The Primary Care Coalition and our Montgomery Cares partners work together to make the quality of safety net health care in our community consistently higher across the board. We do so by agreeing on the indicators we measure and working together to improve performance on them.
PCC releases the results of that work for the system as a whole every fiscal year. At quarterly Quality Health Improvement Committee meetings, our partner clinics can see how their organizations’ performance compares with their peers and with HEDIS Medicaid benchmarks. Recently, we touched base leaders at our top performing clinics in hypertension control (Huixing “Kate” Lu, Director, CCACC Health Center) and colorectal cancer screening (Mark Foraker, President and CEO, Mercy Health Clinic) to find out how they approach quality improvement and how they’ve achieved these results.
Let the population drive priorities.
“Hypertension is the most common condition among our patients,” Kate says. It is also “a silent killer that does not cause active symptoms.” That made focus extra important during the pandemic, when she says many patients stopped seeking care for chronic conditions to avoid COVID risk.
Change is constant. Evaluation and improvement should be, too.
“We are constantly responding to change,” Mark says. “That can be good, bad, and frustrating. It also brings opportunities for us to learn and identify emerging trends. For us, being as proactive as possible and using data trends to inform decisions have had great results. At times that might mean correcting things that are not working before they become a bigger issue or identifying emerging needs so we can get resources in place to smoothly pivot when needs and preferences change.”
Allocate time for complex needs.
“Safety net clinics often are operated with limited funding and manpower, yet, patients' needs tend to be more completed due to social determinants of health,” says Kate. “It is important that the clinic set aside manpower/volunteers to provide supportive service outside of regular clinical practice.”
Focus on what you can control.
“The early stages of the pandemic made access to colonoscopies very challenging and at times nonexistent,” Mark says. Screening providers weren’t always open and tended to have long waiting lists when they were. “What we did differently is pivoted to the screening measures that we could control and placed our focus on providing and completing FIT tests for any patient that met the criteria.” They didn’t give up on colonoscopies as a screening option, but they reserved their scheduling outreach for patients who were not good FIT test candidates.
Get creative with your resources.
“Apart from the typical clinical care that we provide, we also offer Chronic Disease Management,” Kate says. “Under this program, our providers will enroll patients with uncontrolled blood pressure. Our RN and a team of volunteer semi-professionals (pre-med students, retired healthcare professionals) will contact patients once a month to follow up with the patient. In this interaction, they will clarify the care plan, and troubleshoot patients' obstacles to achieving the care plan.”
“We saw a dip in performance for several of our health screenings” during the pandemic, Mark says, “and we also found that staff did not need to spend as much time working with our medical providers due to changes in how patients were accessing care at the time.” More telehealth visits changed the workflows for support staff. “We had to re-think our approach, and we began reassigning staff to assist with follow-ups for available health screenings when they had downtime,” Mark says. “It became a permanent feature of their work where staff would compile lists of patients who were due for a specific screening, and staff would continue to follow up and work through that list until the patients were screened.”
Partnerships can provide extra support.
“We have access to a lot of resources through our partnership with PCC, including data that informs us when our work is going well or when our work needs improvement,” Mark says. “That is essential for us to know when and where we need to focus on transformation efforts. We also gain access to resources such as FIT tests, free medications, and backend technology support that allows us to focus on providing high-quality medical care.”
“PCC provides clinical and technological support to safety net clinics before and during the pandemic,” Kate says. “For example, during the pandemic, PCC helped to coordinate PPE and other necessary resources, such as providing blood pressure monitors for hypertension patients.”
Quality matters for mission.
“The better we perform on measures, the better we are at achieving our mission,” Mark says. “All of our work is about helping people and giving them access to their healthiest selves. It is important to us that not only do we provide care to as many people as possible, but we also do so in a manner that meets or exceeds the care that we expect for ourselves and our families.”
About the clinics
“CCACC Health Center [is] a subsidiary unit of the Chinese Culture and Community Services Center, Inc (CCACC),” says Kate. “The clinic's mission is to provide quality health services for individuals who have difficulty accessing healthcare; to address patients’ holistic healthcare to maintain physical and psychological well-being through health services; address health disparity facing our target population and explore the combination of evidence-based and traditional health practices rooted in our culture, and introduce it to the greater society.” Note, you can see Kate talk about her work in our 2020 storytelling show, Stories About Belonging, available here (Kate's story starts around 34:20).
“Mercy Health Clinic began seeing patients in October of 2000,” Mark says. “We have a mix of paid and volunteer medical providers, and we offer nearly a dozen outpatient subspecialties. We initially began as an all-volunteer organization operating on a “free-clinic” model and focused on serving adults. Many elements of our original model still exist in addition to new elements we have added, such as becoming recognized as a Patient-Centered Medical Home and our recent expansion into seeing adolescent patients. We are located in Gaithersburg, and most of our patients are from the surrounding areas of Gaithersburg and Germantown.”