Health Center Controlled Network - Project Abstract: A Pathway to Intelligent Care Network (existing HRSA HCCN Grantee) Applicant Name: Alabama Primary Health Care Association, Grant Number H2QCS25654 8244 Old Federal Road, Montgomery AL 36117 www.alphca.com Total Participating Health Centers (PHC): 20 PHCs consisting of 18 Health Center Grantees, 2 Look-Alike Organizations Project Contact: Mary Hayes Finch, JD, MBA, 334.271.7068 (o); 334.271.7069 (fax) mfinch@alphca.com Amount of Funding Requested: $2,865,000 Project Need: Alabama continues to have one of the country’s most fragile healthcare systems. Barriers to care within Alabama's medically underserved populations are even more significant, considering challenges to accessing care, decreased patient engagement, heightened shortages in clinical and support workforce, and ongoing fragmentation across healthcare systems. Additionally, the lack of standardized data collection and use of social risks impacting underserved patients creates missed opportunities to meet the whole-person care needs of patients at the direct point of care. Variations in the type of electronic health records systems, reporting platforms, and lack of standardization in data collection, workflow, and procedures continue to present challenges to patient and provider access to health information. While there are advancements in providers' use of health IT, system challenges prevent effective integration across industries to improve quality and health outcomes. Gaps in care are created, resulting in poorer clinical outcomes. Despite having multiple high performers within each category, significant performance variances exist across PHCs within clinical measures. Because of the need for standardization in data collection, workflow, and care systems, expediting best practices across the Network is critical. Proposed Services: APHCA will leverage its Health Center Controlled Network and statewide population health management and information exchange platform to optimize the value and impact of primary care delivered by PHCs. APHCA has increased the adoption of advanced health IT and value-based care participation by 95% over the last three years. Based on HCCN activities, PHCs have increased clinical performance in 78% of CQMs. APHCA will expand the use of advanced health information technology to improve clinical quality, whole-person care, and health outcomes. APHCA's strategy expands upon its current data, reporting, and visualization (DRVS) platform to increase 1) the percentage of PHCs that advance and optimize clinical, financial, and operations data to improve clinical quality and health outcomes; 2) the percentage of PHCs that improve bi-directional interoperability with health care providers and related organizations to strengthen care coordination, reduce unnecessary testing and data duplication, and implement more efficient and effective referral and information sharing that improve health outcomes; 3) the percentage of PHCs submitting disaggregated patient-level data through UDS+ reporting annually; 4) the percentage of PHCs prepared and engaging in value-based care to enhance patient experience, improve health outcomes, and increase access while reducing health disparities; and 5) the percentage of PHCs optimizing digital health tools and AI practices through enhanced cybersecurity and clinical practice to improve health outcomes. Population Served: APHCA's proposal will serve 20 PHCs and 400 providers serving over 340,000 medically underserved patients; 92% of these patients are at or below 200% of the federal poverty level. Over the three-year project period, APHCA will improve access, quality, and health outcomes through advanced health IT, system and process standardization, and care coordination. Continued HCCN funding yields a significant return on investment by leveraging existing IT infrastructure and experience and reduces duplicative costs across APHCA's 20 PHC systems.
