In response to relaxation of telehealth reimbursement rules during the COVID-19 pandemic, Community Health Centers (CHCs) have rapidly transformed in-person visits into telehealth visits that reduce the spread of infection to patients and staff. Although those rules will likely be tightened after the emergency period, it is likely that in many states, telehealth will continue to be a reimbursable option of care. To this end, health centers may consider re-designing their primary care model to expand virtual care and will need to evaluate financial feasibility. From a reimbursement perspective, CHCs in some states were already operating under a primary care capitation alternative payment methodology or able to negotiate one with payers. This provides even greater flexibility in terms of means of serving patients and choice of the most appropriate member of the care team. This workshop will explore clinical and operational considerations which may impact financial sustainability. Furthermore, it will discuss reimbursement options which could incentivize how health centers manage total cost of care in a virtual environment. Participants will learn key concepts which should be integrated into a financial modeling exercise that would serve as a business plan, and identify return on investment (ROI) for a virtual care program.

Prior to COVID-19, health centers often struggled with engaging patients in their care or providing care in non-traditional ways, such as via telehealth or the patient portal. Now, health centers have the opportunity to set a new standard for how patients can access health care services in the “new normal”. By structuring an access monitoring program, health centers can measure and positively impact provider continuity, appropriate schedule utilization, appointment availability, and patient engagement. Health centers have the opportunity to leverage the hard work and ingenuity demonstrated when implementing processes in response to COVID-19, such as those for text message communication, COVID-19 testing services, and telehealth, and can now optimize and sustain these process to improve access to care and increase patient engagement long-term. 

Clinical organizations have rapidly pivoted to provide virtual care during the COVID-19 epidemic; however, there is great opportunity to advance the automation and improvement of other aspects of public health. The CDC in partnership with organizations like Johns Hopkins Bloomberg School of Public Health, has developed electronic approaches to public health reporting on reportable conditions. Public health agencies have similarly rushed to shore up existing systems and innovate and automate public health activities including reporting, contact tracing and public health messaging and control measures that can bend the curve on communicable disease transmission. Here we discuss the available approaches to public health, from the perspective of the federal public health infrastructure, the state/local public health agency and the community health center and their data partners and how interested parties might advance their own clinical enterprise and data towards seamless reuse and downstream public health activities.

COVID-19 has resulted in additional funding for Health Centers. As frequently happens with new federal funding the compliance environment evolves with the latest frequently asked question (FAQ) updates, new reporting guidelines and documentation standards. While the environment is changing that doesn’t mean Health Centers can wait passively for a perfect future date to begin taking compliance seriously. In this session we will provide an update on the current grants management environment. We will share what we know, what we don’t know and provide insight into how the compliance environment is evolving. We can be certain that things will continue to change, but this session will provide confirmation for some, ideas for many, and motivation for others. Compliance is a required part of this funding and ignorance is not an excuse that the Office of Inspector General (OIG) accepts. Join BKD for this session as we work to help you and your Health Center reduce your risk for this federal funding. We are entering the phase of accountability for this funding and we want you to be prepared.

Operating a call center that fields nearly half a million phone calls each year typically requires innovative strategies to support employee recruitment, retention and satisfaction; IT infrastructure; and metric measurement. Then, COVID-19 hit. Erie Family Health Centers was forced to quickly and dramatically transform its entire model of care – and Patient Access Operations along with it. More than 70 employees were transitioned to work from home within the span of two weeks. Training programs were revamped to ensure teams were ready to support rapidly evolving models of care, including the rapid launch of telehealth visits and 7-day-a-week care. This session will discuss the sustainability of potential advantages of many of the adaptations that Erie, and other community health centers, made to the way our Patient Access Centers operate. We will focus on the potential benefits for employee recruitment that a work-from-home model may offer. We’ll look at the important metrics that are necessary to measure to sustain the health of your call center during a time of crisis and beyond. And we will explore the adjustments to employee training that allow organizations to be more agile, more responsive to change, and more empathetic to employees' needs and wants.

This session will describe the state of healthcare cybersecurity from a sector-wide perspective, the cyber threats that healthcare providers are facing, and what strategies and tools they are using in order to address these threats. This session will highlight best practices for improving your security posture. Learn about the impact of the COVID-19 pandemic on healthcare cybersecurity and information privacy programs within healthcare organizations and what organizations are doing to combat cyber threats in a COVID-19 world.

CMS, State Medicaid programs and commercial payers are getting more aggressive in moving providers from volume to value-based pay (VBP).  Exactly how VBP will be implemented is evolving, particularly for FQHCs, but it does appear to be here to stay.  COVID-19 demonstrated that fee-for-service doesn’t provide the flexibility providers need to pivot their models to meet the changing needs of their patients and communities.  And, CMS demonstrated its continuing commitment to VBP by issuing a letter to Medicaid Directors on September 15, 2020, with information on how to advance payment to support value-based care.  FQHCs will need to develop capabilities to be successful as VBP continues to evolve.  This session will describe the types of VBP methodologies that are being discussed, the clinical and financial capabilities FQHCs will need to be successful, and how health centers can prepare for VBP.  

