Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
HIStalk Practice Interviews Daphne Bascom, MD SVP, Community Integrated Health, YMCA of Greater Kansas City
Daphne Bascom, MD is SVP of community integrated health at YMCA of Greater Kansas City in Missouri.
Tell me about yourself and the organization.
I am a physician by training, board certified in otolaryngology, and head and neck surgery. I trained out of the University of Pittsburgh and Oregon Health Sciences University, and have been in Kansas City now for about five years. I completed my fellowship in microvascular reconstruction at Case Western University, then left there and joined Cerner for the first time. I then worked for Ascension Health for a short time and then Cleveland Clinic. I spent six years rolling out Epic at Cleveland Clinic. During that time I was able to work as part of their wellness institute. I went back to Cerner about five years ago and was most recently CMO.
I joined the Y in January of 2017. It’s probably easier to call me the medical director for health and wellness; that is my role today. I am the first physician employed at the association level – the first local doc. The YMCA of Greater Kansas City is actually an association of 14 different YMCA centers that are both in Kansas and Missouri. We have about a million visits to our Y annually, and are the largest provider of childcare in Missouri and Kansas.
I’ve read that you’re also a competitive body builder. How did you become involved with that?
Around the time I turned 40 I treated myself to some personal training, and my trainer was a professional figure competitor. She was preparing some competitors for competition and I thought it looked fun, so I decided to start competing. I earned my professional card six or seven years after I started competing. While I’ve always been a gym junkie, it wasn’t until I turned 40 that I really started to understand how important nutrition was, and how to really wed health and wellness together.
What prompted you to make the switch fro the vendor world to the Y?
I was already a member, and had been on their board for two years. I’d watched this Y as they started to make the transition from what we call “swim and gym” to really starting to engage with the community. I introduced the Y to Cerner because I saw a huge opportunity, given what they were doing, to integrate population health strategies into what the Y was doing. This was while I was still at Cerner. I also started facilitating conversations between the Y and Truman Medical Center, which is our safety net hospital, and then I pulled in the university. It was one of the most fascinating set of conversations I’d heard in years because they were throwing to the wind what we had done conventionally, asking, "How do we do this differently? How do we better leverage our community partnerships?" I got excited about doing the work when I was on the Cerner side. When the Y posted for a clinical leader, I threw my hat into the ring and was fortunate to get the position.
How has your health IT experience already started to help inform your role at the Y?
On top of my Cerner and Epic experience, the YMCA started an Athenahealth deployment in January. Any YMCA that delivers our diabetes prevention program is using Athenahealth, which is going to be our standardized EHR across all of the Ys nationwide. I’m getting a little bit of exposure to Athena now and it’s really exciting.
The technology connection is probably at multiple levels. I think there’s a community connection where we can improve how we are using e-referral processes, and improve decision support so that providers can perhaps be prompted to refer patients to community services in the context of their workflow. I’d also like to get rid of the paper trail by having more electronic processes to refer patients into the Y, or for me to refer patients to a provider. And – this is my dream, especially living in Kansas City and seeing what Cerner is doing with Healthy Intent – having the potential for a true community health record.
If all of this data were above our individual organizations in the cloud, you could tie in clinical needs with community needs and then add in social determinants of health, which isn’t done that well today in the EHR. That could help create a better picture and help people understand what it is they really need from the health side, the care side, and the community side.
We’re also in the process of rolling out a mobile platform for delivering evidence-based programs. We partner with a company called Noom. We just started our first diabetes prevention program on smartphones.
Given that the Y isn’t a conventional healthcare provider, how does it plan on using the EHR?
The diabetes prevention program is delivered by trained lifestyle coaches, who we are training to use the EHR to almost as if they were an ancillary care provider. Every one of their classes becomes a schedule for them, the provider. All of the participants in their classes will be on their schedule as if they were seeing people in clinics. They are required to enter the participant’s weight, their activity, if they are completing their food log. We also have them doing "billing" just to document their participation – if it’s their first session, their 10th session – so that we can also report on their progress. It’s the same Athena that everyone uses. It’s a little nuanced.
The funny thing is I hear the exact same complaints from the coaches that I hear from the physicians with regard to the technology: “It’s too many clicks. It takes me too long.” The great thing is that it’s standard, so regardless of whether you’re in Atlanta or Kansas City, you will have the same experience and the same data will be collected. At the national level, the Y is beginning to aggregate the data across all of our facilities so that we can begin to look at our outcomes. One of the primary motivators is that we want to be able to participate in Medicare reimbursement starting in 2018. We needed a certified EHR in order to be able to submit those claims.
