Carina Well being Community empowers all of Colorado’s 19 group well being facilities (CHCs) with knowledge, know-how, and strategic assist to advance value-based care and enhance inhabitants well being for underserved populations. Two of Carina’s executives not too long ago spoke with Healthcare Innovation about how its members are reaching success in value-based care fashions.
Carina was launched in 2025 via the merger of two organizations that had been already supporting CHCs: Neighborhood Well being Supplier Alliance (CHPA) and Colorado Neighborhood Managed Care Community (CCMCN). CHPA was shaped in 2014 particularly to work on value-based care. CCMCN grew to become a HRSA-designated Well being Heart Managed Community in 1995 to assist well being facilities collaborate on well being IT and different data-driven initiatives.
In 2024 Carina’s member improved look after 11,829 Medicare beneficiaries throughout Colorado, whereas additionally producing $17.6 million in Medicare financial savings within the Medicare Shared Financial savings Program.
Brandi Apodaca, Carina’s chief efficiency officer, got here to Carina from CHPA, whereas Michael Feldmiller, Carina’s chief data officer, got here from CCMCN.
Healthcare Innovation: Brandi, may you discuss your group’s historical past with value-based care?
Apodaca: In 2017 we entered into the MSSP as our first contract. And in our third 12 months, 2019, we achieved shared financial savings — so fairly fast to shared financial savings. Since that point, we’ve got entered into 10 complete value-based care contracts, principally in Medicare Benefit, after which a number of business contracts. In MSSP, we’ve got elevated the quantity of shared financial savings each single 12 months.
We realized from the value-based care facet that we actually wanted a powerful knowledge set, and it simply made sense to merge the 2 corporations. We had been serving the identical clientele, which had been the group well being facilities. So why had been we working these parallel organizations? From an effectivity standpoint, it simply made sense.
HCI: I not too long ago wrote one thing about a corporation known as Built-in Well being Companions in California, which has maybe the same mannequin of serving to FQHCs. Have you learnt if there are networks like Carina in different states?
Apodaca: Sure, there are. C3 in New England. Iowa and Montana come to thoughts. I’d say we’re forward of the sport. Most of them have simply gotten into the MSSP within the final couple of years. We had been positively one of many first to do it.
HCI: Do your clinics additionally take part in Medicaid managed care preparations which have value-based care points to them in in Colorado?
Apodaca: Colorado does not have managed Medicaid. They’ve their very own system of accountable care the place they’ve regional entities which can be targeted on Medicaid from a value-based care perspective, and we assist them in that.
HCI: Michael, from the IT facet, what are a few of the issues that Carina has accomplished to assist the clinics with tech infrastructure? Are they on a large number of various EHRs? And has it turn into simpler to unify that knowledge into a knowledge warehouse?
Feldmiller: The CHCs in our community are all on completely different EHR situations. Plenty of them are on OCHIN’s Epic occasion, NextGen, or athena. From a community perspective, during the last decade we have leveraged Azara Healthcare, which has a very good historical past by way of working intently with FQHCs on mandated federal reporting via the UDS (Uniform Information System) mandated reporting annually. We use our Well being Heart Managed Community funds and different state and federal funds to assist the adoption of Azara within the state. So 95% of the FQHCs are on Azara in the meanwhile, after which that builds a very massive EHR medical knowledge warehouse that we have been capable of leverage. So our grasp affected person index is about 3.5 million sufferers, and loads of that’s from the FQHC EHR knowledge.
We have leveraged Snowflake as our knowledge warehouse. We have been actually pleased with Snowflake, and that is the place we combine the EHR knowledge. But it surely’s additionally allowed us to combine loads of different knowledge units. We’ve actually good well being data trade inside the state. We obtain the state’s immunization registry, after which we have been capable of retailer loads of claims knowledge, both via Brandi’s ACO work, and even via the state all-payer claims database. So we’ve got a number of knowledge sources contributing to the protection web knowledge warehouse that we’ve got right here at Carina.
HCI: And did I see that Carina additionally works with Innovaccer?
Feldmiller: We simply began working with Innovaccer not too long ago. That got here via our merger actions and seeing the necessity for extra ACO-based know-how.
HCI: Do the clinics find yourself getting high quality hole alerts or ADT feeds to know what’s taking place with their sufferers after they’re not within the clinic?
Feldmiller: Sure, and there is not one dimension that matches all for lots of that. We do have both customized reporting we have developed in Tableau that we can provide organizations to have a look at loads of the ADT knowledge. We have used care administration purposes up to now to assist handle transitions of care and attain out to these sufferers instantly, to get them again into the first care setting and decrease prices and utilization for these affected person populations. Azara and Innovaccer will assist with care hole reporting as effectively.
HCI: Do these clinics have their very own IT employees or analytics individual there? Or is Carina taking over that function for them?
Feldmiller: It actually varies. We’ve a number of well being facilities which may see only one,000 to 2,000 sufferers a 12 months, so they do not have enterprise intelligence groups or a number of individuals on their high quality enchancment groups. Then we’ve got a middle that sees over 100,000 sufferers within the Denver metro space known as Denver Well being, the place they do have a bigger enterprise intelligence group. We attempt to meet them the place they’re and supply them with the instruments to take it to that subsequent degree.
HCI: Brandi, to what do you attribute the success within the MSSP after a few years in this system? Had been there classes realized or stuff you needed to fine-tune inside the community itself to get to that success?
