Alliance for Health Reform Briefing: Medicaid and Health IT Community Health Centers and HIT Driving Innovation in the Patient-Centered Medical Home Presented by: Judith Featherstone MD, FAAFP Medical Director HealthPoint August 1, 2011

Today, Health Centers serve as the health care home for more than 20 million patients nationally, including : 1 in 7 Medicaid beneficiaries 1 in 7 uninsured persons 1 in 3 individuals in poverty 1 in 7 rural Americans * Includes patients of federally-funded health centers, non-federally funded health centers or “Look-Alikes” Health Centers Today

HealthPoint is the largest CHC in the 14 th largest county in the US.  12 Clinics: 7 medical, 4 dental, 1 school-based  Patients = 62,542, Visits = 210,865  Medicaid, Medicare and Public Insurance- 55%  Uninsured – 37%  In addition to primary medical and dental care, services include:  Prenatal care and delivery  Complementary and alternative medicine including naturopathic medicine, acupuncture and nutrition counseling  Behavioral health  Pharmacies in all clinics HealthPoint: Your Community Health Center

HealthPoint Patients Patient income by Federal Poverty Level Patient race/ethnicity Patient by insurance

Nationally, three quarters of all health centers are now on the road to adopting integrated health information technology systems. Health Centers and HIT: National Perspective

-2005 Electronic Health Record/ Practice Management Adoption Quality of Care Outcomes Reports Immunization Data Interface with the State Registry Population Recall Reports Templates for Behavioral Health, MSS, Homeless care Electronic Prescribing Internal Pharmacy System Integrates with EHR, Electronic Dental Record Integrates with EHR, Billing from EHR Future: Patient Portal, HIE, Enhanced Reporting and Decision Support HealthPoint Perspective

Challenges to Adopting Health IT Equipment Staff training Provider use Reassignment of Medicaid HIT Incentive Payments

Medicaid HIT Incentive Payments Health Center Controlled Networks Primary Care Associations Regional Extension Centers Opportunities for Health IT Support

Health centers use Health IT in varied ways to meet the needs of their patients, for example… Telehealth: patients, including those in rural or remote areas, can “see” a provider for screenings, behavioral health encounters, remote eye exams, and chronic disease management. Referral Tracking: the record, patient history, medication and Rx plan follows the patient across health center sites and other health care providers. Personal Chronic Care Management: electronic records notify providers and patients when it’s time for a check up or check in. Health Centers and HIT: National Perspective

EHR Specialist guidelines for referrals built into EHR. Coordination of EDR and EHR Tracking referral completion Managing for quality of care outcomes Reports on health disparities to target community approaches. Innovations at HealthPoint Other Video interpretation Mobile phones for health reminders Website with links to mobile applications for healthy living. Telepharmacies

Patient Experience Time of visit activities Invite in for individual visit or group with cohort. Coordinate with specialists, ER and hospital, decrease redundant work. Decision support built in for referral appropriateness, referral preparation, evidence based testing. Health IT: Improving the PCMH Population Care Outreach to patients due for health maintenance services Outreach to patients with chronic diseases which are uncontrolled or due for monitoring. Reports can guide us in setting up appropriate systems such as community health workers for new immigrant populations. Develop interventions targeting obesity based on our reports including language and ethnicity.

Health IT: Improving the PCMH Patient-Centered Medical Home Six standards align with the core components of primary care 1)Enhance Access and Continuity 2)Identify and Manage Patient Populations 3)Plan and Manage Care 4)Provide Self-Carte Support and Community Resources 5)Track and Coordinate Care 6)Measure and Improve Performance Health IT is vital to meet these standards.