An ASO’s First Year as a New Health Center
An ASO’s First Year as a New Health Center
Several years ago, we highlighted the multi-year transition of the South Carolina AIDS Service Organization (ASO) Catawba Care to Affinity Health Center, a Federally Qualified Health Center (FQHC). We checked in to get an update from Anita Case, Executive Director. Case described the past year as a non-stop series of federal grant applications, rapid growth in their patient population, staff turnover, and a slew of new clinic procedures, some of which are still underway.
“It’s been a long journey.”
Case and nearly half of the original staff, pre-transition, are still with the agency a year or so into the transition, while many new individuals have come aboard. Affinity Health Center has undergone, according to Case, a "shift in culture" far greater than she and the board anticipated. Case was generous in sharing some of the significant challenges – and Affinity Health Center’s response – during their transition from ASO to Health Center. Below are highlights.
Soaring Patient Population Drives Change
The former Catawba Care was somewhat of a concierge HIV/AIDS service provider, seeing a limited number of patients each day and thus affording staff the opportunity for longer appointments and intensive staff triage sessions. It "felt like VIP medicine and we had great health outcomes," said Case.
“In the last 12 months, we’ve served 70% more patients than the previous 12 months.”
This model, however, was not sustainable for the new Affinity Health Center and its status as a Health Center, which officially began October 2014. The biggest change was the expanded patient population, which changed everything: the agency’s culture, processes and staffing. Catawba Care had 500 HIV patients a year. Affinity Health Center sees 3,500 mostly uninsured and low-income individuals annually. The census continues to increase by 200-250 every month given demand for health care and greater awareness of Affinity Health Center’s services through new referral relationships with a local hospital and other agencies. Many new Affinity Health Center patients are hospital referrals with complicated medical needs. Affinity Health Center is one of two Health Centers in the area. The other sees about 10,000 patients annually.
Reimbursement also changed dramatically. Catawba’s HIV patient population was 35% uninsured. The figure doubled to 70-75% for Affinity Health Center as most patients have low paying jobs with no health insurance or are unemployed. Most are also not eligible for Affordable Care Act (ACA) coverage as South Carolina did not expand Medicaid under ACA. Affinity Health Center has worked to improve its eligibility systems and enroll more people in coverage, which has seen results as the uninsured rate has dropped to 60%.
Key Changes Ease the Transition
More patients and new Health Center requirements created many new challenges. Calls for new appointments overwhelmed the clinic. Phone lines were jammed. Patients couldn’t get through. Even Case had a hard time getting a call answered. Staff turnover was high given the increase in patients being seen each day, the complexity of patient healthcare needs, and changes in clinic processes. Some HIV patients left due to the challenges of accessing staff and appointments in a timely manner.
In late 2016, 1.5 years into the transition as a Health Center, Affinity Health Center brought a private consultant team in to help map out a new plan of adjustment. Case said it was costly and "worth every penny." It resulted in a "shift in our model of how we deliver care." Key changes are outlined below.
One of the biggest challenges for Affinity Health Center’s clinical team was “we really needed to ramp up visits,” said Case. Formerly, the agency had a complex approach to making different types of appointments with variable services and time frames for those appointments. Affinity Health Center totally revamped its schedule to 15-minute appointment slots for every patient. Despite shorter visits, the new flow actually resulted in greater time with the medical provider.
Upgraded Phone System
There was a period of time when patients simply couldn’t get through on the phone. Hundreds of messages were left on voice mail. Obviously, patients were very upset. “We weren’t prepared for the volume,” said Case. Affinity Health Center changed to a call center approach with a new phone system, phone menu set-up, and staff training on how to give information (instead of just transferring calls). “We are still not there but are getting much better,” said Case.
Staff Communications: Old School Hi-Tech
Communication among staff was impossible. The front desk was often left unattended as staff rushed around to find people. Affinity Health Center adopted walkie talkies, which staff “love.” Case says it was a “cheap way to improve efficiency.”
Paper Be Gone
Affinity Health Center also got rid of paper-based processes and now relies solely on electronic health records. They use SuccessEHS, one of many packages available on the market.
Expanded Role for Medical Assistants
Affinity Health Center expanded the role of Medical Assistants in the visit. Medical Assistants, who typically are trained in a 6-month to one year technical school program, handle tasks like checking patients in, doing patient education, screening, and then reporting information to providers. In turn, providers can “spend more intensive time” with patients. Medical Assistants also do post visit wrap-up and follow-up visit scheduling. All of these interactions take place in the exam room. Patients don’t have to go through check out at the front desk. In addition to their school training, Medical Assistants receive additional in-house training with providers, attend conferences, listen to webinars and engage in other ongoing training.
Affinity Health Center convenes twice-daily care team huddles. It's a PCMH best practice and takes no more than 5 minutes for each huddle, one in the morning and another post-lunch session for the remaining half day. The team includes prevention workers, HIV case managers, behavioral health staff, referrals coordinator, HIV peers, and clinical staff. It’s a “team dance” that helps make visits and the day flow, said Case.