5 Questions with Vincent Siasoco, MD Medical Director, Metro Community Health Centers

Vincent Siasoco, MD is medical director of Metro Community Health Centers (NY). MCHS employs between 90 and 100 staff to care for 220 patients daily across its five FQHCs. MCHS is working with its physicians, some of whom also work for other healthcare providers, to help them meet the various stages of Meaningful Use. “Gathering data can be challenging,” Siasoco explains, “however, we continue to work with our providers to meet MU measures. We’re also considering submitting for MIPS as an ACO.”

In addition to its focus on MU and MIPS, MCHC implemented population health management technology from HealthEC to stratify risk, identify high utilizers of care, and give its physicians access to benchmarking tools and analytics. The organization is also working on adding specialized templates for behavioral health to its EClinicalWorks software, as well as dental-specific software developed for ECW. “We’re implementing a new VOIP phone system to better track and log calls and voicemails to the health centers,” Siasoco adds. “We’re also collaborating closely with the residential leadership of the Cerebral Palsy State Association to develop workflows to transmit clinical information digitally from their group homes to our health centers.”

Why did Metro Community Health Centers decide the time was right to implement population health management technology? What benefits do you hope to gain from deployment?

As an FQHC, we routinely monitor over 12 different clinical quality metrics through our EClinicalWorks EHR with the support of the Comprehensive Primary Care Initiative data reporting system. CPCI draws clinical, operational, and financial data nightly from our five health centers’ EHRs. Some of the quality metrics include HgBA1C, colon cancer and cervical cancer screenings, obesity, and tobacco use and education. We monitor these metrics on behalf of all primary care providers on a monthly basis and review at our QA meetings. Moreover, we break down the metrics even further by presenting each PCP with an individual, custom report disclosing quality metric scores for their seen patients. Internally, the metrics have been exceptionally beneficial, gauging not only each health center’s performance including practice variations and patterns, but also providing insights to help our physicians identify high-risk and rising-risk patients.

Besides serving as senior medical director of MCHC, I’m also the medical director of our ACO, Alliance for Integrated Care of New York. Through the ACO, we use the HealthEC population health management platform to access a tremendous amount of patient data via Medicare claims. A large number of our ACO patients have intellectual and developmental disabilities and live in group home settings. One of the challenges of providing services for IDD patients is that the group homes have their own nursing triage system in place. Therefore, although we have an after-hours on-call service, the decision to send patients to the ER is made by the group home’s nursing staff. While this triage system works well for the group home, our health center providers are not always aware of the date and time when patients are transported to the ED, nor the reason why. We usually learn about ED visits when these patients are seen at follow-up visits. Access to HealthEC data has changed this scenario in that we now track outside care administered to our patients. In fact, we can use the data to pinpoint which patients use the ED the most, which EDs treat the majority of our patients, and which patients have incurred the highest overall health spending. This valuable information has led to the enhancement of individualized care management plans and the ability to appropriately identify and address barriers to care.

The data also helps us achieve the Triple Aim’s three goals of improving the health of populations, enhancing the patient experience of care, and reducing costs. With a network of five health centers throughout NYC providing services to a highly complex patient population, MCHC’s implementation of population health technology is key to providing the best care possible for our patients. Knowing exactly when and where our patients are receiving care outside our network empowers our physicians and medical staff to appropriately coordinate with those providers and gain critical information. Essentially, we can collect all the pieces needed to view a holistic picture of a patient’s health to make more informed health decisions.

Aside from population health management technology, what other types of health IT is MCHC looking at?

I view telehealth as another promising solution to better coordinate care and expand the reach of healthcare delivery. Medical information can be exchanged as clinicians remotely diagnosis, consult, monitor and treat patients via electronic communications. Studies show that telehealth applications can enhance information access, improve the quality of care, increase patient and provider satisfaction, and reduce costs. However, equipment startup costs, as well as the billing and reimbursement rules applicable to telehealth delivered services, present several ongoing challenges for FQHCs. We’re looking at the possibilities of employing telemedicine at our FQHCs and how it could enhance our after-hours on-call service. We’re also exploring the chronic care management module and how best to support using it.

