Collecting Data on Patient SDOH & Interventions to Address Them

Presented by: National Association of Community Health Centers and Association of Asian Pacific Community Health Organizations Health Outreach Partners

A hallmark of community health centers is their ability to address the multiple, complex needs of their patient populations, both through high quality clinical services as well as non-clinical enabling services that promote full patient engagement. Having comprehensive data on both clinical and non-clinical needs is essential for understanding patient circumstances, developing interventions that address their needs, allocating resources effectively, and proving the value of services provided. During this webinar, presenters will provide an introduction to PRAPARE, a standardized, social determinant of health risk assessment tool, and how it has been used in health center settings through different workflow models, its use to inform diabetes care, and its impact on care and community transformation. They will also describe tools and resources for documenting enabling services, such as care coordination, language assistance, transportation, and/or other support services, as well as present a case study describing how efforts to track enabling services provided the data necessary to support a health center in targeting and improving diabetes management services.

By the end of this webinar, participants will be able to:

• Compare and contrast different workflow models for collecting standardized data on the social determinants of health using PRAPARE and using PRAPARE data for care and community transformation.
• List at least two ways that using PRAPARE data can inform diabetes care.
• Describe the importance of enabling services data collection and documentation in demonstrating their value in addressing patients with uncontrolled diabetes.
• Use existing resources and TA support to launch PRAPARE and Enabling Services Data Collection initiatives in their own health centers.

Assessing Readiness to Incorporate SDOH into Health Centers

Presented by: Association of Clinicians for the Underserved and Capital Link

Health centers have always been innovators, at the forefront of negotiating numerous opportunities and challenges in providing care to complex patient populations. In today’s health care environment, how can health centers best prepare to continue that legacy of innovation? What considerations should health centers evaluate before embarking on a new initiative focused on addressing social determinants of health? Before you begin a new program, join this webinar to explore the operational, financial, and workforce implications of incorporating social determinants into your health center. Presenters will explore a framework for organizational readiness to take on work that might require substantial collaboration, financial resources, and new requests of an existing team of staff and clinicians. Presenters will share real health center examples of these types of service expansions, free resources for evaluation, and suggestions for starting various levels of interventions to improve diabetes outcomes at your health center.

By the end of this webinar, participants will be able to:

• Identify major financial and workforce considerations for implementing a new program focused on addressing social determinants of health, particularly diabetes management.
• Describe the operational impact of developing new programs, and best practices to mitigate risk and minimize challenges.
• Access resources and evaluation tools.

With value-based care, providers are increasingly being asked to take on more accountability, and in some cases financial risk, for cost and quality outcomes for a defined population. This webinar aimed to help health center leadership assess whether they are investing sufficiently in the clinical and administrative infrastructure and analytics to succeed under risk-based payment.  The session addressed three key questions: 1) What data do I need and how do I get it? 2) What do I do with the data once I have it? and 3) How do I apply what I learn from the data to manage quality and costs?  The session featured health centers engaging successfully in risk-based contracts using a robust population health management system.

The CMS Medicare EHR incentive program has ended with the 2016 reporting period. Medicare eligible professionals (EPs) are now being directed to report to the Quality Payment Program (QPP), which most health center providers are not eligible for. Similarly, while the Medicaid EHR incentive program is ongoing, the enrollment period has ended. In this complex environment, what are the options for health center providers?

This webinar summarized the latest CMS guidelines, and clarified the options and requirements for providers in the 2017 EHR incentive program reporting period and beyond.

This webinar explored: 

• Helping rural healthcare orgs advance key clinical initiatives
• Overcoming connectivity hurdles
• How to improve connectivity at your organization

Note: HIMSS has approved this webinar for up to 1 contact hour of continuing education toward CPHIMS credential renewal.

Register for the webinar now!