Without the help of the Greater Flint Health Coalition, “it would be very hard today for an HIE or anyone else to go into a community and just have the SDOH data be available in any sort of meaningful way.”
Author: Rajiv Leventhal
February 13th, 2020
Great Lakes Health Connect (GLHC) is one of the largest health information exchanges (HIEs) in the country. A 501(c)(3) nonprofit organization, GLHC is comprised of a network of 129 hospitals and 4,000 primary, specialty and allied care organizations, and a registry that houses more than 11 million unique patient records.
But for an HIE of this size and scope, to improve services across the state, the organization’s leaders knew they needed to remedy a disconnect that existed between provider and community-based organizations, and ensure that patient data and records could be shared easily throughout the continuum of care.
As a result, GLHC ended up adopting a technology platform—Holon Solutions’ CollaborNet platform—inclusive of three patented technologies that surface relevant patient-specific insights such as transitions, risk scores, care gaps, food insecurities or pre-authorizations for patients. GLHC leaders believe that many other care collaboration platforms on the market miss much of this relevant data. Ultimately, all this information can be sent to providers’ electronic health record (EHRs) at the point of care.
The pilot project of this collaboration was the Flint region of Michigan, which has made national headlines in recent years for its struggles with poverty and poor water quality. As detailed in this piece last year from Healthcare Innovation, working with the Greater Flint Health Coalition (GFHC) and Michigan’s State Innovation Model (SIM) program, GLHC helped link 85 providers and more than 40 community-based organizations in the Flint region, ensuring they had access to social determinants data, enabling them to provide better care in the struggling region.
Aiming to prevent ED overutilization and aligning Medicaid beneficiaries with needed care, GFHC developed a short SDOH screening survey that is administered to every beneficiary, to ask about their food, transportation, housing, substance use, water, employment and other needs. Based on those responses, providers can access CollaborNet to refer the beneficiary to the appropriate community-based organization.
Since November 2017, the GFHC SDOH screening tool, combined with the facilitated referrals through GLHC, and extensive coordination of resources, has helped the Genesee County Community Health Innovation Region—a partnership of diverse healthcare organizations—reduce ED visits among its attributed Medicaid population by 15 percent, while helping thousands of beneficiaries receive access to appropriate care and community-based services, according to the HIE’s officials.
As a whole, GLHC surpassed access to more than 1 million closed-loop referrals statewide from fall 2017 to early 2019 using the CollaborNet application, with a total of more than 3.5 million attachments shared. The point-of-care platform is accessible to more than 11,229 users at 824 different organizations across the state, including three of Michigan’s largest health systems.
Doug Dietzman, CEO of GLHC, recently discussed these efforts—and how partnering with GFHC allowed for the collection of SDOH data in an impactful way—in an interview with Healthcare Innovation. Below are excerpts of that interview.