Given your ACO efforts and diverse patient populations, what coordinated care initiatives are underway?

We’re a Level 3 NCQA recognized Patient Centered Medical Home. As a result, systems are in place to ensure we provide continuous, comprehensive, and well-coordinated care. For example, our processes track referrals for labs, diagnostic tests, and outside specialists; monitor high-risk groups; and track transitions of care. We’ve implemented pre-visit planning huddles to ensure the clinical team can best prepare for patient visits.

How is MCHC working with staff to help everyone adjust to the adoption of the new technologies you’ve mentioned?

Metro’s move from paper to digital documentation has eliminated many inefficiencies and restructured our service delivery model to maximize the collective strength of our care team members. We’re now engaging RNs, LPNs, and MAs to help with care provision and management, pre-visit planning, care transitions, health education and patient self-management support, and accessing community-based supports and services. The challenge (or rather excitement) is to determine how we can make the most of advanced technologies. We’re aiming to institute a good plan for workflow transitions. For example, we organized a number of team meetings and on-site training sessions for our staff to begin using eClinicalWorks for our pre-visit planning huddles. Our goal is ensuring our staff has the necessary support managing successful transitions.

What advice can you share with other physicians who are looking to adopt PHM technology and programs?

Talk with other physicians who are involved with similar projects. Compare programs and health centers, and discuss and share best practices so you can identify what works best and is specific to your healthcare organization’s needs.

Contacts

Jenn, Mr. H, Lorre

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5 Questions With Carlos Menendez, MD Medical Director, Family Health Services of Darke County

Carlos Menendez, MD is medical director of Family Health Services of Darke County in Greenville, OH, and the Ohio Academy of Family Physicians’ 2017 Family Physician of the Year. Nearly 200 FHS employees care for 10,000 patients each month across four facilities. The organization is looking at replacing its E-MDs EHR, which it uses for primary and behavioral healthcare, to EClinicalWorks due to difficulty extracting data for reporting requirements as an FQHC. That data extraction difficulty has led FHS to postpone its attestation plans for stage 2 of Meaningful Use. “We anticipate catching up with Meaningful Use after our new EHR is up and running,” says Menendez. “The new system will help solve this [data extraction] problem,” he adds. “EClinicalWorks also offers modules for behavioral health staff, dental, and eye care providers, thus allowing our entire center to work with a single software system. We hope to transition to the new system by first quarter of 2018.”

How have you seen the role of community health centers change during your time as a practicing physician – particularly in rural communities?

Community health centers have been able to considerably expand access to healthcare, largely as a result of the Affordable Care Act. We were able to convert to an EHR, add dental services, and upgrade our physical plant. Similar expansions have occurred across the country. As a result, our health centers are seeing more patients and providing more services.

The opioid epidemic and physician burnout seem to be the two biggest issues facing physicians. How is your organization dealing with the epidemic?

Unfortunately Darke County has not been spared from the opioid epidemic. We have established an Addiction Recovery Team, headed by Laurie White to help our center deal with this problem. Anna Hatic, DO serves as the physician champion and clinical leader for this team. They meet regularly with other community organizations. They have helped update our procedures and protocols. We have been administering Vivitrol and hope to soon offer Suboxone as a treatment option. Their most valuable contribution has been the education of our clinical staff.

Is burnout a hot topic in the physician’s lounge? What are your thoughts on technology as a contributing factor?

Burnout is not only a topic that has been discussed, but has also been identified as an area of priority. We have a burnout team headed by Sherry Adkins, MD. They have been able to assess the severity of this problem at our center and provide education and support to battle it. Technology and the time it takes to keep up with entries in the EHR has been the main factor causing burn out. Our hope is that changing to a new system will have a positive impact.

How have you seen healthcare technology help improve access and outcomes during your time at FHS?

