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Today Is About Recovery. Tomorrow Is About Sustainability.

By Michele Hannagan, RN, MS, FNP

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Today’s Federally Qualified Health Center (FQHC) C-suite is charged with managing the near impossible: recover and stabilize from COVID-19 while figuring out how to reach more patients with fewer staff. And there is no miracle cure. Resources are slimmer than ever before. Clinician burnout is a quantifiable problem keeping both CMOs and CFOs up at night. Health center leaders and their mission-driven teams have pulled together to deliver COVID-19 testing and vaccinations all while continuing to provide primary care to their patients.

Practices across the country have been given a lifeline this April: President Biden announced the American Rescue Plan Act Funding (H8F) in which 1,376 FQHCs will receive more than $6 billion. With this record-setting infusion of cash, health centers are now uniquely poised to change their present and their future. How is this to be accomplished? The answer comes from HRSA by way of their broad and flexible H8F grant parameters. HRSA and the Biden administration have made the single largest investment into FQHCs because they recognize that community health centers are the anchor for delivering on the Quadruple Aim: healthier people, lower costs, improved patient and clinician satisfaction. The Quadruple Aim is the four-legged stool upon which the smartest health centers will build their initiatives for this H8F funding.

Clinical Imperatives

Using a lens of health equity and eliminating health disparities, health centers must meet patients where they are. Never has this been more concrete than during these past 12–18 months. Telehealth–virtual visits and telephonic visits–became the vehicle to do this in 2020. Many health centers were already on that road and many others were caught by surprise. Given the federal government’s investment and parameters, telehealth isn’t going anywhere anytime soon. 

Today’s recovery can be tomorrow’s sustainability. The smartest healthcare leaders are thinking hard and fast to make telehealth sustainable for clinicians, staff, and patients from equipment to access to workflows. Invest in telehealth to secure sustainability. Invest time and strategy into increasing patient access. Why? To improve health outcomes—one goal of the Quadruple Aim.

Workforce Imperatives

Clinician burnout and staff burnout. Employees who have left healthcare and aren’t coming back. How do health centers do more with less? These are the dilemmas of every CMO, CNO, and CFO. Everyone has heard the adage, “no margin no mission.” Employees are an organization’s most important asset. HRSA thought this topic so important that they specifically called it out in the H8F guidance. There is more competition than ever for a shrinking pool of qualified, mission-driven applicants. One could argue that offering bonuses or hazard pay is the way to fix this, but one could argue that this is a temporary fix and thus does not address HRSA’s ask that health centers plan for their future health. 

There is another idea. Invest in culture and education. Invest in learning that yields high-performing team members who work at the top of their scope for the Why of mission-driven care. This leads to happier workforce, less burnout, and once again toward that Quadruple Aim. 

Are you fully optimizing the systems you have in place? How do you know the ROI for your investments, whether technology systems or people? HRSA is asking health centers to learn from this past year and make changes based on those lessons learned. Workflow review, education/re-education of support staff, and an intense and uncomfortable self-awareness campaign designed to uncover areas of underutilization of one’s current EHR are critically important for the forward-thinking FQHC.

IT Infrastructure and Security Imperatives

Here comes the yawn part for those of us with a heavy eye toward clinical care: cybersecurity. Cyber-insecurity is a real and present threat to all healthcare systems everywhere. It is truly not if but when and HRSA knows this too. They are calling upon health centers to prepare for when and to consider using this H8F funding for such measures if they haven’t done so already.

The good news is, FQHCs do not have to do this work alone. In fact, engaging with others is key: PCAs, HCCNs and of course one’s EHR vendor should be top of mind for this kind of strategic planning. From hosting to cloud-based solutions, there are now more options available than ever before. Today’s recovery includes protecting data. Tomorrow’s sustainability depends on the proper investment and management of data protection. 

Data Analytics and Business Intelligence Imperatives

In the era of ACOs and IPAs, Value-Based Payment models, and a host of other marketplace competition, the health center who manages its data is setting the most strategic pathway toward long-term sustainability. Business intelligence leaders who have mastery of their data and invest in its integrity understand this. C-suite leaders who have made the significant investment in structure and process also know this. Are you data smart, data ready? How do you know if you are or aren’t? 

Costs of care are quantified in many ways. That is the point. There is no one easy way to measure the cost of quality. The Quadruple Aim has a goal of lower costs—but which tool is being used to measure? Which metric? Is it the cost of hospitalization, ED utilization, or clinician burnout leading to mass shortages in primary care clinicians? 

The point is: you don’t know what you don’t know and to be in this for the long game, a health center must invest in data analytics of the highest quality. Does your EHR system provide population health analytics that you trust? Are you focused on providing coding expertise to your clinician and billing teams to maximize revenue? Clinicians all too long have been told to “see more patients” without fully knowing the whole truth of the revenue cycle. Finance folks will begrudgingly admit that a fair percentage of claims end up in the waste bucket of write-offs due to demographic order-entry errors (just to name one). Does your RCM system offer a 360-degree view of the patient visit? Is that information easily consumable by those who are generating the revenue? These questions are being asked by the savvy data/finance teams not just once a quarter but continuously as these teams provide the analytics backbone to drive toward APMs (Alternate Payment Models). Hitting the Quadruple Aim’s lower the cost of healthcare goal cannot be achieved without robust data analytics and trusted advisors—both internal and external—to muster that business intelligence in a truly wraparound fashion.

Want to learn more about solutions that can put your health center on the path to success and sustainability?

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Michele Hannagan, RN, MS, FNP

Director, Specialty Solutions

Michele’s mission-driven focus drew her to community health and Federally Qualified Health Centers two decades ago. As a Family Nurse Practitioner and Executive Leader, she worked side by side with clinicians, nurses, and patients at Jordan Health—a legacy FQHC in Rochester, NY. Whether leading teams, implementing change, or meeting patients and colleagues where they are, Michele’s currency is curiosity and compassion. She joined NextGen Healthcare in 2021 to elevate the lived experiences of the people of community health—patients, clinicians, staff—into the work of electronic health record solutions.

Michele’s mission-driven focus drew her to community health and Federally Qualified Health Centers two decades ago. As a Family Nurse Practitioner and Executive Leader, she worked side by side with clinicians, nurses, and patients at Jordan Health—a legacy FQHC in Rochester, NY. Whether leading teams, implementing change, or meeting patients and colleagues where they are, Michele’s currency is curiosity and compassion. She joined NextGen Healthcare in 2021 to elevate the lived experiences of the people of community health—patients, clinicians, staff—into the work of electronic health record solutions.

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The financial and clinical challenges you face now are evolving rapidly. Here are resources, solutions, and ideas we think will help.

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