Apodaca: I believe a few of the success was government buy-in, with management believing within the shift to value-based care. Making {that a} precedence took loads of work originally, by way of explaining what value-based care is. Saying to them, ‘Right here’s what these contracts appear like, and that is what’s going to make us profitable.’
After which we set it up very well. We do loads of work round follow transformation. Our coaches are all transformation-certified, in supporting PDSA-type high quality enhancements, cycles. We meet month-to-month with every of our group well being facilities to assist maintain them accountable in enhancing on these high quality measures, and that has confirmed profitable.
We additionally do loads of sharing of greatest practices among the many group well being facilities. We host alternatives for a well being middle to speak about one thing progressive or thrilling that they are doing.
We even have value-based coding groups whose members are all licensed in threat adjustment coding. They’re working with the suppliers inside of every of the CHCs to teach them about threat adjustment and supporting them in what we name like pre-visit planning or seeking to see the place codes have not been captured.
HCI: I do know there is a group data trade effort happening in Colorado. Might you discuss whether or not Carina is concerned with teams making an attempt to construct these?
Feldmiller: The state Workplace of eHealth Innovation is beginning the event of the Colorado Social Well being Data Change. They’ve spent two to a few years growing the muse — loads of knowledge governance points, loads of technical infrastructure wanted to be be constructed by the state’s third-party vendor. Ideally, particularly with loads of the protection web knowledge and suppliers that we work with, we’re trying ahead to leaping into that mission within the very close to future, to develop extra community-based group referrals. The state needs to scale back the duplication of these efforts and have extra closed-loop referrals to maneuver the needle on social determinants of well being. So we will probably be taking part in that, hopefully within the subsequent 12 months or so.
HCI: Can I ask about somthing else I noticed in your web site: centralized pharmacy and medicine adherence assist. Are you able to discuss that?
Apodaca: As we grew and located success, we introduced on a full-time chief medical officer who has labored fairly extensively with a piece group involving the medical management inside every of the CHCs. One of many areas the place they acknowledged they wanted assist is round medical pharmacies. So we have employed a medical pharmacist who helps to drive good protocols round pharmacy administration for sufferers with power circumstances.
As well as, we have introduced on a few pharmacy techs who’re working instantly with the sufferers — if we’re seeing that you have not refilled, why have not you stuffed your meds? And what are the social determinants which can be driving that? And the way can we show you how to? Whether or not that is getting an appointment or altering you to mail order — doing a few of that direct work. Our CMO and our medical pharmacist have created some protocols round treatment inertia for sufferers with power circumstances — you are on the identical meds ceaselessly, they usually have not been reviewed. Ought to we be advancing the medication you are on since you’re A1c is not transferring or your blood stress is not getting higher?
HCI: As you begin trying into subsequent 12 months, are there some other new initiatives or adjustments you are planning to make?
Apodaca: I believe enlargement of the pharmacy group, as a result of we have seen a lot success in creating optimistic affected person outcomes with that. We’re additionally centralizing different companies. FQHCs are in a tricky spot proper now from a monetary perspective…Is there centralized assist round transitions of care or well being teaching we may supply? The opposite factor I’d say is we’re very excited by having extra community-based companies, or integrating with community-based companies which can be on the market already.
HCI: Michael, how about on the IT facet?
Feldmiller: We’re fairly enthusiastic about taking part within the Colorado Social Well being Data Change and having the ability to leverage extra knowledge integrations there. We’re working intently with the state to assist group psychological well being clinics. The state’s asking us to assist some data-driven applications for that facet. Plenty of the FQHCs are often known as group psychological well being clinics, so there are alternatives to combine their two sides collectively inside their group and share knowledge.
HCI: In the event you had a want listing for CMS or the state authorities that would make your work simpler, is there something you’d prefer to see?
Apodaca: I stated this to CMS instantly, so I do not thoughts saying it. We’d be excited by what an FQHC or group observe would appear like within MSSP. We’re transferring to full affected person inhabitants measures, and if you’re speaking a few affected person inhabitants that’s 40% uninsured and 40% Medicaid, it appears very completely different than what a personal follow appears like the place it is 80% Medicare or insured. From a top quality standpoint, what does an FQHC or group well being middle or rural well being middle observe appear like?
HCI: I used to be simply listening to a NAACOS presentation by an exec who’s from a long-term care ACO, and he or she was saying the overall ACO measures that CMS makes use of for everyone else do not make sense for the long-term care inhabitants, and it makes them look dangerous on high quality despite the fact that they focus actually exhausting on high quality.
Apodaca: Sure. I sit on the medical high quality committee for NAACOS, so that they’ve heard me say all this.
HCI: OK, Michael, what would you say?
Feldmiller: I believe waiting for subsequent 12 months, positively something that will assist interoperability and to assist with work necessities in Medicaid eligibility and enrollment underneath the State of Colorado. We’re actually specializing in that heading into some federal deadlines there.
HCI: Normally at NAACOS there’s loads of discuss shifting to digital medical high quality measure reporting. Is that a difficulty you concentrate on but?
Feldmiller: We really feel actually good about the place we’re on that. We had been one of many first to report eCQMs for the community. There’s extra data I wish to learn about FHIR-based eCQMs. I do know there’s loads of discuss what route that is transferring in for the foreseeable future.
