PROVIDENCE – Money talks, and quality performance in health care is rewarded. That was the message delivered on Tuesday, Aug. 25, when the federal Health Resources and Services Administration, or HRSA, awarded more than $63 million to some 1,153 community health centers in all 50 states, the District of Columbia and seven U.S. territories.

The monetary awards recognized achievements by community health centers in providing high quality, comprehensive care, according to HRSA Acting Administrator Jim Macrae.

“Today’s funding rewards those health centers that are achieving the highest levels of clinical quality performance and improvement,” Macrae. “The awards will help health centers continue to provide comprehensive primary care to the nation’s most vulnerable communities.”

Here in Rhode Island, HRSA made quality improvement awards totaling $615,878 to eight community health centers.

Blackstone Valley Community Health Care received the largest total award, $171,146, in Rhode Island, recognized for its quality work in five metrics:

• High-value health centers, for health centers that improved cost efficient care delivery compared to the national average, while also increasing quality of care and improving access to comprehensive services between 2013 and 2014.

• EHR reporting, for health centers that report clinical measures on the full universe of patients using EHRs.

• Clinical quality improvements, for health centers that have demonstrated improvements in one or more clinical measures.

• Health center quality leaders, for health centers that have the highest clinical performance compared to their health center peers using risk adjusted quartile rankings.

• Access enhancers, for health centers that increased the total number of patients served and the number of patients receiving comprehensive services between 2013 and 2014.

More impressive than topping the charts in Rhode Island for its quality performance, Blackstone Valley ranked No. 4 overall in New England.

Of the 95 community health centers receiving nearly $6.4 million in awards in the six New England states, Blackstone Valley’s $171,146 was the fourth highest financial reward: one health center in Massachusetts received $177,071; one health center in Connecticut received $176,685; and one health center in New Hampshire received $176,033.

For Raymond Lavoie, the executive director of Blackstone Valley, the recognition by the federal government is very gratifying. Blackstone Valley has been a leader in integrating health IT data at the point of care, and in building out its own health information exchange as a critical tool in improving patient outcomes and moving toward population health management analytics. The next steps, Lavoie believes, require that payers share the savings and reward the community health centers for the quality and cost improvements.

“While it is very gratifying to be recognized by the federal government for our quality improvement efforts, HRSA is somewhat prescriptive in how the funding can be used, i.e., to further expand our quality efforts by investing in additional health IT and care management systems and data analytics,” Lavoie told ConvergenceRI.

It does not represent, Lavoie continued, “a return on the investments we have already made in health IT. Granted, these additional investments will serve to only improve our outcomes going forward, but it is increasingly clear that ROI must come from the payers, who are the primary financial beneficiaries of our quality and cost efforts.”

A funny thing happened on the way to the forum
The future way that health IT data is shared, stored, analyzed and integrated into health care is at the center of a swirling debate over who will control the data, as population health analytics becomes a critical tool in calculating the costs in the new bundled reimbursements approach in accountable care. At the same time, the explosive growth in what’s known as mHealth, or connected health with wearable devices, is disrupting the world of health IT.

This week, Sen. Sheldon Whitehouse will convene a meeting of industry stakeholders to discuss potential new federal legislation on Tuesday, Sept. 1, at The Tech Collective, hosted in partnership with MedMates, a nascent medtech cluster group. Unfortunately, it’s a closed conversation, with the news media barred from participating, at Whitehouse’s request.

As detailed in last week’s newsletter, ConvergenceRI had registered to attend the discussion after receiving a broadcast email, only to be disinvited by MedMates. [See link to ConvergenceRI story below.]

Some new details have emerged since then. First, it was Whitehouse who asked MedMates and The Tech Collective to convene the meeting, according to Seth Larson, Whitehouse’s communications spokesman.

Second, Larson made it clear that the news media was not welcome to attend, at Whitehouse’s insistence. “This is intended to be an opportunity for local stakeholders to provide their input in a low-pressure setting,” Larson told to ConvergenceRI in an email. “The meeting is closed to the press to facilitate a free-flowing discussion,” he said, explaining that he would not be in a position to provide a detailed readout of the discussion after the event. 

Third, a series of questions that ConvergenceRI had sent to Whitehouse on Aug. 21, remain unanswered. Initially, Larson had said that Whitehouse was traveling out of the country and could not respond in time. The latest response by Larson on Aug. 28, changed the reason for not responding: “Some of the questions you raise are what Senator Whitehouse wants to hear from stakeholders about, so we’re not really in a position to answer them in advance.”

For the record, here are the questions again:

• With the tremendous growth in mHealth and wearable bands, how does that change the equation in terms of electronic health records?


• In a patient-driven, patient-centric, mobile connected world, how do you believe that changes the way that patients and their caregivers communicate with their doctors and health care team?


• In terms of population health management analytics, who owns the data? Is it the insurer, the hospital, the provider, or the patient? What if the data is self-collected by the patient?


• Why do you think that CurrentCare in Rhode Island, the state’s health information exchange, has not been readily adopted by doctors [some 82 percent in 2014 survey conducted by the R.I. Department of Health were not using it] or by consumers [only 35 percent of Medicaid patients are enrolled as of the second quarter of 2015, matching the enrollment rate for commercially insured Rhode Islanders of 35 percent]?


• How does the investment in major upgrades in health IT platforms get paid for? What's the ROI for the investment? How much of that burden will fall to the consumer?

If and when Whitehouse responds to the questions, after the event, ConvergenceRI will publish them.

Transparency
One of the key points in continuing discussion around health IT is transparency and access to data: who owns the data, who is responsible for the analyses, how are the privacy rights of patients protected, and which health IT systems will control the quality measures and the information flow?

Convening an exclusive, closed-door session with local industry stakeholders for an off-the-record conversation, under the auspices of The Tech Collective and MedMates, without identifying the stakeholders, does not appear to promote transparency, to say the least.

Of course, what the stakeholders actually say to Whitehouse may turn out to be be far different than what he may be expecting.