How Delaware Health Net Is Leveraging HIT to Enhance FQHC Patients’ Health Status

Exciting things are happening at federally qualified health centers (FQHCs) these days, as those patient care organizations work to provide the best possible care and care management for uninsured and under-insured patients in organizations all across the country.

Among the organizations working to help patient care organizations move forward in a number of areas, including around health information technology (HIT) implementation, implementation of quality improvement processes, achieving patient-centered medical home (PCMH) recognition, and, until recently, fulfilling requirements of the meaningful use (MU) program under the HITECH (Health Information Technology for Economic and Clinical Health) Act, are health center controlled networks (HCCNs), which are networks of health centers working together to improve performance, with supportive funding from the Health Center Controlled Networks Program under the Health Resources and Services Administration (HRSA).

One very active HCCN is Delaware Health Net, a Wilmington, Delaware-based organization that has been helping FQHCs nationwide to improve their performance and operations. As described on its website, “Delaware Health Net is a membership organization made up of medical practitioners who collaborate as ‘safety net providers’ to improve access to care, enhance quality of care, and achieve cost efficiencies through the redesign of practices to integrate services, optimize patient outcomes or negotiate managed care contracts on behalf of the participating members.”

Using various digital information technologies, collectively, participants in DHN have achieved measurable clinical improvements, with expanded activity planned for 2019. Among the clinical improvements that member organizations have made are the following:

> Member organizations have increased screenings for cervical cancer in women aged 21-64 to 60-80 percent, nearly double what it was just a few years ago.

>   Tobacco use and cessation education rates are now all over 80 percent, triple what it was from a couple years ago.

>   While colorectal cancer screening in the uninsured population has always been traditionally challenging, the DHN centers are seeing 60-percent-plus successful screening rates.

Delaware Health Net’s membership encompasses 17 FCHCs in Delaware, New York, North and South Carolina, Ohio, Minnesota, Washington state, and California. The organization has been partnering with the Chicago-based Allscripts, to help its member FQHCs implement a text message-triggered patient portal called FollowMyHealth®.

Recently, Delaware Health Net’s CEO, Craig Law, spoke with Healthcare Innovation Editor-in-Chief Mark Hagland, regarding his organization’s work in this area. Below are excerpts from that interview.

Tell me a bit about the work of your organization, and how your current efforts fit into it?

Delaware Health Net is an HCCN, health center controlled network, under HRSA. We receive grant funds to help FQHCs (330s) manage change, etc., and really stay on the forefront. We’re focusing on PI (formerly MU), help the organizations obtain PCMH status, help them with analytics. They’re trying to keep their lights on, so the whole idea of being on the cutting edge is a stretch.

So we help them with the latest features and functionality, and with measures. Like some clinical measures, per screening rates, and that’s really important, because in our patient population, 50 percent of patients are below the poverty level. So they don’t have a lot of resources. So we’re trying to help them with preventive care and help them manage their chronic illnesses, and connecting them with resources. And we’re also forward-looking in terms of getting some advanced analytics out there.

This is a challenging population to help with in terms of enhancing their health status, correct?

Yes, that’s right. With this patient population, patient engagement is really tough—it’s tough to get them engaged; frankly, most don’t have access to email on a regular basis. The good news is that nearly all have smartphones—so that’s where we started.

We’ve been working with Allscripts to help our member FQHCs set up a portal via text links, instead of email. Allscripts calls it FollowMyHealth®. That could be a game-changer for us. Though many our FQHCs’ patients have language and literacy barriers, most can text fluently. So we can use that capability to help them with scheduling and patient engagement. Another capability involved is the ability to create a to-do list for providers, so that clinicians can get immediate prompts, around primary and preventive care tasks in the patient visit.

Is the portal live yet?

We’re in the final stages of rolling it out. Usually, we get one or two health centers to pilot any new feature. Once we’ve piloted, we expand a rollout to other member FQHCs. We’re scheduled to go live with the first couple of sites in May.

Can you explain a bit about the mechanics of texting to open a portal?

Essentially, the solution allows you to send a secure, encoded text message to the patient’s phone; the patient can click on that link, and it will open the browser-based account, and then the patient can begin the registration process; using this solution, all the patient needs to do is to enter their name, cell phone number and date of birth, to fully register.

How many patients are in the universe of the population who could make use of this solution?

It will easily be around 400,000, but it may very well be 450,000. This could potentially have a large impact.

And will the instructions and information in the portal be set at an easy literacy level?

To be completely transparent, that’s one of the big challenges that the industry faces right now. When portals share information, even a clinical summary, that summary isn’t necessarily adjusted down to the level of the literacy level of the patient. We have to look at that, at bringing those summaries down to a third- or fourth-grade level, and in many cases, translating them into different languages. I go all the way to CMS [the federal Centers for Medicare & Medicaid Services], in terms of an issue we still need to address, in terms of a legislative or public health perspective.

How does this fit into the broader picture of care management, population health management, and patient engagement?

Everybody recognizes that we have a primary care provider shortage. From that, we’re dealing with how to reach a greater number of patients virtually; we can’t bring them all into the office, we don’t have enough providers or space or time. With this capability, you’ll be able to launch a telehealth capability. This is part of the whole concept of starting to reach out and eliminate barriers to communication and connection. If patients have to come into the office, they might lose an entire day’s work, other burdens. So being able to check in with them periodically outside of a face-to-face encounter, that’s where we’ll be able to make a difference.

How big a staff do you have at Delaware Health Net?

We’re a very lean staff. We have four FTEs: one person is focused on analytics, and one is focused on customization and optimization of EHRs and clinical information systems. We have one person focused on end-user and super-user training; and then then there is myself, who really keeps everybody going, and who manages the internal and external relationships.

That’s very lean.

It is; but that’s the nature of being federally funded. There will never be huge dollars there. But we can gauge the ROI, and look at the impact. We’re getting to between a 2-to-1 and a 3-to-1 return on investment on much of what we do. We think we’re on the right path.