Psychiatry has been a significant need for our patients. In 2016, we hired Keith Ashbaugh, MD. Prior to hiring him, we were able to provide psychiatry services through videoconferencing. In addition, patients are able to now reach their clinicians through our patient portal. Our pharmacy’s portal is also widely used by Family Health patients. We are also capable of sending notifications via text messages.

Is FHS participating in any coordinated care initiatives right now?

Our office has hired an RN, Jane Urlage, who is our first chronic disease manager. She has been working on protocols for chronic care management CCM. As we explored CCM software options with a representative from CliniSync, an Ohio-based regional IT initiative, we found eClinicalWorks has a very workable CCM feature, so we are looking forward to seeing this in action after we make our transition.

Bonus question: What type of healthcare technology would you like to see FHS implement in the near future? What’s on your wish list?

I hope more patients take advantage of our patient portal so that we can communicate electronically. In the future, we hope to allow patients to schedule their own visits through our portal. I look forward to the day when we can offer the option of virtual visits to a patient in their home or wherever they may be through their laptop or phone.

True interoperability – a quick and easy avenue to communicate with and access information from other health care providers – a specialist, a radiology center, hospital or emergent care center – is also on my wish list. Finally, I hope for all EHRs to find a way to make the data entry process easier so that clinicians and nursing staff can spend less time with their computers and more time with their patients.

Contacts

Jenn, Mr. H, Lorre

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5 Questions With Mark Lewinsohn, Vice President of Clinical Services, LifeWorks NW

Mark Lewinsohn is vice president of clinical services at LifeWorks NW, a behavioral health and addiction treatment nonprofit with 15 locations in and around Portland, OR. The organization recently implemented population health management technology from Enli Health Intelligence to better enable its participation in the federal Certified Community Behavioral Health Clinics demonstration project.

How has LifeWorks NW used healthcare technology in the past to serve its patients? How have you seen health IT improve access to services and treatment outcomes?

LifeWorks NW was an early adopter of the EHR. Implementing electronic records allowed us to build the infrastructure to monitor and track client and service data, and to then support a data decision-making system. Thus, we already had the foundation in place to move forward with the population health solution to address issues that impact a consumer’s outcome (no show, engagement, access to treatment, etc.)

Health IT enables us to use data to determine the root causes of barriers to accessing care, which is critical to improving outcomes. For instance, with such insight we may discover we are not offering enough new patient times or scheduling at times/days that are not desirable. In addition, we can readily identify strategies to engage clients who may be missing appointments or who are disconnected from our services.

What prompted you to begin looking at population health management solutions?

LifeWorks NW has been a pioneer in integrating mental health and primary care. We have had mental health staff embedded in primary care clinics for more than a decade. That integrated care model has proven successful, so now we are focusing on reverse engineering integration: Through a better understanding of an individual’s overall physical health, we will have improved insight into how it may be impacted by their behavioral health condition or vice versa. We know that people with serious mental illness do not access preventative care and have a shorter lifespan than those without. We want to impact
that statistic. Plus, our involvement in the national demonstration project for Certified Community Behavioral Health Clinics has provided additional resources and requirements for increasing our tracking of health metrics and improving coordination of care with primary care providers.

What impact will Enli’s technology have on your participation in the CCBHC demonstration project?

We hope to develop specific protocols that look at the whole health of the individual rather than the siloed approach historically taken in healthcare. Enli will allow LifeWorks NW to efficiently track clients who are receiving CCBHC services and identify those with high health risks due to their chronic medical condition(s). In line with the CCBHC model, we can then more readily identify how their co-morbid condition impacts both physical and mental wellbeing. In addition, through data automation, staff will be able to devote more time to client support because they no longer have to manually track information or look through charts to figure out which clients need outreach/support.

What advice do you have for other behavioral health organizations looking to implement population health management technology?

Population health is new to behavioral health providers. We had a good foundation through our EHR system, and were able to build on that as we moved to implement technology for population health management. To ensure that effort is successful, we believe it is critical to find a partner, like Enli, that has a solid foundation, but is nimble and willing to blaze a new trail and work together to learn what will result for the best outcomes and achieved objectives.

