Session
Improving Quality in Health Services and Programs through Patient-Centered Care, Session 1
APHA 2022 Annual Meeting and Expo
Abstract
Best Practices for the Development of Sliding Payment Systems in Community Health Centers
APHA 2022 Annual Meeting and Expo
Background: Sliding scale discount programs refer to payment systems in which uninsured patients receive adjustable pricing based on their ability to pay. Although such programs are documented to improve accessibility, there is a lack of research on the implementation of sliding scales in community health centers. Furthermore, health centers that promote a federally subsidized sliding discount program remain beholden to enforce limitations on which patients may qualify. This creates a gap in affordable clinical care for those without health insurance. To date, the authors of this project have been unable to find any prior research on sliding fee scales that do not require proof of income documentation.
Methods: This is a pro bono consulting project conducted by a team of medical students that aims to redesign a sliding scale payment system for the Chicago Women’s Health Center to retain clinic revenue while providing affordable and patient-centered care for their clients. The authors were tasked with determining the best practices for the development of a sliding scale that did not require proof of income. This sub-study was conducted through 8 semi-structured interviews with community experts over a five-week period. The interviews were recorded through comprehensive field notes. Established qualitative methods were used to analyze data and aggregate themes into best practices.
Results: Universal process within the sliding payment system promotes equitable patient adherence. When the process is standardized, patients will elicit more accurate information. To facilitate this, sliding systems should be evaluable and flexible, utilize client-center language, and incorporate simple and broad financial input factors.
Conclusions: The results have implications for the expansion of sliding scales without requiring proof of income, particularly among community health centers without federally qualified health center status. Additionally, such payment systems have the potential to increase equitable health care access while retaining clinic revenue.
Abstract
Advanced Team-Based Care for Medicaid patients: Evaluating a new model of care in an urban federally-qualified health center
APHA 2022 Annual Meeting and Expo
Background: Patients on Medicaid who seek care from federally qualified health centers (FQHCs) often have complex conditions and face barriers to receiving care. Due to projected provider shortages, FQHCs need new models of care to address health equity, including patients' complex and idiosyncratic care needs. Our goal in this study is to compare an advanced team-based care (aTBC) model (described previously) to traditional team-based models of care. The aTBC is a 2:1 model that incorporates care team coordinators (CTCs) into patient visits with providers. We evaluate care team interactions, healthcare utilization, and health outcomes.
Methods: The study uses a mixed method design, including observations of care teams in each model and a quantitative analysis using electronic health record data to compare patient health outcomes and utilization. The EHR sample includes Adult Medicaid patients who received at least 50% of their primary care from a single FQHC in a large US city from 2019-2021 (N=5,583).
Results: Observational data show that providers in the aTBC versus traditional model, experienced more substantive conversations with patients and fewer interruptions. Patients spent less time alone, providers spent less time navigating their computers, and CTC and provider effort overlapped less. EHR data shows aTBC patients are more likely than traditional model patients to receive a flu shot (32% vs 18%, p<0.001), receive a Covid-19 vaccine (61% vs 47%, p<0.001), and have a lower PHQ-2 score in subsequent visits (mean score decrease: -0.35 vs -0.044, p=0.01).
Conclusions: The aTBC improves collaboration and communication among care team members, including patients. It also reduces down time, allowing for richer provider-patient conversations. Some high-value preventive services, including vaccinations, increase in the model, and key measures of patient well-being also improve.
Abstract
Center of excellence: a novel program to improve surgical outcomes while reducing financial burdens for patients
APHA 2022 Annual Meeting and Expo
Background:
Prices for surgical procedures are not necessarily correlated with better outcomes. As the health fund for a self-insured union of predominantly working class immigrants and people of color, we have access to all medical claims data, and found disparate and varied prices and outcomes for common procedures at hospitals in our network. Therefore, we designed a Center of Excellence (COE) program for total joint replacement (TJR) and bariatric surgery, to improve outcomes for our plan participants while also reducing expenditures.
Methods:
We directly contracted with high quality hospitals in six states for both TJR and bariatric surgeries. If participants reside within 50 miles of a COE hospital, they must have the surgery performed by a COE doctor at any COE hospital. Both the procedure and 10 physical therapy visits within 50 days of the procedure (for TJR) have $0 copays and no additional cost-sharing. Free transportation is provided to and from the procedure.
Results:
Since its January 2022 start date, we enrolled over 150 participants in the two COE programs, saving participants up to thousands in cost-sharing, and improving overall surgical outcomes. We have seen near universal patient satisfaction with the programs.
Conclusions:
This program is one of the first COE programs in the country and has drastically improved our participants’ quality of life. We believe the COE program can serve as a model for how hospitals and self-funded plans can work together to improve outcomes while removing financial burdens for patients and reducing prices for all parties.
Abstract
Empower-Act Committee (EAC): A Community-Health System Collaborative Approach to Advance Patient-Centered Outcomes at Federally Qualified Health Centers (FQHCs)
APHA 2022 Annual Meeting and Expo
AltaMed Health Services (AltaMed) is the largest FQHC in Southern California. FQHCs are embedded in medically-underserved communities and are uniquely positioned to improve health outcomes among working-class residents of color. However, FQHCs often lack processes to engage with community members/patients beyond the provision of clinical services, missing an opportunity to meaningfully activate these stakeholders around the programs and policies designed to benefit them. Value-based care stresses a team-oriented approach to patient care.
Through the Empower-Act Committee (EAC), which aligns with the National Academy of Medicine’s Health Equity through Transformed Systems for Health conceptual model, AltaMed builds the capacity of patients, community, healthcare staff, clinicians, and community-based organizations to engage community members and patients in co-designing and co-leading programs and policies that aim to advance patient-centered outcomes. EAC has 27 active members, including six clinicians, five research scientists and associates, and five community organizing and engagement coordinators. EAC set the following priorities: 1) Engage patients & community year-round in building health equity; 2) Increase patient-community centeredness in research, service grants, & health services; 3) Build the infrastructure to disseminate outcomes; and 4)Increase patient/community-centeredness in clinical training & staff on-boarding.
Early lessons highlight that transforming healthcare systems requires capacity-building of key stakeholders to collectively examine healthcare system transformation from the patient and community member perspective. Our work has focused on increasing opportunities for community engagement, relationship building and management with key internal and external stakeholders, adopting new organizational policies with patient and community input, and building community power. We aim to grow the depth of community and patient engagement across initiatives. Lessons learned from the Empower-Act Committee can inform other health systems interested in advancing patient- and community-centered research, medical education, programs, and policies as a key strategy to strengthen value-based care.