5 Questions with Dennis Dunmyer, VP, Behavioral Health & Community Programs, Kansas City Care Clinic

Dennis Dunmyer is vice president of behavioral health and community programs at Kansas City Care Clinic in Kansas City, MO. The clinic, previously known as the Kansas City Free Health Clinic, was awarded FQHC status last year. It employs 140 to care for an average of 120 patients each day for primary care, behavioral health, and oral health visits. The clinic sees a similar number of patients for HIV or hepatitis C tests. It also caters to patients seeking a case manager, peer counselor, or community health worker. KCCC uses a variety of health IT, including Greenway’s Success EHS and patient portal, and NextGen’s Scout care coordination software for HIV patients enrolled in its Ryan White HIV/Aids care coordination program. It recently incorporated BluePrint Healthcare IT’s Care Navigator platform in its Community Health Worker program. It plans to attest for Meaningful Use for 2016.

Why did KCCC decide the time was right to implement Care Navigator technology? What are the organization’s goals for the tool and its impact on patient care? 
We run a community health worker (CHW) model care coordination program that serves patients from a regional network of providers, hospitals, and community-based settings, including our own primary care practice. These CHWs are performing intensive, community-based patient navigation with these largely uninsured patients. KCCC decided to adopt Care Navigator primarily to be used with this program to allow for a centralized system to manage the day-to-day workflows of the CHWs, the assessments and care plans for these patients, and to allow cross-provider communication. This platform will allow us to more efficiently create care plans, track referrals, and provide automated prompts to the CHW to ensure that patients are connected to the resources and providers they need to improve their health. After this initial use case, we envision further adoption with our patient-centered medical home team within our FQHC practice.

The final MACRA rule is still making news. What are the clinic’s participation plans?
Since FQHCs have different payment methodology systems for Medicare and Medicaid, we are not planning to do anything with MACRA. We understand that we are not expected to participate in either track.

What has the PCMH journey been like for the clinic? How do you believe this experience will help the clinic transition to value-based programs?
The PCMH journey is a challenge and we continue to travel that road as this practice model is a shift in culture from how most clinicians are trained. The team-based concept requires putting the patient first and thinking about aspects of patient care that do not fall within traditional healthcare interventions. As an FQHC, our patient population often has more social barriers to their health than they do healthcare barriers to health. We certainly believe this framework helps set us up for improved patient outcomes, and value-based reimbursement models make more sense to encourage these additional activities. For us, the challenge has been finding ways to support the additional staff infrastructure required while a large number of our patients remain uninsured, and to make this investment prior to the proliferation of value-based reimbursement that will reward us for improved health of the population we are managing.

Are any other coordinated care initiatives underway?
As I alluded to above, we are an NCQA Level 3 PCMH, Missouri Medicaid Primary Care Health Home and have care coordination processes embedded throughout. Our practice is working to fully integrate our primary care, behavioral health, and oral health services through technology and staff-driven care coordination models. We are also a large Ryan White provider and have a lot of medical case management for those clients, and we run a regional CHW model care coordination program that serves patients from four area hospital systems and several other safety net healthcare providers.

How is the clinic using technology to better integrate behavioral health and primary care? What impact is this having on patient access and outcomes?
The clinic uses the same EHR platform for primary care and behavioral health, and our EHR allows integration of our dental module as well. We made a choice to not blind anyone on the care team from any aspect of patient care in the EHR so that the team can use the information gathered in other disciplines to drive care decisions. A shared medication list, labs reports, and access to care plans and progress notes across the system allow for better coordination of care in an integrated environment. We have not yet found an ideal platform for this type of practice, and have had to sacrifice some functionality on the behavioral health side to allow this shared model. We are hopeful that over time we will make up for some of the limitations in our EHR in this regard as we fully implement the Care Navigator functionality across our system.

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Contacts

Jenn, Mr. H, Lorre

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