Is LifeWorks NW looking at other types of health IT? What’s on your wish list?

In sum, yes! We believe that there is so much opportunity to make a positive impact on client outcomes and improve community health. We are currently exploring a host of solutions that will improve care coordination between behavioral health and other healthcare and non-healthcare entities. We really see the value of – and great need for – HIEs that will be the pipeline for mobilization of information across our region. That kind of technology will greatly enhance our ability to support the people we serve – and the larger community – with more effective care and treatment.

Contacts

Jenn, Mr. H, Lorre

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5 Questions with Dennis Eberhardt, Clinic Director, Cow Creek Health & Wellness Center

Dennis Eberhardt is clinic director of Cow Creek Health & Wellness Center, which provides healthcare services to the Cow Creek Band of Umpqua Tribe of Indians at two locations in Oregon. Part of the US Indian Health Service, the center recently decided to replace its government-issued Resource and Patient Management System with Intergy software from Greenway Health.

Why did Cow Creek decide the time was right to move from its government-provided patient management software to a commercial product?

The need to move from RPMS has been present for a long time. RPMS, never developed as a true EHR but rather as an Indian Health Service-centric public health data collection device, has been obsolete for a couple of technological generations at least. From an operational vantage point, the decision was simple. Implementing a change of this magnitude, however, is difficult and can be more injurious to an operation than staying with a poor solution if not done correctly. Once the expertise to select and implement a new EHR was brought into the operation, along with the time resource to perform the selection and data conversion, the time was right to proceed. The pressure to bring the EHR technology into the current century is mounting as healthcare is rapidly evolving to a data-driven venture.

What adoption and implementation challenges are unique to organizations that are part of the Indian Health Service?

For a compacted facility there really are not that many. Of utmost importance are the Purchased and Referred Care functions, and accurate data collection and reporting for the National Data Warehouse – both of which are easily handled by Greenway Intergy.

Is Cow Creek participating in any federal value-based programs? If so, which ones, and how important is healthcare technology to your participation?

Unfortunately, RPMS makes participation in value-based programs difficult. Technologically, the reporting of the necessary data is resource intensive and, depending on how the report is formatted, the data can appear to be different for two queries. Greenway’s recording and reporting functions are made with value-based programs in mind, so it will be a natural progression for us once the EHR is fully implemented.

What other types of health IT is Cow Creek using at the moment? How have you seen these technologies improve patient access and care outcomes?

Part of the Intergy package is a patient portal, which will allow patients to communicate with the clinic electronically; and request appointments, refills, and information. The clinic can push out surveys and relevant information regarding current events or patient-specific education.

An optional program within Intergy is the Community Health module, which constantly scrubs the records and reports for actionable items for each patient, called “care gaps.” These can be reported according to established selection criterion, be that all patients or even the next day’s scheduled patients. This will increase our compliance with value-based initiatives, as well as help us deliver a more comprehensive primary care service to our patients.

We are investigating an add-on to Intergy that improves the patient experience. Allowing full electronic patient check-in and then delivery of (age/gender) relevant and branded interactive education for consumption during the waiting time.

Patient outcomes and safety are partially dependent on a well-trained staff. We just recently implemented a fully functional Learning Management System that houses all training and training records online, and is accessible 24-7.

Due to our two-clinic footprint and the fact that our PCP teams travel between locations, patients sometimes need to be seen by the resident team and not by their own PCP team. Although quality is good, it is less than optimal. We are instituting an in-house telemedicine program that will allow the PCP to be virtually present at the other clinic if one of their patients desires to be seen on a day when they are at the other location. This increases access as well as continuity of care.

After-hours care is always problematic. Placing providers on-call has been the go-to option in the past. This is suboptimal for a provider, and has not been shown to deliver better outcomes nor increase patient satisfaction when a provider who is not their PCP is answering the call. We have instituted a 24-7-365 After-Hours Nurse Triage line. RNs address the issues of the patient according to nationally accepted protocols. Patient satisfaction has been higher than on-call since the patient expectation is different. Emergency department visits for routine care are decreased as a result.

