ multiple needs
Source: Commonwealth Fund

15. ES addresses patients’ multiple needs
Source: Commonwealth Fund

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

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

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

20. Why do we need to collect standardized data?
Source: Center for Care Innovations. Available at:

21. 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”

22. 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”

23. 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.

24. 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

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

26. Activity using AAPCHO’s Enabling Services Data Collection Toolkit (2017)
Visit:

27. 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

28. 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.

29. Resources
Visit AAPCHO’s Enabling Services homepage at: the AAPCHO Training & Technical Assistance (T/TA) team at: Visit the PRAPARE website at:

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