Last week we were excited to host an incredibly informative webinar with our long-time partner, ChapCare Medical and Dental Health Center.
As a non-profit tech organization, one of our greatest privileges is bringing together FQHCs to share best practices and insights from their unique experiences serving local underserved populations. This presentation from ChapCare’s Chief Deputy Officer, Sergio Bautista, reflects not only their commitment to improving access to high-quality comprehensive care to their patients but also their dedication to applying technology in ways that honor and support the needs of their community.
Location: San Gabriel Valley, California
Patient Population Size: 16,500 unduplicated patients annually
Number of Clinics: 8 clinics offering medical, dental, retail pharmacy, optometry, podiatry, behavioral health and substance use counseling
EMR: OCHIN Epic
The California FQHC started an expansion and rebranding initiative in 2011. At the time, they had only one health center. Since then, they’ve added 7 in the San Gabriel Valley and have upgraded their EMR to OCHIN Epic, a decision that equipped them to provide comprehensive services as they grew.
ChapCare recognized the need to respond to a changing healthcare landscape well before the Affordable Care Act (ACA) impacted their growth. They were questioning how they could support their patients as healthcare transitioned from episodic to value-based models of care. To answer this question, they needed an engagement strategy that allowed them to listen to and understand patient wants and needs.
ChapCare was dedicated to building out a collaborative relationship with their patients and providers to achieve positive outcomes. They highlighted these five elements as critical to their success.
- Defining the organization’s vision for patient engagement
- Creating a culture of engagement
- Empowering patients to grow as collaborators in their care
- Charting progress and being ready to change and adapt
- Employing the right technology and services
The technology piece was key and Sergio stressed ChapCare’s dedication to choosing not just the right solution types, but also the right partner.
What ChapCare Looked for in Texting
Understanding the potential of texting, ChapCare began searching for the right vendor partner. During the webinar, Sergio shared the list of requirements they were looking for in a text messaging vendor partner.
- A mission that aligned with their own
- A track record of impact in the underserved community
- A perspective that aligned with the FQHC outlook
- A deep understanding of the underserved patient community
- A product that was easy to use and scalable in a way that fit ChapCare’s growth
Because CareMessage met its requirements, ChapCare signed on as an early adopter of our platform, rolling out the technology across a 5-year timeline.
Sergio also shared four compelling use cases, illustrating how they leveraged CareMessage to engage patients, assist staff in managing patient health needs, and educate their patients at all stages of the healthcare continuum.
Use Case #1: Health Insurance Enrollment Reminder
Much of ChapCare’s growth involved adjusting to and leveraging the 2013 launch of the Medi-Cal program through the Covered California state ACA. This meant increasing awareness of eligibility and helping their patient base navigate enrollment and annual renewals.
- Implemented CareMessage in 2014, right before the second Covered California open enrollment period
- Saw tremendous savings in time and money through automation — outreach workers no longer had to go out and find eligible patients. ChapCare staff could look at their internal system to find patients who appeared to be eligible to contact them.
- Realized financial savings by getting patients insured earlier
- Reduced the rate of uninsured patients from 28% to 21% while increasing overall patient volume
Use Case #2: Proving the Efficacy of Health Education
ChapCare’s CMO wasn’t sure if text messaging was the best approach for intervention with low-income diabetes patients and needed convincing.
In 2015-16, they began offering a 12-week type 2 diabetes text messaging education program at two of their clinics as partnership test cases with the University of California.
- Saw clinically meaningful improvement in glycemic control
- .62 point reduction of HbA1c overall
- Highly engaged patients saw a 2.23 point reduction
- Vocal feedback from patients during interviews revealed that the program provided both practical and emotional support.
- Staff enjoyed the ability to scale their efforts. They could reach numerous patients at one time — a huge boost for a resource-limited community clinic.
- Overall, ChapCare learned that their population wants to engage through text messaging for self-management.
Use Case #3: Filling Gaps in Care Through Expanded Outreach
ChapCare also had a goal of reducing gaps in care to ensure they were taking preventive measures to improve outcomes. They addressed this by launching an automated calendar of outreach communications, sent every month, from a menu of messages.
- 13.6% improvement for adult hypertensive patients with readings under 140/90
- 19.6% improvement in patients over 50 with an influenza vaccine in the past year
- 7.7% improvement in the number of patients age 50-75 without appropriate colorectal cancer screening
- 6.5% improvement in the percent of adult diabetic patients with a foot exam in the past year
Use Case #4: No-Show Reduction Through EHR Integration
The health center had an objective to reduce no-show rates through clinical appointment reminder integration. So in March 2019, they deployed reminders through integration with EPIC OCHIN.
- Helped decrease no-show rates by facilitating appointment reminders earlier (they were previously sent 48 hours before visits via phone) and with greater frequency.
- No show rates dropped from 17.83% to 15.8% — a significant change for a health center that has over 72,000 annual visits.
- Saw financial gains of $245,427.
Financial Impact of Text Messaging
ChapCare receives pay for performance (P4P) incentives through a California HMO in addition to their contracted monthly per-member payments for providing primary care services. By implementing CareMessage. they’ve seen an increase in the percent of earnings from PFP contracts.
- Before CareMessage: Between 2011 and 2013 they recorded a percent range between 16.7% to 21.2%.
- With CareMessage: Between 2014 and 2017, the range shifted upward to between 29.5% to 42% after implementation.
Looking to the Future
ChapCare is looking forward to three points of improvement in the future.
- Developing their data warehouse to integrate various data sources and improve monitoring and tracking of patient health gaps by provider.
- Redesigning provider onboarding and establishing more robust, discipline-centered training that’s founded on evidence-based protocols and best practices of patient management.
- Redesigning the QA/QI department by reviewing current QA/QI resources, roles, and responsibilities to align them with future needs and get ahead of outcome goals.
ChapCare also plans on expanding use of CareMessage functionality into additional health education programs once their OCHIN Epic integration is complete.
They intend to better leverage technology to collect more immediate patient feedback to rate services after each visit and will expand current use cases via enhanced content for outreach messages, improvement of text language, etc.
If you’d like to learn more about ChapCare’s experiences with text messaging, take some time during your next break or commute to sit down with the webinar, or consider downloading our in-depth case study here.