Proof of Concept Project: Enable Community Health Centers to Operationalize Strategies to Impact Improvements in Health Care Quality and

Cost Control Use

Project Objectives
The Massachusetts eHealth(MeHI) Institute of the Massachusetts Technology Collaborative (MTC) contracted with the Massachusetts League of Community Health Centers (MLCHC) to provide services along with Arcadia Solutions to support a pilot project that seeks to establish a replicable model and road map for reducing medical expenses for Medicaid patients in Massachusetts, while maintaining or improving the quality of healthcare through improved preventive care and patient care coordination and management. The Project engaged three community health centers in an ACO Readiness Assessment and Quality Improvement Projects, incorporating data from the Azara DRVS EHR reporting solution and “total medical expense” data from two Medicaid payer plans. MeHI with the MLCHC and Arcadia Solutions, as Project Managers, has completed a Proof of Concept to determine how prepared CHCs as Medicaid providers are to take on risk in alternative payment models, such as ACOs, and how capable they are to use the Total Medical Expense (TME) and other quality, operational and financial data for patients to improve care coordination and delivery. Completed deliverables include an ACO readiness assessment and strategic road map for three pilot centers and development of a replicable ACO playbook to guide other centers on managing with data for success in payment reform and ACO.

ACO Readiness Assessment
Arcadia completed ACO Readiness Assessments for three Community Health Centers (CHCs): • • • Family Health Center of Worcester Harbor Health Services Lynn Community Health Center.

These Assessments evaluated each CHC’s readiness to be successful in risk contracting and ACO participation across a broad set of criteria, which included the following. Each Center received recommendations to address gaps • • Network affiliations Proficiency with Health Information Technology (Health IT) Use of data to drive quality improvement Access of patients to appointments with primary care providers Adoption of team-based care models Ability to manage and coordinate care across multiple specialties and facilities Readiness of each CHC to take on the financial risk in an ACO.

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The Assessment included the following: • Structured interviews with CHC leadership and managers On-site observations to understand patient flow and use of health IT Review of clinical performance data from DRVS – the CHC’s data reporting tool Analysis of standard financial and clinical performance measures Review of aggregated TME and patient utilization information from two Medicaid payers.

Key Findings
While CHCs appear well-positioned for clinical transformation demanded by an ACO, the project initial findings have identified cross system and center based operational processes that if not corrected will undermine the CHCs’ ability to sustain and thrive in this new payment model. The transformation efforts at CHCs are challenged by inconsistencies between payer requirements and desired outcomes. Five key areas of opportunities have emerged. 1. More efficient systems to support accurate attribution of patients to CHCs and Physicians 2. More complete and efficient aggregation of information about patient TME and utilization 3. Maximization of the implementation and adoption of existing and evolving HIT functionality 4. Increased adoption of Patient Centered Medical Home (PCMH) and related Care Coordination 5. Enhanced data use and analytics with modeling of clinical and financial risk for CHC’s patients.

Improvement Project
The Proof of Concept included a quality project at each center to improve the care and care coordination for a subset of Medicaid patients. Arcadia, with the Health Plans, identified high TME patients at each Center. With the support of MLCHC Project Team, CHCs prioritized high TME patients for care plans to improve care coordination. Not only will the care plans lead to improved health outcomes and health costs for patients, but “learnings” from these projects will inform efforts to incorporate this use of data and strategies into providers’ practical workflows.

Contact Information Massachusetts eHealth Institute A Division of the Massachusetts Technology Collaborative 2 Center Plaza, Suite 200 Boston, MA 02108 617.371.3999 | info@maehi.org mehi.masstech.org www.maehi.org

Laurance Stuntz

Director, Massachusetts eHealth Institute stuntz@masstech.org