Transformation in U.S. health care delivery systems and associated quality measurements in the wake of reforms implemented by Affordable Care Act might be most impactful within community health centers (CHC). Many are shifting from an acute care, clinic-visit model toward more holistic, population-based care, according to the chief executive of a large health center caring for underserved populations in his keynote remarks to the annual conference of the National Association for Healthcare Quality (NAHQ.
Juan Carlos Olivares is executive director of the Yakima Valley Farm Workers Clinic, which was founded in 1978 and now has some 12,000 employees providing medical, dental, mental health and social services at 22 facilities in Washington and Oregon. "Healthcare reform gives us the opportunity to demonstrate that community health centers can expand their quality improvement capabilities and show favorable outcomes mandated by the Affordable Care Act," said Olivares. "To achieve this, it is imperative that we continue to build chronic disease registries to track the health of our various subpopulations, which will enable us to better anticipate and organize their future healthcare needs."
Olivares told the NAHQ audience that until recently CHCs have not had the robust data capture and analysis capabilities to measure quality of care, but implementation of integrated electronic medical records has enabled CHCs to share clinical outcomes data and best practices for underserved communities.
"We are already beginning to produce data to demonstrate the quality of care we have been providing over the years to a population that historically has been difficult to serve and, as a result, difficult to show good healthcare outcomes," Olivares explained. "Among the challenges we will face in upcoming years is the expected influx of patients who have not been receiving care and do not have medical histories with clinical data to help us understand their overall condition."
He added that undocumented patients will continue to pose challenges because they have limited access to the healthcare system, and it is almost impossible to engage in follow up care to accurately measure health outcomes in this population.
"Moving forward, community health centers should concentrate less on enumerating patient visits or "touches" for acute care and focus more preventative care practices and policies we can repeat and track," he said. "For example, we know there are serious health implications associated with poverty. Poverty breeds vitamin deficiencies and obesity because families usually eat cheap, filling food with minimal nutritional value. So we must focus on wellness improvements for this population and accumulate actionable data that can help change behaviors to improve long-term health outcomes."
Olivares believes that achieving behavioral changes is a necessity, not an option, in managing the continuum of care for underserved populations. "Community healthcare providers should be practicing population-based care that helps minimize health risks through education, prevention, wellness screenings and behavioral modification. This will ensure that we are able to provide high-quality care to populations that are excluded from the national initiative to expand coverage and improve access," he said.
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