1. USING HEALTH INFORMATION TECHNOLOGY TO IMPROVE CARE OUTCOMES HCN BOARD RETREAT TONY AMOFAH, MD, MBA, FACP, CMO, COMMUNITY HEALTH OF SOUTH FLORIDA, INC CMIO, HEALTH CHOICE NETWORK, INC

2. OUTLINE The changing health care landscape for CHCs Traditional patient flow Time-tested interventions HIT as a strategy for success – Use of available HIT in our CHCs – Positioning for success with Managed Care, ACO, HRSA Inertia – Overcoming inertia Take home messages

3. CHANGES IN EXPECTATIONS OF CHCs PAST – CHCs –”only game in town” – Sole Medicaid provider – Focus on patients seen in our CHCs Active – 2 visits – Quantity # of patients seen Poverty level # of A1c done – Credit for ordering tests – Good old paper – Funding guaranteed PRESENT & FUTURE – Competition – Population health 1 visit – Patient engagement in care – Quality + Quantity Outcomes – Health information technology Initially # with E.H.Rs Now: E.H.Rs used meaningfully – Transparency and Accountability – Pay for performance

4. THE HEALTH CENTER STRESSORS FINANCIAL STABILITY CHC RISK MANAGEMENT MANAGED CARE E.M.R PROVIDER RECRUITMENT & RETENTION SURVIVAL QUALITY STAFF TURNOVER FACILITIES & LOGISTICS MONITORING AGENCIES UNFUNDED SERVICES CORPORATE COMPLIANCE & AUDITS GROWTH PAYROLL ANCILLARY SERVICES PRODUCTIVITY COMMUNITY ALLIANCES GRANT FUNDING CODING UDS MU ICD 10 HEDIS PCMH PAY FOR PERFORMANCE

5. TRADITIONAL PATIENT FLOW 5 Patient arrives Front desk check in ID verification Payment collected Nursing encounter Vital signs, BMI, pain scale Reason for visit FBS Provider encounter Chronic dis mgmt Med refills Labs Referrals mgmt Patient discharged Apptmt

6. HEALTH CENTER STRATEGY: WHICH OF THESE INTERVENTIONS? PCP visit Specialist Visit Emergency Room Hosp Visit Case Management Capitation Patient Arrangements DRGs PCP Gatekeeper Risk Sharing Arrangements Pay for Performance Provider Report Cards Telephonic Case Management Outreach Interventions Diabetes Education Classes CoPay Adjustments Grocery Shopping Sessions Self Management Support Pre-visit Planning Shared Medical Appointments Health Information Technology Tools Patient Bundled Payments Closed, Limited Panels Discharge Planning HEALTH CARE INDUSTRY TIME-TESTED INTERVENTIONS

7. BEST BANG FOR THE BUCK IN OUR CHCS? SUPPORT STAFF/CARE TEAM BASED CARE PATIENT ENGAGEMENT STRATEGIES PRE-VISIT PLANNING HEALTH INFORMATION TECHNOLOGY

8. AVAILABLE HIT TOOLS 1.E.H.R tools – Forms/Templates – Health reminders – Flow sheets – Pharmacy Benefits Management History (PBM Hx) 2.Patient portal tools – Appointment scheduling – Medical summary – Pre-visit questionnaires 3.Informatics tools: CLEAR dashboard – Quality indicators – Provider report cards – Personalized Care Gap Report

9. PATIENT PORTAL TOOLS My Medical Summary Satisfies Meaningful Use CORE MEASURE 7: Patient Electronic Access Required fields to display are: Allergies, Lab Results, Plan of Care Problems, Procedures, Social History, Vital Signs, Chart Summary Chart Access History

10. PATIENT PORTAL TOOLS Requesting an Appointment Patient completes all fields in the Request Appointment screen. Clicks Submit once complete. Staff reviews message details. Searches for an open time slot in POMIS.

12. PROVIDER REPORT CARDS

13. 13 Patient schedules apptmt Prompted to complete pre-visit forms Patient completes pre-visit tests Arrives for visit Support staff visit Provider visit Patient discharged Care team reviews planned care visit report and patient’s record for care gaps (Pre-orders tests) Pre-visit care team phone call Care team huddle; Review of personalized patient care gap report; Left at front desk for patient Address care gaps Provide education handouts Commence self mgmt. goal setting Patient home Hospital & Specialist visits Patient home Care Coordination Phone Tree Calls Shared medical visits CLEAR HEALTH REMINDERS PATIENT PORTAL FORMS & TEMPLATES Informatics at point of care CLEAR HIE PATIENT PORTAL CLEAR Appointment request & receipt via portal Resolve remaining care gaps Underscore self mgmt. goals

14. WHAT HAS MADE THESE POSSIBLE? 1.Economies of scale 2.Collective brain power 3.Collaboration – Across CHCs – With vendors and stakeholders 4.Inherent competitiveness sparked by benchmarking

15. THE TRADITION OF THE FEUDING GIANTS

16. Q-TECH: COMPLIANCE WITH SELECTED UDS MEASURES

17. POSITIONING FOR SUCCESS 1.Answers to questions – Who are our patients? – Which are at highest risk? – What are their care gaps – What is our current performance? 2.Value in facilitating management of patients in their “white space” 3.Enhanced efficiency of patient visits

18. REASONS FOR “TECH INERTIA” 1.Insufficient staff 2.Too many patients 3.Limited patient access to the internet 4.Reports inaccurate 5.Wrong phone #s 6.Competing priorities 7.Funding

19. TAKE HOME MESSAGES 1.“>50% of payments in a few years will be value based” 2.Health Information Technology Tools will be increasingly critical for success – Population health analytics, care coordination and patient engagement solutions 3.No barriers should prevent HIT utilization maximization 4.Its all about results!

20. THANK YOU TONY AMOFAH E mail: samofah@hcnetwork.org