The next step is to institute a year-round after-hours, physician-staffed telemedicine service option for patients. Again, patient expectation is that this is equivalent to an urgent care visit. But this increases access to 24-7-365, and patient satisfaction with these services is high. Due to the high degree of communication between the telemedicine vendor and the clinic, as well as our practice of follow up for each after-hours call, outcomes are likely to improve.

What’s next for the clinic in terms of health IT adoption?

Telepsychiatry and tele-behavioral health augmented by in-person support personnel. We are investigating a vendor relationship to bring in service that we would not be able to staff due to rural location and patient loads. These would address true capacity gaps in the community.

Next year will see us fully embrace the outsourcing of claims management, payment posting, and patient statements functions. While this may not directly translate to better outcomes, it does release resources that can be used to deliver more services.

The other next big thing is health information exchange. We will be engaging with partners to share aggregated and specific PHI among various providers and entities to facilitate prior authorizations, insurance eligibility confirmation, referrals, and care coordination.

Finally, interactive online education. There is a large body of knowledge now about how brains function while learning – what sticks and what doesn’t work. Interactivity that is contextual, gamified, and meaningful is under development by our own content producers to be deployed via the patient portal as well as our revamped Web presence.

Contacts

Jenn, Mr. H, Lorre

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5 Questions With Pediatrician Ashley Moss, MD

Ashley Moss, MD is founder of Ashley Moss Pediatrics (MD), and vice president of the Montgomery Pediatric Medical Society. She opened her house call-based practice in January 2017, and now sees three to five patients a day.

What prompted you to launch a house call-focused practice?

I wanted to create a practice that was highly personalized and offered the best quality medical care for my patients. After working in a large traditional practice for nine years, I felt that the trend toward larger practices had hindered my ability to connect with my patients, and provide the continuity and individualized care that I felt was imperative to providing high-quality medical care. I had heard about similar house call-based practices in New York, California, and Texas and so I investigated and decided that not only was this type of practice feasible, it seemed like a really powerful model that could leverage new technology to improve healthcare quality, convenience, and outcomes.

What types of healthcare technology do you use on a daily basis?

I use an EHR that enables me to write notes while seeing patients in their home, email prescriptions to pharmacies, send lab orders and receive results.  I also use an electronic fax that interfaces with my Practice Fusion EHR.  I rely heavily on creative mobile devices that I can easily bring to the homes of patients. For well child check ups where vision and hearing screens are required, I use a handheld mobile device to perform visual acuity, photoscreening, and hearing screens.  The visual screening device then faxes the screening results to my EHR so that the vision screens are easily integrated into the chart. Finally, I use an online direct care practice administration platform from Hint Health that streamlines the signup process and billing for my patients.

What health IT is on your wish list?

I am considering purchasing a temperature monitor for my vaccine refrigerator that remotely monitors and records the temperatures inside my vaccine refrigerator and freezer. It also immediately alerts me by cell phone when either the refrigerator or freezer temperature is out of range. Currently, I keep handwritten temperature logs for the refrigerator and freezer.

I am also considering different telemedicine companies that would enable me to examine patients remotely via a virtual exam room. I’d like these telemedicine programs to interface more efficiently with my EHR; when I find one that does, I will probably decide to make that investment.

Are you participating in any type of value-based payment program?

I don’t participate in value-based payment programs as defined by insurance companies. I do provide my patients with high-quality medical care that is research- and experience-based, and delivered with genuine concern for each child’s wellbeing.

What are your thoughts on the role new business models like yours play in reducing physician burnout?

These models play a tremendous role in reducing physician burnout! Direct patient care practices enable physicians to do what they love and enjoy, which is establishing meaningful relationships with patients so that they can effectively care for them in a financially transparent manner. Physicians can keep patients healthier, provide better medical care, and avoid costly ER or hospital admissions when they know each patient individually. Both physicians and patients are happier with the delivery and quality of the medical care.

Contacts

Jenn, Mr. H, Lorre

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