How a FQHC balances innovations in health IT with budget

Strategic health IT investments

FQHCs face some unique challenges compared to other healthcare organizations, such as private practices and hospitals. The community health centers are designed specifically to treat underserved populations -- which face significant health challenges themselves --  using primarily funding from the federal government, including Medicare, Medicaid and grants.

For FQHCs like Mountain Laurel, its location also presents unique challenges.

"We are disadvantaged by our remoteness," Storey explained. "We're in a very rural area with a mostly retired population, so finding a robust workforce is one of our biggest challenges."

Not only is Mountain Laurel up against the nationwide clinician shortage, but the FQHC operates with a very limited number of IT staff: Storey and just one other colleague.

"We like to try to use health IT and different platforms to augment staffing to make us as efficient as possible," Storey stated.

With limited grant funds and revenue, Mountain Laurel has had to make strategic technology investments to ensure their dollars stretch the furthest they can.

One way Mountain Laurel has used health IT to bridge staffing gaps without compromising innovation is by investing in cloud-based technologies, specifically an EHR system.

"Our old system was on-premises," Storey said. "But servicing four offices can be up to 80-90 miles apart geographically, with one or two people, is a challenge. We had to maintain the servers and all the hardware and software, which require expertise and manpower. Then, when you're open until 7:00 P.M., four days a week, it gets difficult to staff and it’s expensive. The upgrade process would also take six months of my time and staff time because of retraining."

The FQHC needed something more modern, according to Storey. They settled on a cloud-based EHR system designed for community health centers from athenahealth.

Cloud-based EHR systems do not have the same maintenance requirements as on-premises solutions. Storey no longer had to maintain servers and software as much as he had with an on-premises system. A cloud-based model also enabled a "more straightforward switch" as he could leverage the vendor's expertise through the cloud and with a dedicated support team.

"Having not just a platform, but a partner is key," he said. "It's not me or the other person that works with me that's responsible for keeping it on, so to speak. Instead, it's a team of people that you know are motivated to make sure it's reliable and consistent and who take that burden off of us so that we can focus more on every click the clinical team makes within the EMR is optimized."

A lot of people might think of FQHCs as being behind the curve or underfunded -- that's not to say we don't operate on a shoestring -- but we try to be smart with our dollars and invest in emerging technologies to stay on the cutting edge.

The other "sell," according to Storey, was the EHR system's data interoperability capabilities.

"We can get notes from hospitals that are on not just Epic, but Cerner and MEDITECH, systems that are also in our backyard," Storey explained. "From the patient care aspect, it was great to have that holistic picture of where a patient goes; seeing that across all sites of care was really critical for us."

Interoperability didn't stop at the hospitals and other care sites within Mountain Laurel's community, albeit a rather spread-out rural community.

"We live in a winter climate with a lot of retirees," Storey explained. "So, if you go to a hospital in Florida because you're down there for the winter, that's a gap we don't want to have in your record."

"We have a whole department of nurse care coordinators whose job is to coordinate care across different specialties, community resources and other providers," he added. "It's important if you are a Mountain Laurel patient and you are seen in the hospital, we get you a follow-up visit. We want to keep you from returning to the ER or the hospital. So, we need the information: Why were you in the hospital? What did they do while you were there?"

The information enables care teams at Mountain Laurel to make better decisions, Storey stated. But it also helps the FQHC with its value-based contracts.

As an FQHC, Mountain Laurel is beholden to quality measures in its contracts. The FQHC must prove to the government through its quality performance that it is using its grant dollars wisely, so investments in data interoperability help to improve quality and revenue.

Integrating AI into FQHCs

FQHCs are balancing innovation with budget to bring the latest technologies to bear in healthcare, including AI.

AI has become a staple in healthcare, from clinical decision support and medical imaging to revenue cycle management and patient engagement. The technology is primarily optimizing workflows, according to research, but providers are also leveraging it to automate routine tasks, schedule staff, predict patient demand and predict staffing needs.

Mountain Laurel is looking at ways to deploy AI to use it in "the most reasonable and beneficial way."

Already, the FQHC has been able to use grant funding to invest in some AI tools through its EHR system -- which cannot be purchased with grant funding, Storey noted. However, grants have enabled Mountain Laurel to purchase add-ons that integrate within the EHR to optimize workflows.

For example, Mountain Laurel uses an AI assistant to listen and summarize patient visits for clinicians. The AI assistant called Suki uses generative AI to automatically craft clinical documentation through ambiently listening to patient-clinician conversations.

Suki has significantly reduced the burden of clinical documentation for providers at Mountain Laurel, as well as so-called pajama time. The AI's integration with the EHR system has also improved revenue since time to completion for clinical documentation and charge capture is down, meaning the FQHC can get claims out quicker.

Mountain Laurel also uses an AI tool to support its value-based contracts -- another way health IT can produce ROI for FQHCs. Navina is an AI-powered solution enabling evidence-based risk adjustment and automated management of quality care gaps. The tool mines disparate data points associated with patients to provide a clearer picture of health for clinicians.

"Medicine is moving to value-based reimbursement, so it helps us make sure we give the best value for the dollar," Storey said. "And tracking that manually can be arduous at best. The AI tool finds the information, surfaces it and brings it to the point where a provider can make a decision on it. It is also important information to track for our value-based contract."

AI adoption at Mountain Laurel is just starting. Storey said the FQHC is now looking at ways to use AI for revenue cycle management, specifically denials management.

"Denials management is a priority for us," he stated. "Insurance companies are already using AI to deny us, so why shouldn't we use it to find out why and try to get ahead of it?"

Mountain Laurel is an example of how FQHCs are not behind the curve, but can lead trends like AI adoption, data interoperability and value-based care. The key to getting ahead of health IT despite scarce resources and unique populations, though, is balancing innovation with budget to achieve value and ROI.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.