HIT Think

How a New Mexico facility is using IT to battle addiction

McKinley County, New Mexico, is home to many Native Americans of Navajo decent living on a reservation. It borders on Gallup, N.M., which gained renown as "Drunk Town, USA" 30 years ago.

For many years, Gallup ranked No. 1 nationally in the number of alcohol-related deaths, highlighting the need for behavioral healthcare. The National Institute of Health reported that Native American youth have the highest rates of alcoholism of any racial group in the country. Addiction’s partner is the abject poverty of McKinley County, one of the poorest counties in the U.S., with a large population of Navajo, Zuni and Hopi Indians.

In addition to addiction, another behavioral health related disease afflicting the territory is diabetes. In 2016, diabetes was the sixth leading cause of death for New Mexicans and the seventh leading cause in the U.S.

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When he became CEO of Rehoboth McKinley Christian Health Care Services (RMCHCS) a few years ago, David Conejo took the financially failing hospital and turned it around with the help of William Kiefer, the hospital’s chief operating officer. Recognizing that the root cause of the region’s health problem was addiction, Conejo revitalized a former rehab building on the hospital’s grounds, and with some fundraising, he launched the Behavioral Health Treatment Center.

From this traditional form of behavioral health addiction treatment, Conejo has turned to health information technology in his pursuit of behavioral healthcare remedies while leveraging government insurance changes in Medicare and Medicaid under the Obama Administration. Rather than traditional acute care services, the federal programs began to shift its focus on preventive care, identifying a 6:1 cost savings ratio.

Conejo recognized that RMCHCS would benefit by offering preventative care services, which fit perfectly with his behavioral care plans while creating a new revenue center through reimbursements by CMS. To achieve this, he recognized the need for the convergence of hospital information across clinical, financial, and operational systems.

He began by integrating data from the hospital’s three clinics—the College Clinic for family and internal medicine, the Red Rock Clinic for general surgery and the Acute Clinic for emergencies and occupational health. He used a cloud suite application from Zoeticx which integrates and streamlines data from the Center for Medicaid and Medicare Services (CMS) including annual wellness visits (AWV), chronic care management and care transition between physical and behavioral health services.

The cloud application streamlines data from annual wellness visits and integrates it with the hospital’s electronic health records system from athenahealth and MedTech. The app also enables the management of tracking for patient wellness visits, provides a physical assessments guide through preventative exams and maps out the risk factors for potential diseases for patient follow-up visits.

In addition, the app includes other services that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurer requirements for organizations like Blue Cross and Blue Shield plans. The app’s time tracker capability automates invoices for faster billing.

RMCHCS' business is growing with full or near-full coverage compliance. And with its accountable care organization in startup mode, RMCHCS is also receiving a bonus check from Medicare for containing costs, in addition to the new revenues being generated. During the first five months of using the app, the new revenue has matched the financial incentive from its ACO, with the outlook of at least doubling the bonus from the ACO. Furthermore, RMCHCS does not increase its current operational cost to achieve this type of outcome.

Joe Wright, the hospital’s director of clinical services, has found the apps provide significant time savings for the nurses and medical assistants when disparate EHR data is integrated and streamlined. He also notes more patients can be seen. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day, that’s an extra 180 minutes.

In addition, his chronic care patient practice has grown significantly since the recent implementation of the chronic care management application, since many patients suffer from diabetes. Patients participating in AWV visits have grown to 250, a 50 percent increase since the apps have been installed. The AWV appointments also mean less patient visits to the hospital. At the hospital’s Behavioral Health Services facility, where addiction to alcohol and opioids are the main patient affliction, all 68 beds are full.

Conejo’s next big technology push will be a telemedicine program enabling reservation patients to be seen by mobile healthcare physicians connected by satellite to the Internet to extend the hospital’s outreach to patients who can’t visit the hospital for various reasons. This will enable patients to be treated as if they were at one of the hospital’s clinics with all their data entered into the appropriate systems and ready to be whisked off to the insurance organizations.

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