Case Study: Advancing Population Health Through Data at HRSA

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The Health Resources and Services Administration (HRSA) is the federal agency within the U.S. Department of Health and Human Services that administers the Health Center Program and provides grants to federally qualified health centers (FQHCs). These health centers, which are mandated to serve vulnerable and underserved communities, are considered pioneers in PHM strategies in order to best serve their patients and communities.

To learn more about HRSA’s efforts, GovLoop spoke with Dr. Suma Nair, Director of the Office of Quality Improvement in HRSA’s Bureau of Primary Health Care.

Nair pointed out that HRSA-funded health centers serve an enormous population and therefore create, store and access an enormous amount of data.

“There are nearly 1,400 organizations that we fund through grants that comprise over 11,000 service-delivery sites all across the country and serve over 27 million patients,” she said.

Given this massive amount of data, how does HRSA work to support health centers nationwide to analyze and improve operations, based upon the information that they have? The answer to that question has been a focus of Nair’s for several years.

“Health centers have a growing cohort of people who are focused on quality improvement and data analytics,” she said. “Strengthening both HRSA and health center data infrastructure and analytic capabilities has helped our success in advancing population health.”

Nair explained that HRSA is extremely focused on a specific set of clinical measures. Health centers use these metrics to measure success, and in order to do that, they need access to data. They developed the following framework and foundation to enable their cause:

• Health infrastructure and technology: Nair said they’ve worked to make sure their centers have the infrastructure and IT in place to access the data and information to proactively manage the population.
• Advancing adoption of electronic health records: “Right now, 99 percent of health centers are utilizing an Office of the National Coordinator for Health Information Technology-certified electronic health record,” Nair said. “In fact, most of them have gone beyond adoption and now are using additional health IT to manage their patient populations and the volume of data, especially as we’ve moved towards value-based care.”
• Data transparency: HRSA has then taken this data and made it transparent and public on its website. “If you go to our website, you can find data at the national level, the state level, and a profile for each one of our 1,400 organizations, and you can see how they compare with each other,” said Nair. “That’s been really transformative in terms of population health management and quality improvement by creating the opportunity to benchmark and identify opportunities for improvement working across health centers locally, statewide and nationally.”
• Employ location data: HRSA also imports all of its data into a Geographic Information Systems platform. This allows health centers and other stakeholders to understand where patients are, the outcomes they’re experiencing, overlaid public health surveillance data and more.

So are these approaches working? According to the metrics, yes:

• Ninety-two percent of HRSA health centers have met or exceed Healthy People 2020 goals.
• A study that looked at 13 states found that, when HRSA-funded health centers are used as the primary care home for patients, there was 24 percent less spending compared with other primary care providers. “We also found that spending on specialty care was 33 percent lower, indicating health center patients were cared for more appropriately in primary care,” Nair said.
• There was a 25 percent decrease in inpatient admission, as well as a 27 percent decrease in spending on inpatient care.
• “When extrapolated out to all of our patients who are Medicaid-fee-for-service, that’s $10 billion in savings,” Nair said.

The outcome is clear: When thinking about population health management nationally, health centers are an important piece of that puzzle – and data is driving their continuous improvement.