Managing Specialty Care Costs in a Value-Based World
Partnering to Lead: FQHCs Drive Quality Patient Care with a Clinically Integrated Network
Amanda Simmons, Executive Vice President at Integrated Health Partners of Southern California
Hope Kraatz, Assistant Clinical Director at Integrated Health Partners of Southern California
For Federally Qualified Health Centers (FQHCs), the transition to value-based payment brings unique challenges. Their patient population includes low-income and uninsured patients seeking support within opaque and fragmented community care networks. Amanda Simmons, MSHCT, Executive Vice President and Hope Kraatz, RN, Assistant Clinical Director at Integrated Health Partners of Southern California, discuss how FQHCs can:
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- Integrate data to improve clinical performance.
- Develop risk-stratified care management to target at-risk patients.
- Partner with health providers and services in the community to avoid unnecessary, high-cost utilization.
Amanda Simmons, MSHCT
Executive Vice President at Integrated Health Partners
Amanda is Executive Vice President of Integrated Health Partners of Southern California (IHP) and is accountable for setting the vision and ensuring stellar performance of the clinically integrated network to positively impact member health centers and the communities they serve. Prior to IHP, Amanda was a Principal over the Premier Strategy, Innovation, and Population Health Value Based Transformation pillar and the Medicaid and Managed Medicaid Transformation Consulting line.
Hope Kraatz, RN
Assistant Clinical Director at Integrated Health Partners
Hope is a Registered Nurse with over 22 years of experience in the healthcare sector and serves as the Assistant Clinical Director for Integrated Health Partners of Southern California (IHP). She has worked with payors and providers, building care management programs to improve integration and quality of healthcare. In her most recent experience, Hope worked with a network of rural health providers to deploy a clinically integrated network across the State of Montana. Hope has a Master’s Degree in Nursing from Gonzaga University and is a Certified Case Manager from the Commission of Case Management.
How to Stay Engaged with your Primary Care Network and Drive Quality Patient Care
Effective communication and collaboration between referral specialists and primary care providers (PCPs) are pivotal for delivering comprehensive quality patient care. Referral specialists play a vital role in extending specialized medical expertise to patients requiring advanced treatments, while PCPs act as the initial touchpoint in a patient’s healthcare journey.
Nurturing a strong bond between these two critical components ensures seamless patient transitions and fosters a synergy that enhances diagnostic accuracy, treatment efficacy, and overall patient outcomes. Read as we dive into strategies and approaches that referral specialists can employ to maintain active engagement with their primary care network, resulting in improved coordination, shared knowledge, better healthcare delivery & accessibility, and overall improved referral management.
Referral Management Tools Help you Stay Engaged with your Primary Care Network
Regular Communication
Maintaining a connection between referral specialists and primary care providers goes beyond simple communication; it involves cultivating a collaborative relationship that enhances the quality of care and patient outcomes. Effective engagement ensures that the transfer of patients from primary care to specialized care is smooth and seamless, with relevant information and insights readily shared. Such a dynamic collaboration not only benefits patients by reducing delays in receiving necessary treatments but also empowers primary care providers with enhanced medical knowledge, enabling them to make more informed decisions and referrals.
By actively engaging with primary care providers, referral specialists can tap into the broader clinical context of a patient’s health history, medications, and ongoing treatments. This comprehensive understanding aids in tailoring specialized interventions to align with the patient’s overall well-being, minimizing the risk of conflicting treatments or recommendations. Maintaining open channels of communication and feedback enables both parties to address any concerns promptly, ensuring that patients’ evolving needs are met with agility and efficacy.