Use Data From All Available Sources to Enhance Community Needs Assessment and Critical Access Hospital Performance

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The U.S healthcare industry and the rural health community is experiencing profound changes in the areas of financing care and the delivery services. Rural and Critical Access hospitals face the most significant challenges to survival in the current reimbursement paradigm, as well as preparing for value-based contracts with payers and employer groups. One of the opportunities the Critical Access Hospital (CAH) has for managing this transition is using a comprehensive systems-based approach, including the tracking of a balanced set of strategic metrics both internally and externally with partners such as financing institutions and other healthcare providers. In the urban markets, the systems-based approach has been in production for many years to achieve clinical, operational and financial excellence but are typically out of reach for the CAH. 

The CAH facilities traditionally behave as independent health care delivery islands and operated by either a for-profit management company or the local municipality, either of which may not be as informed about the environment the CAH must survive within or has the financial motives to aligned with the regulatory environment. Either way, a significant disruption is occurring within the CAH and rural market, and there seems to be less useful news every day that passes. Hospital closures and health plans at odds with these facilities seem to be top of every news story for this industry. While there is no one right answer, there is a set of opportunities that seem to be moving a few of these facilities in the right direction.

A couple of CAHs in far southwest Oklahoma have taken it upon themselves to begin to effect bold changes to save their facilities and provide better quality health care than some of their urban counterparts. The belief is that with a strong focus on building relationships with patients, partners and the community through transparency, better access and appropriate care these endangered facilities can flourish under a much-reduced fee for service or value-based payment structure. The first step is to use processes and technology typically reserved for the big urban health care systems to participate in public and private reporting programs on quality and customer experience. CAHs have had the advantage with customer satisfaction due to the nature of the “small-town” environment they operate. However, they must have the proof in empirical data to illustrate this in the market. This is where GuideIT and iVelociti have come together with other partners to bring a unique set of solutions specifically designed for the CAH environment to exceed performance through technology impacting cost, quality, and access to health care for their communities.

Many CAHs have focused on a single dimension of the “Digital Transformation” process taking place in healthcare today. Much of that focus has been on “Meaningful Use” requirements and the development of portals for patients the implementation of the electronic health record, as the sole way to reach out and engage the community. Unfortunately, this will not address the growing focus on population health management, and the decrease of traditional acute and swing bed patient volumes customarily seen as the financial stabilizer for these facilities.

To become relevant again in the overall rural health care market, these essential health care providers must look to different ways to increase market share and engage the community in creating required outpatient services locally. GuideIT’s iVelociti working in concert with a reputable management company and their partners have started the process of creating transparency for two facilities in far southwest Oklahoma. By leveraging the facilities investment in electronic health records and revenue cycle systems the iVelociti integration and analytics platform as a service uses data from all available sources to provide community needs assessment and CAH and health system performance. What this illustrates for the CAH is a concise picture of the community’s healthcare needs and why community members often travel elsewhere for locally available services. The platform provides a real-time view of where patients are within the CAH’s health care delivery system and provides for meaningful management of that individuals care as it is occurring.

CAHs are overwhelmed by the wide variety of regulatory requirements on a state and local level and do not have the time or type of resources required to leverage this kind of comprehensive technology environment. This is where the iVelociti platform provides a turnkey ability to integrate information from existing and new data sources and turn it into a simple, usable format which is critical to effect change on the CAHs environment. The combination of integration and analytics as a service allows the staff and partners for these CAHs to focus on their day to day work while the platform brings the people, process, and technology to inform as part of the normal course of business without disruption. As clinical and business functions continue, the platform illustrates opportunities for improvement and creates alternative workflows that can be implemented as a normal course of change management processes. 

Technology is not the entire answer for the CAH's current situation. However, two facilities in southwest Oklahoma are proving in real-time that the focused implementation of a common-sense integration and analytics platform as a service allows for these small facilities to illustrate how they are a better alternative to driving to the tertiary care centers sometimes hours away. Implementation of this type of performance excellence framework focuses on the goal of not only improving outcomes but illustrating them to all who may be impacted. Now more than ever, CAHs need to demonstrate their value provided to patients, their families, doctors and other partners in the community. It is the combination of a management team that recognizes the value of integrating all the constituencies that support these facilities and providing complete transparency through integration and analytics to these groups will shift the focus to measurable outcomes. It is no longer feasible for CAHs to use technology in the same passive manner as the traditional EMR and portal approach. With the recognition that quality and safety measures reported in this manner are not adequate to illustrate the care provided at CAHs, high performance and proactive technology approaches are no longer an option but critical to the facilities survival. 

Authored By: Frank Avignone, Practice Leader, GuideIT