One health center out of Hope Valley, Rhode Island will share their experience in building a new patient visit model that reached the following results: a 33% increase in patient access, 46% decrease in no-shows, and a 38% increase in capacity utilization. While improving patient access to care has many favorable benefits to patients including improved health outcomes and quality of care, it requires process changes, innovation, and a bold leadership group. Results include a greater volume of patient visits while also attaining improvements in no-show reductions and capacity utilization.

COVID-19 changed how health centers approach providing access to primary and specialty care for communities disproportionately affected by COVID-19. This session will highlight two examples of health centers that leveraged alternative delivery models for providing high-quality services to their patients in communities.   The first example will feature CCI Health and Wellness Services, which transitioned its group-based prenatal care program – which had a successful track record improving birth outcomes – to virtual group-based care within two weeks. CCI’s Centering Program combines standard health assessments, interactive learning in a group setting of 10-12 women, and community building to help foster positive health outcomes and behaviors amongst its prenatal population.   The second example will highlight a virtual diabetes education program and efforts to address social determinants of health. Community Care Network of Kansas and Health Ministries Clinic (HMC) participated in a demonstration project that focused on the social determinants of health (SDOH) in a targeted Medicaid population of Hispanic patients with diabetes. HMC staff used PRAPARE to collect actionable data and Azara DRVS to identify care gaps and report average assessment score, specific social risk factors, and clinical diabetes measures. To maintain positive outcomes during the COVID-19 pandemic, HMC began offering telehealth services, which allowed a diabetes educator and care management staff to use audio only and audio/video telehealth along with in-person visits to stay connected to their patients.

The COVID pandemic has upended CHC financial models. Previous financial projections aren’t useful, and it is hard to project visits. Testing and immunization financials are also unclear. This session will discuss using shorter, flexible budgeting templates, and evaluate the medium-term financial outlook.

A resilient team is able to effectively respond to unforeseen challenges and agilely pivot when confronted with crisis. These teams are made up of confident and self-managed individuals able to focus their attention on the right things at the right time. They are better equipped to perform in an environment of continuing uncertainty and uncontrollable change. Decisions must be made in the moment. Leaders need to be adaptive and, often working remotely, trust the actions of their work force on the ground. They must strengthen the environment that supports their front-line teams who need to be present and, despite challenges, adversity and constant changes, meet the needs of the organization and take care of patients as well as themselves. During this session we will discuss factors that define resilience, the unique components of a resilient team and steps for development. Take away tools to improve communication and build trust, build adaptive leadership skills and engage diverse perspectives and increase inclusivity across your organization.

Tools such as workflow process analysis and Lean methods can be very helpful in implementing new programs effectively. They can also be used to optimize programs that have been implemented rapidly. Many health centers implemented telehealth programs rapidly in response to the current pandemic and public health emergency. Some of these programs may benefit from the improvements that can be gained from using a more structured analysis and process. This presentation will provide an overview of workflow process analysis tools and an example of how Lean methods were used to implement a telehealth program both rapidly and efficiently across a multi-site community health center.

The COVID-19 global pandemic has changed lives and work forever. Remote staff management, demand for telehealth, elevated levels of “free” testing for all (regardless of insured coverage), care rendered virtually across state lines, and with so many newly unemployed… expanded Medicaid enrollment. Remotely evaluating staff and team building, mastering telehealth (billing and documentation), understanding enrollment/credentialing for virtual care rendered across state lines, and assuring “front desk” (virtual or in person) are verifying Medicaid eligibility status, etc. These are just a few areas of focus in the COVID world of health center RCM. Attend this session to elevate awareness of potential liabilities and learn opportunities to find success in our “new normal.” Learn what remote management tools exist to keep your RCM team on task. Hear suggestions for optimizing telehealth income and address potential liabilities around rendering virtual care (e.g., provider licensure, payer enrollment, consent, and the myriad of coding options).

Pharmacists are a key member of the health care team in community health centers, providing chronic disease management, medication education and preventive health care. The Holyoke pharmacy team has an integrated model, utilizing pharmacists and pharmacy residents to address gaps in care. Hear from the Holyoke Health Center pharmacy team about the development of their integrated model, including their residency program, and steps they have taken to include immunizations in their daily work. Specific workflows surrounding the Shingrix, flu and COVID-19 vaccinations will be shared.

