Today’s health care landscape is changing, often faster than which health care centers and clinicians can keep up. Reimbursement for health centers/clinicians is increasingly favoring Value Based Care vs. the traditional Fee-for-Service models. We are also seeing more policies and plans to increase federal grants and awards for implementation of technical frameworks to improve quality and reduce inequity. This underscores the importance of seeking ways in which health care centers can adapt to this new landscape to improve reimbursement as well as to improve health outcomes, patient engagement, and address inequities in delivery of health care for the benefit of their patients and community health. I have experienced this on the frontlines of health care in my role as an RN Care Coordinator as part of the Case Management team at Waianae Coast Comprehensive Health Center (WCCHC), in West Oahu, Hawaii.
The challenges for the population of Waianae are numerous, with it being one of the most financially depressed areas of Hawaii with a large population of native Pacific Islanders, who have increased rates of chronic diseases such as Diabetes and Heart Disease. The cost of living, including food and housing, is exceptionally high, putting the population at even further risk.
For rural health clinics around the country, such as Waianae Coast Comprehensive Health Center, allocation of resources to manage clinic population to increase quality of care, reduce costs, improve patient access to resources, and reduce disparity and inequity can be hard to determine. This was the case for us and our small Case Management team of Nurses and Social Workers in Waianae, until our partnership with Foresight Health Solutions and their AI-enabled analytics tool, Caliper, started several years ago.
Partnering with Caliper
In partnering with the Caliper team along with Medicaid Payers in Hawaii, we were able to utilize Caliper’s unique population management tools including composite risk and impactability metrics, and AI driven predictive modeling to develop Patient Cohorts. This enabled the Case Management team to target the most needy, impactable, at risk and vulnerable patients as well as to increase significantly engagement rates with patients. This partnership with Caliper has resulted in huge cost savings for WCCHC totalling several million dollars over the last few years through reduced cost, reimbursements, awards, and shared savings with payer partners. Caliper also helps the health center by assisting to track cost, quality, and disparity data to demonstrate improvements that were made and demonstrating the value of the Care Coordination team in concrete, measurable data, which was never possible before.
As a nurse, I always return to Maslow’s Hierarchy of needs when trying to assess and address challenges and barriers to patients improving their health team engagement and health management, understanding that if patient’s essential needs such as food or housing security are not being met, that there is a low likelihood of improved health outcomes or ability of Case Managers to move the needle when it comes to cost, quality, and outcomes.
Caliper’s prioritization to capture and appropriately analyze and weigh Social Determinants of Health when generating risk and impactability scores and recommendations, underscores how the Caliper Team really understands best practices and priorities of case managers which indicates how SDOH is typically not integrated or weighted appropriately by other competitors and tools that help with clinic population management.
One of the other issues related to SDOH data, is that this information is not always captured in templates/screening tools and SDOH risks are often missed or lacking. Caliper’s unique NLP technology is able to use AI to read mine clinic notes that may indicate SDOH risks that would otherwise not be available to Case Managers or Providers and may have led to artificially low risk score if we did not have access to such powerful tools integrated into the Caliper product.
Another major unique feature of Caliper is the powerful health disparity tool that allows providers, case managers, and administration teams to break down disparities and inequities within clinic population by race, ethnicity, age, sex, location (zip code), and many other differentiators. This allows health clinics to specifically target inequities as it relates to delivering health care effectively to their clinic population. This is a major focus when it comes to federal priorities for health clinics in adopting HRSA HCCN objectives and should be a major priority for all Federally Supported Health Care Centers.
"Caliper helped demonstrate the value of the Care Coordination team with concrete, measurable data—something we never had before"
The Caliper platform has so many other tremendous and easy-to-use features that provide Case Managers and Clinicians with many tools that can be utilized to track patient specific data related to quality measures, chronic disease management, and patient engagement. These tools help to target interventions that will have maximum impact and specific recommendations for interventions are provided to help the health care team to provide effective support to patients, drive down costs, and improve health outcomes.
Now on the other side
I was fortunate to work in an organization where the leadership team was forward thinking in trying to adopt policies. Through Caliper, they were able to provide more tools to the health care team to help improve effective health care and social services being provided in a targeted way and to help track improvement and further areas of need to potentially increase resource deployment. WCCHC continues to commit to partnering with Caliper to help to continue to adapt to the continuously changing health care landscape, improve outcomes and reduce disparity.
I am now so thrilled to be working at Caliper as a Clinic Success Manager to help our clients to meet their unique needs in managing their clinic populations. I am so excited to help other Clinics and Case Management teams to help them find solutions and make improvements and strengthen their sustainability in the ever changing health landscape.
