Carina Well being Community empowers all of Colorado’s 19 group well being facilities (CHCs) with knowledge, expertise, and strategic assist to advance value-based care and enhance inhabitants well being for underserved populations. Two of Carina’s executives lately spoke with Healthcare Innovation about how its members are reaching success in value-based care fashions.
Carina was launched in 2025 by means of 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 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 info 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 yr, 2019, we achieved shared financial savings — so fairly fast to shared financial savings. Since that point, we’ve entered into 10 whole value-based care contracts, largely in Medicare Benefit, after which a number of business contracts. In MSSP, we’ve elevated the quantity of shared financial savings each single yr.
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 firms. We have been serving the identical clientele, which have been the group well being facilities. So why have been we operating these parallel organizations? From an effectivity standpoint, it simply made sense.
HCI: I lately 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 might 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 elements to them in in Colorado?
Apodaca: Colorado would not have managed Medicaid. They’ve their very own system of accountable care the place they’ve regional entities which are centered 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 completed to assist the clinics with tech infrastructure? Are they on a mess of various EHRs? And has it change into simpler to unify that knowledge into a knowledge warehouse?
Feldmiller: The CHCs in our community are all on completely different EHR situations. A variety 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 carefully with FQHCs on mandated federal reporting by means of the UDS (Uniform Knowledge System) mandated reporting every year. 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 intervening time, after which that builds a extremely massive EHR scientific knowledge warehouse that we have been capable of leverage. So our grasp affected person index is about 3.5 million sufferers, and lots 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 lots of different knowledge units. Now we have actually good well being info change inside the state. We obtain the state’s immunization registry, after which we have been capable of retailer lots of claims knowledge, both by means of Brandi’s ACO work, and even by means of the state all-payer claims database. So we’ve a number of knowledge sources contributing to the protection web knowledge warehouse that we’ve right here at Carina.
HCI: And did I see that Carina additionally works with Innovaccer?
Feldmiller: We simply began working with Innovaccer lately. That got here by means of 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 lots of the ADT knowledge. We have used care administration functions previously 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 properly.
HCI: Do these clinics have their very own IT employees or analytics individual there? Or is Carina taking up that position for them?
Feldmiller: It actually varies. Now we have a number of well being facilities that 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’ve 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 stage.
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 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 lots of work initially, 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 lots of work round apply 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 lots of sharing of finest 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 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 trying to see the place codes have not been captured.
HCI: I do know there is a group info change effort occurring 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 Trade. They’ve spent two to a few years growing the muse — lots of knowledge governance elements, lots of technical infrastructure wanted to be be constructed by the state’s third-party vendor. Ideally, particularly with lots of the protection web knowledge and suppliers that we work with, we’re wanting ahead to leaping into that challenge 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 will probably 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 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 scientific management inside every of the CHCs. One of many areas the place they acknowledged they wanted assist is round scientific pharmacies. So we have employed a scientific pharmacist who helps to drive good protocols round pharmacy administration for sufferers with power situations.
As well as, we have introduced on a few pharmacy techs who’re working immediately 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 are driving that? And the way can we provide help 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 scientific pharmacist have created some protocols round treatment inertia for sufferers with power situations — 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 strain is not getting higher?
HCI: As you begin wanting into subsequent yr, are there some other new initiatives or adjustments you are planning to make?
Apodaca: I believe growth 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 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 might say is we’re very thinking about having extra community-based providers, or integrating with community-based providers which are 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 Trade and having the ability to leverage extra knowledge integrations there. We’re working carefully with the state to assist group psychological well being clinics. The state’s asking us to assist some data-driven applications for that facet. A variety 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 record for CMS or the state authorities that might make your work simpler, is there something you’d prefer to see?
Apodaca: I stated this to CMS immediately, so I do not thoughts saying it. We’d be thinking about taking a look at what an FQHC or group observe would appear like inside 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 seems very completely different than what a non-public apply seems like the place it is 80% Medicare or insured. From a high 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 unhealthy on high quality although they focus actually arduous on high quality.
Apodaca: Sure. I sit on the scientific high quality committee for NAACOS, in order that they’ve heard me say all this.
HCI: OK, Michael, what would you say?
Feldmiller: I believe waiting for subsequent yr, undoubtedly something that might assist interoperability and to assist with work necessities in Medicaid eligibility and enrollment below the State of Colorado. We’re actually specializing in that heading into some federal deadlines there.
HCI: Often at NAACOS there’s lots of discuss shifting to digital scientific high quality measure reporting. Is that a difficulty 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 learn about FHIR-based eCQMs. I do know there’s lots of discuss what path that is transferring in for the foreseeable future.
