Patient access: How to unlock optimal service, maximum efficiency

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Federally qualified health centers have long cared for the uninsured and underinsured by providing free or low-cost primary care services in underserved communities.

Patients in these communities often have unique challenges to accessing care, such as lack of transportation, inconsistent housing and other socioeconomic barriers. That means ensuring care quality, consistency and continuity is challenging; these health centers, despite having highly skilled care managers, aren't always equipped to connect people to the resources they need to improve outcomes.

In a workshop sponsored by Orb Health as part of the Becker's Hospital Review 9th Annual CEO & CFO Roundtable, Alejandro Romillo, president and CEO of Health Choice Network (HCN), discussed how partnering for certain care management services helps patients and the federally qualified health center's bottom line.

Four key takeaways were:

 

1. Federally qualified health centers aren't equipped to fully address gaps in care. When an uninsured or underinsured person leaves a clinic with instructions and next steps, there are any number of reasons why those instructions are not followed. Patients at these health centers are a unique population with unique challenges. They often need additional resources and services, but payers, hospitals and other providers aren't always equipped to fill these gaps, whether the issues are related to social determinants of health, COVID or something else.

This leaves federally qualified health centers, whether in fee-for-service or risk-based contracts, to solve care transitions and other issues. However, community health centers, like other providers, face challenges of staffing shortages, call center inefficiencies and other overwhelming issues.

 

2. Care managers already have their hands full. At health centers and payers alike, many care managers are serving double duty as project managers or in other roles. Also making care managers' jobs harder are EHRs that are not connected to other parts of the care system, hindering care managers' ability to see the complete picture of a patient.

 

3. Care management as a service helps fill those gaps. A solution like Orb Health provides not only scalable call center support, which is where HCN started, but many other features of care management that can connect people to resources outside of what most provider networks can offer: transportation, help with shelter, food and other basic needs. For those patients, Orb can simplify their healthcare journey and maximize outcomes, while helping care providers achieve financial success.

 

4. Maintaining connection with the patient and ensuring patient access are key. Sometimes it's as simple as transferring people to the right resources rather than telling them to call another number. Benefits also include data bridging between platforms that Orb has access to and having trained U.S.-based clinicians available to talk to people: Mr. Romillo said HCN has found that 74 percent of people do not want to speak to someone in another country about their healthcare.

With planning, federally qualified health centers and other community health centers can provide health-related services for underserved patients to thrive, even in today's trying times and with COVID-related challenges. The key, Mr. Romillo said, is recognizing strengths and finding valuable partners — like Orb — who can show ROI with their solutions. "It's hard to be good at everything," he said. "When we started looking at what we're really good at, we're really good at that point of care and following up on the patients. But we're not good at opening our phone systems and making sure patients can easily access us." That's where a partner like Orb comes in.

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