All of the Ys have their NPI and we’re in the process of working on NPIs for our coaches. From an organizational change perspective it’s huge, because YMCAs historically have not really had to be HIPAA-compliant. Now, one of my responsibilities is as our privacy officer, and getting everyone HIPAA-trained and HIPAA-certified, and putting in place the policies and procedures to make sure that we are compliant. It’s been a massive organizational change effort, and I have to applaud the national office for taking this on.
We’re also working on e-referrals. The three primary EHRs that we’re working with in Kansas City are Cerner, Epic, and Athena. I can’t directly receive a referral from any of them or send a note back to them. We’re hoping to turn on Athena Communicator, which will give us some capability to do Athena to Athena communication. We’re exploring Direct messaging, although we know some of the challenge with Direct nationally in terms of adoption and usage. And then we’re also part of an initiative out of the Million Hearts program that is interested in exploring the same things. There are a few different organizations trying to figure this out.
Are you thinking about adding telemedicine?
That’s a great question. The answer is yes. I just don’t have the answer for who the provider will be. We just built a new Y in one of our underserved communities called Linwood. In partnership with Truman Medical Center, we’re going to build a clinic that’s physically attached to the Y. It’s not a new model; there are multiple Ys that already have integrated rehab and physical therapy or other clinical services. But as part of that, we are going to have an e-visit room, and so we’re looking at what that may be and who may provide that. I’m advocating that it should not be seen as just a clinical visit, but that it could be a care team visit. If I needed to have a provider on a line along with a coach, along with the patient … we want to make sure that the technology can scale and have a care team concept – not just a patient-to-provider concept.
Are you already thinking about connecting to a local or regional HIE?
Yes. We met with the Kansas Department of Health several weeks ago to see if we can help them with some of their rural communities. They wanted to know, “Can we send this health data to the Kansas HIE?” I’ve also talked with the Missouri Primary Care Association. We have three HIEs in Missouri. I think the challenge from the YMCA’s perspective will be point-to-point in every state. It’s going to be very expensive. And will it be sustainable?
I would love to have all of this go up into some big, massive cloud, but again I’m probably just dreaming. In Missouri I have to decide, “Do I send the data to all three HIEs or do I bet on one being sustainable? Will I make people mad if I choose one and not the other?” There are some politics involved. Nationally, I don’t know if funding and maintaining all of those connections is going to be the Y’s long-term strategy.
You mentioned working with a public health agency. What social determinants of health are you incorporating into your community-integrated health program?
As many as possible. And I know that’s not an answer. One of the things I’ve been doing for the past four months is making introductions around the community, both to share what the Y is doing and then also to better understand what other resources are available. I’ve also been visiting all of our Ys to understand what are the important non-swim-and-gym elements of healthcare that we can address with appropriate services from the Y or our partners. We’re already working with Truman, KU, and food trucks. There are significant areas of Kansas City that are food deserts.
With our Million Hearts Program, the Dept. of Health in Missouri has agreed to help us organize transportation for patients that may want to participate in our blood pressure self-monitoring program. If they are recommended by their provider to be part of a BPSM program and transportation is an obstacle, can we work with the health department to schedule a van or Uber to get them to meet with our Healthy Heart ambassadors. From a language and literacy perspective, our Y is piloting an English as a second language program. We’re helping address literacy within members of our community. These programs are actually taught by community volunteers, not even employees at the Y.
What are your goals for these programs? What are your aspirations when it comes to continuing to build them out?
I think the first goal is for both the community and the healthcare community to know that these programs are available. Communication and program availability is key, and more importantly, as well as making our programs part of the clinical care workflow. I’d love to enable providers to either refer patients and/or to see data from participation in these programs. Another goal is to scale the programs across more of Kansas City and Missouri and Kansas. Kansas and Missouri are not the healthiest states. I need to be able to scale the programs and deliver them to more members of the community. Those aren’t just YMCA members. We deliver programs in churches, schools, and to employers. To do that, part of it has to be having the resources to fund our coaches.
I think a lot of what I’m going to be leveraging technology for is to meet people where they are. You may not be able to come into a Y physically, but if you can meet with a YMCA coach on your smartphone or iPad, then we can help you maximize your health potential with whatever resources are available. The last part would be for the Y to become a trusted and respected member of the community care team. It takes a village to be healthy. In a 15- or 20-minute clinic visit, there’s no provider that’s going to be able to address all of the key factors that make people well or help keep them healthy. It may be that they don’t have electricity, or that they don’t have great access to food. They may not have an ID that allows them to get their health insurance on the exchange.
We want to continue to extend what we consider to be health and care to be inclusive of our community resources, and to make those resources available to people as they need them. We want to make sure that the provider community has immediate access to us when it’s appropriate so that we can help extend what they’re doing to keep people healthy.