USING HEALTH INFORMATION TECHNOLOGY TO IMPROVE CARE OUTCOMES

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 • 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 • 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

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

5. TRADITIONAL PATIENT FLOW

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

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

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

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

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

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

15. THE TRADITION OF THE FEUDING GIANTS

16. Q-TECH: COMPLIANCE WITH SELECTED UDS MEASURES

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

18. REASONS FOR “TECH INERTIA” • Insufficient staff • Too many patients • Limited patient access to the internet • Reports inaccurate • Wrong phone #s • Competing priorities • Funding

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

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