Elevate Health, an “Accountable Community for Health” in Washington state’s Pierce County, is partnering with the Tacoma-Pierce County Health Department to launch a program to support people diagnosed with chronic heart failure to address the social and economic barriers impacting their wellness. In a recent interview, Alisha Fehrenbacher, Elevate Health’s CEO, described the importance of having a strong population health platform to measure the impact of such interventions.
An Accountable Community for Health (ACH) is a cross-sectoral alliance of healthcare, public health, and other organizations that plans and implements strategies to improve population health and health equity for all residents in a geographic area. ACHs play an integral role in Washington’s Medicaid Transformation Project efforts. Nine ACHs in Washington state are testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries’ through screening, referral, and community navigation services will impact health care costs and reduce healthcare utilization.
Fehrenbacher said the effort involves bringing as many stakeholders in the community as possible to the table. “I like to call it a community activation table, because you're activating not just the big players that have the dollars and have the power, but you also activate the community member who has a child in the criminal justice system or had, experience with substance use or been utilizing the system because of comorbidities,” she said. “They also have a seat at the table. The value could be different for each person sitting at the table, but you equalize the power structure by allowing the voices to be heard at a community table. And that's to me the accountability component of it.”
Elevate Health has a community advisory council that is made up of diverse community members. “They are helping us find solutions and understand the data. They help us validate data in our data platform, and they help us build solutions,” she said. “Then we sit together and say, here are our assets in the community and we ask how we can build equity and pay for it in a new unique way that can be sustained.”
I asked Fehrenbacher if we looked across the nine ACHs in Washington state, would we see that they are working in a similar fashion or prioritizing different things?
“We're becoming far more aligned now,” she responded. “I think there are a lot of similarities in what we do, but there are a lot of differences based on regional need.” She said she tends to push harder for systemic change than some CEOs might. “I want to shake the tree a little harder. I would say that my colleagues all want to make sure that there's equity in the market; they want to have a community-based care coordination system that links to clinical delivery reform. They want to see integration of behavioral, physical, and oral health. I am known to be pretty aggressive, because I do think that if you are given a finite period of time make something happen, you have to use it. So I don't mind making people a little upset.”
Fehrenbacher described a multi-pronged approach Elevate Health and partners are taking. The first prong involves creating the data linkages and analytics infrastructure, and the education and research efforts that goes with that, to inform the work of the community. The second prong is developing a care continuum network that is bridging the gaps in the system and partnering with the providers and the community-based agencies around the life of the patient.
The third is a OnePierce Community Resiliency Fund, which she describes as a way to build tranches of funds to support economic viability in the region — including workforce development and long-term housing. “It allows us to stack funds from various sources inside and outside the healthcare system,” she said. “We had $19.9 million in leveraged and committed dollars for 2020 through the fund that not only supports healthcare, but also supports the economic vitality of the region. That also goes back to this Accountable Community of Health idea. It's using the data, the wraparound care continuum, and that investment to make short-, mid- and long-term sustainable change in a region.”
Elevate also is developing a community health information exchange — a community-owned asset that is agnostic to EHRs and agnostic to any proprietary closed loop system. “It allows us to stack the data from public sources, such as our public health department, our human services department, our health systems, our community-based agencies to inform our legislators to help them make legislative decisions on some of our rural communities, or some of our more high-impacts areas, but also to help our provider partners with use cases on things like building out community health action teams,” Fehrenbacher said. “We have been really fortunate to be able to start looking at the data in a different way, not just claims and clinical data, but looking at more social determinants of health data, and then using that to inform decision-making.”
Elevate Health has been working with a platform from vendor Innovacer as its hub for population health efforts. It is using the Innovacer Health Cloud’s integrated application suite and developer toolkit.
“What I liked about them early on is that the community health record basically can float on top of the clinical record,” Fehrenbacher said. “Our big local health system, MultiCare, was already using their platform, so it had synergies. We brought them on to get that global population health view of our region. We can look at things like immunizations and risk components. It’s easy to use on the front end for the community health workers or care coordinators, and it's easy to access by the providers or the caregivers who are doing the clinical care. It has been a very adaptable platform for us. And then it links in beautifully with the clinical EHR.”
The partnership to address chronic heart failure involves building out a Community Health Action Team (CHAT) using social determinants of health data connected to better clinical care coordination. A community health worker works with the patient and then does a warm handoff to a clinician who can do more of the case management. “We're seeing a lot of really positive impact in our pilots and in the data that we're pulling from our platform,” Fehrenbacher said. “That is why the data platform is key to me. How do you do this work without having data to inform the effort? You can't do retrospective data two years after the fact. You can't do any PDSA [plan-do-study-act] cycles if you're data is old.”
The Innovacer platform helps Elevate iterate as it goes, she says. “We are finding that as we develop the evidence base, we might need to add data fields. As we see a dashboard come out, sometimes we’re not getting everything we need to know in the picture. That is the beauty of having this platform and working with Innovacer. We’ll say we need to add this data element because we found that there's a gap, and they help us do it. If you're waiting two years down the road, and you're just getting some static data, there's nothing you can do with it.”