Health Centers have seen a boom of available electronic patient engagement tools promising everything from decreasing no shows to improving patient self-registration and screening. Throughout 2020 health centers have been increasingly interested in adopting patient engagement tools to reach patients at home and minimize waiting room time to keep everyone safe. Knowing whether these tools will succeed in health centers, where patients may have more complexity and budgets may be leaner, is an ongoing challenge. To this end, HITEQ along with several HCCN Partners, interviewed a number of health centers and vendors about the use of electronic patient engagement tools. This session will share with you the results of those interviews, key lessons learned, and some tips as to what you may want to look for when considering these tools for your health center.                   

Too often, finance and quality teams speak a different language in terms of “value” – e.g., productivity vs health outcomes. This panel presents a framework that assesses strategic plans and priority projects in the context of maximized value. The discussion will review considerations for measuring “value” in the broader terms of access, service, outcomes and cost. They will share lessons from the Making the Value Connection program, a pilot of California clinics structuring “Value Projects” that have direct linkages to strategic priorities and are tracking both outcome and cost variables.

Medical Assistants are sometimes described as the “choreographers” of the team-based care visit. But how does the choreography of an in-person visit translate to the telehealth visits that have been adopted in response to COVID-19? With telehealth, health centers are forced to e-design and re-imagine the team-based visit, and the role of the MA. This session draws on the experience of two community health centers and the National Institute for Medical Assistant Advancement to explore the changing role of the MA, and the implications for MA skills, aptitudes, and training. The session will highlight the various roles MAs can take on in a telehealth model, and what “choreography” looks like in telehealth. Panelists will also discuss MA skills and aptitudes needed to support a successful telehealth visit, and how their organizations have facilitated the development of those skills. The panelists will share a brief self-assessment that participants can use to identify 1) how they can better use MAs to support telehealth visits, and 2) skills that their MA staff may need to build to better support telehealth.

A deadly pandemic. Business shut down and health center closure. Shelter in place. Financial stress. Racial Injustice. A Perilous Future.   In four months of outreach, 31,586 texts and phone calls were attempted to our elderly and chronic conditions patients, to check in and offer them telehealth appointments with their PCPs. We reached 32% (10,225) of them and successfully booked 5,320 mostly telehealth appointments. Highlights include 1,983 Diabetes and Hypertension patients reengaged in disease management and 756 seniors reconnected with their PCPs. As the burden of COVID infection, death and economic hardship among our patients of color became increasingly apparent, we expanded our efforts and made contact with 1,081 African-American and Hispanic/Latino patients and connected 681 (63%) of them with their PCP for a telehealth appointment. Understanding the mental health impacts of these difficult times, we completed a standardized depression assessment with 273 of our patients receiving a phone call. Overall, this outreach effort resulted in 3,947 billable visits and $480,000 in revenue.   Speakers will reflect on the financial benefits realized through this effort and clinical outcomes garnered, and share meaningful interactions between outreach staff and patients.

1.    Discussion of overall implications of pharmacy issues 2.    Impact of manufacturers on CHCs and the risk to the CHC program as a whole 3.    Strategy for moving forward 4.    Split billing and compliance strategy 5.    Legislative updates 6.    Q&A

The dearth of physicians in underserved communities widens health disparities. The California Oregon Medical Partnership to Address Rural Disparities in Education and Health (COMPADRE), a robust collaboration between UC Davis School of Medicine, Oregon Health and Science University and 32 residency programs, aims to transform the workforce by better selecting and training physicians for practice in rural and underserved communities. This unique partnership between community health centers, academic institutions, and hospital systems will allow students to train in their future clinical practice environments throughout medical school and residency, participating in a curriculum that includes health systems science, novel competencies for practice in under-resourced communities, and wellness activities to promote meaning and joy in practice. In this interactive session, representatives from academic institutions and a community health center will describe how your organization can develop robust partnerships to create a workforce that is prepared, more equitably distributed and more deeply connected to underserved communities.

Childhood immunizations is a UDS measure on which is notoriously difficult to improve. The change in the age cut-off for the measure from 3 to 2 years along with persistent cultural and social factors surrounding vaccinations has made this measure a challenge for community health centers. Hear how one CHC in Missouri approached improving their rates of both childhood and adolescent immunizations through a combination of community outreach, staff education, and a strong IT solution. Samuel U. Rogers experienced a ~40% drop in their rates of childhood immunizations between 2015 to 2016 with the measure change from 3 to 2 years and resolved to improve. Staff conducted outreach campaigns using specific registries to identify children missing immunizations and turning two in the next 6 months, as well as a patient visit planning report to see what vaccinations were due at the point of care. Staff engaged in a similar process for adolescent HPV immunizations, at the same time working within the community to educate parents on facts about vaccinations and provide financial assistance for care. Samuel U. Rogers achieved a 13% improvement between 2016 and 2019 and continues to improve steadily with their combination of patient education and data usage.