Leveraging Data to PCMH Level 3 Accreditation: Blackstone Valley Community Health Care Case Study
Blackstone Valley Community Health Care is a federally qualified health center that provides primary medical, dental and behavioral healthcare in Pawtucket and Central Falls, R.I. The providers at BVCHC — currently eight physicians, five dentists, two pharmacists and a myriad of mid-level providers — have always prided themselves on providing high quality, patient-centered care.
The practice took its quest to be a patient-centered medical home a step further when it applied for and earned Level 3 PCMH accreditation from the National Committee for Quality Assurance in 2011, due largely to leveraging data.
Basis for accreditationBVCHC had a good foundation of patient-centered care before it even began the application process. We were already a medical home; we just didn't have the recognition," says Ray Lavoie, the practice's executive director.
"Process-wise and patient-centered wise, we were in line with the model," agrees Christine Grey, COO of Blackstone Valley. "Our philosophy was closely aligned with patient-centered medical homes."
Beyond having the right philosophy, the practice already had experience with quality reporting. "Federal guidelines require us to report on quality metrics, and they keep adding to them each year, so we were adept at quality reporting," says Mr. Lavoie.
However, there was one thing BVCHC had to have before applying for accreditation: data. "Before HIT systems, [our quality reporting] was done manually," Mr. Lavoie explains. "I could not see living the rest of our lives doing quality reporting that way."
Implementing data systemsSo, the practice started to develop their HIT systems in 2006. In 2007, BVCHC went live with NextGen Ambulatory Electronic Health Record. In 2010, the practice installed NextGen's patient portal, a key tool for enhanced patient engagement and a requirement for PCMHs.
After implementing all of the new systems, Blackstone Valley applied for NCQA PCMH accreditation in 2011 and earned Level 3 status, the highest level available, on its first attempt. "When we implemented the HIT, that allowed us to meet the reporting standards necessary [for accreditation]," explains Ms. Grey.
Using the dataIn 2012, BVCHC hired a consulting firm to build a clinical data warehouse in order to better handle quality reporting based on the EHR data. "The quality reporting tools allow us to run the compliance and registry reports that we…would be running…retroactively and gave us the ability to run them prospectively," says Mr. Lavoie. "We can query the patients [who are] coming in next week and see what services should be provided [to them] during their visit, which will also improve our quality metrics at the same time. It gives us a leg up on taking better care of our chronic-care patients."
Even with all of the internal data available from the EHR system, BVCHC took it a step further and worked with its Medicaid managed care payor to add monthly claims feeds to the data warehouse. The claims data is incorporated into daily visit reports available to the providers at the point of care. "I think we're far ahead of the curve by adding claims data to the mix and incorporating it into the reporting we do," Mr. Lavoie says.
BVCHC distributes the daily visit reports to the "daily huddles" held with its care teams. "We have a huddle where the needs of the patients are discussed prior to their arrival," explains Ms. Grey. Care teams at BVCHC consist of two providers, two medical assistants, an administrative medical assistant, a registered nurse and a nurse care manager. The care team makes sure the patients' needs are met during the visit.
The reports made available through the EHR, patient portal and data warehouse allow BVCHC providers to better manage their patients with chronic conditions and the health of their population in general.
Importance of dataEven though BVCHC has essentially been operating as a PCMH since it opened in 1990, it was still necessary for BVCHC to update and implement its processes and data systems in order to be accredited as a Level 3 PCMH on its first try.
"The selection of robust EHR is crucial," says Ms. Grey. "And Ray has been willing to invest in HIT. You have to have an administration that is willing to invest in that area."
Mr. Lavoie also believes that data and HIT are a necessary part of becoming a recognized PCMH. "I don't think I could stress anything more strongly than having robust HIT for patient-centered medical homes," he says. " It is a given that one must be able to report to external agencies and funders on compliance, but most importantly, one must provide the feedback to the staff on performance and feed forward for prospective [patient] visit planning in order to improve the quality of care."
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