Carina Well being Community empowers all of Colorado’s 19 neighborhood well being facilities (CHCs) with information, expertise, and strategic assist to advance value-based care and enhance inhabitants well being for underserved populations. Two of Carina’s executives just lately spoke with Healthcare Innovation about how its members are reaching success in value-based care fashions.
Carina was launched in 2025 by the merger of two organizations that have been already supporting CHCs: Group Well being Supplier Alliance (CHPA) and Colorado Group Managed Care Community (CCMCN). CHPA was fashioned in 2014 particularly to work on value-based care. CCMCN turned a HRSA-designated Well being Middle 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 info officer, got here from CCMCN.
Healthcare Innovation: Brandi, may you speak about 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 yr, 2019, we achieved shared financial savings — so fairly fast to shared financial savings. Since that point, we now have entered into 10 complete value-based care contracts, largely in Medicare Benefit, after which a number of industrial contracts. In MSSP, we now have elevated the quantity of shared financial savings each single yr.
We realized from the value-based care aspect that we actually wanted a robust information set, and it simply made sense to merge the 2 firms. We have been serving the identical clientele, which have been the neighborhood well being facilities. So why have been we working these parallel organizations? From an effectivity standpoint, it simply made sense.
HCI: I just lately wrote one thing about a company known as Built-in Well being Companions in California, which has maybe an analogous mannequin of serving to FQHCs. Are you aware 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 have been undoubtedly one of many first to do it.
HCI: Do your clinics additionally take part in Medicaid managed care preparations which have value-based care features 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 centered on Medicaid from a value-based care perspective, and we assist them in that.
HCI: Michael, from the IT aspect, what are among the issues that Carina has carried out to assist the clinics with tech infrastructure? Are they on a mess of various EHRs? And has it change into simpler to unify that information into an information warehouse?
Feldmiller: The CHCs in our community are all on totally different EHR cases. A whole lot of them are on OCHIN’s Epic occasion, NextGen, or athena. From a community perspective, over the past decade we have leveraged Azara Healthcare, which has a extremely good historical past when it comes to working intently with FQHCs on mandated federal reporting by the UDS (Uniform Knowledge System) mandated reporting annually. We use our Well being Middle 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 for the time being, after which that builds a extremely massive EHR medical information warehouse that we have been capable of leverage. So our grasp affected person index is about 3.5 million sufferers, and numerous that’s from the FQHC EHR information.
We have leveraged Snowflake as our information warehouse. We have been actually pleased with Snowflake, and that is the place we combine the EHR information. But it surely’s additionally allowed us to combine numerous different information units. Now we have actually good well being info trade inside the state. We obtain the state’s immunization registry, after which we have been capable of retailer numerous claims information, both by Brandi’s ACO work, and even by the state all-payer claims database. So we now have a number of information sources contributing to the security web information warehouse that we now have right here at Carina.
HCI: And did I see that Carina additionally works with Innovaccer?
Feldmiller: We simply began working with Innovaccer just lately. That got here by our merger actions and seeing the necessity for extra ACO-based expertise.
HCI: Do the clinics find yourself getting high quality hole alerts or ADT feeds to know what’s occurring with their sufferers once 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 may give organizations to take a look at numerous the ADT information. 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 nicely.
HCI: Do these clinics have their very own IT workers or analytics individual there? Or is Carina taking up that function for them?
Feldmiller: It actually varies. Now we have a number of well being facilities which may see just one,000 to 2,000 sufferers a yr, so they do not have enterprise intelligence groups or a number of individuals on their high quality enchancment groups. Then we now have 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 belongings you needed to fine-tune inside the community itself to get to that success?
Apodaca: I feel among the success was govt buy-in, with management believing within the shift to value-based care. Making {that a} precedence took numerous work in the beginning, when it comes to 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 numerous 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 neighborhood well being facilities to assist maintain them accountable in enhancing on these high quality measures, and that has confirmed profitable.
We additionally do numerous sharing of finest practices among the many neighborhood well being facilities. We host alternatives for a well being heart to speak about one thing revolutionary or thrilling that they are doing.
We even have value-based coding groups whose members are all licensed in danger adjustment coding. They’re working with the suppliers inside of every of the CHCs to coach them about danger 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 neighborhood info trade effort happening in Colorado. Might you speak about 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 Info Alternate. They’ve spent two to 3 years growing the muse — numerous information governance features, numerous technical infrastructure wanted to be be constructed by the state’s third-party vendor. Ideally, particularly with numerous the security web information and suppliers that we work with, we’re wanting ahead to leaping into that venture within the very close to future, to develop extra community-based group referrals. The state desires to cut back the duplication of these efforts and have extra closed-loop referrals to maneuver the needle on social determinants of well being. So we can be taking part in that, hopefully within the subsequent yr 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 speak about 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 make it easier 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 remedy inertia for sufferers with power circumstances — you are on the identical meds perpetually, and so they 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 wanting into subsequent yr, are there another new initiatives or adjustments you are planning to make?
Apodaca: I feel growth of the pharmacy group, as a result of we have seen a lot success in creating constructive affected person outcomes with that. We’re additionally taking a look at centralizing different providers. 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 thinking about having extra community-based providers, or integrating with community-based providers which can be on the market already.
HCI: Michael, how about on the IT aspect?
Feldmiller: We’re fairly enthusiastic about taking part within the Colorado Social Well being Info Alternate and with the ability to leverage extra information integrations there. We’re working intently with the state to assist neighborhood psychological well being clinics. The state’s asking us to assist some data-driven packages for that aspect. A whole lot of the FQHCs are also referred to as neighborhood psychological well being clinics, so there are alternatives to combine their two sides collectively inside their neighborhood and share information.
HCI: For those who had a want checklist for CMS or the state authorities that might make your work simpler, is there something you’d wish to see?
Apodaca: I mentioned this to CMS instantly, so I do not thoughts saying it. We might be thinking about taking a look at what an FQHC or neighborhood monitor would appear like within MSSP. We’re transferring to full affected person inhabitants measures, and once you’re speaking a couple of affected person inhabitants that’s 40% uninsured and 40% Medicaid, it appears to be like very totally different than what a non-public follow appears to be like like the place it is 80% Medicare or insured. From a top quality standpoint, what does an FQHC or neighborhood well being heart or rural well being heart monitor 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 final 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 regardless that they focus actually laborious 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 feel looking forward to subsequent yr, undoubtedly something that might assist interoperability and to assist with work necessities in Medicaid eligibility and enrollment beneath the State of Colorado. We’re actually specializing in that heading into some federal deadlines there.
HCI: Often at NAACOS there’s numerous speak about shifting to digital medical high quality measure reporting. Is that a problem you consider but?
Feldmiller: We really feel actually good about the place we’re on that. We have been one of many first to report eCQMs for the community. There’s extra info I wish to find out about FHIR-based eCQMs. I do know there’s numerous speak about what route that is transferring in for the foreseeable future.
