Julie Bonello, CIO, Access Community Health Network, Chapter 1

The changing landscape of healthcare has meant a shift in strategy for CIOs. Whereas aligning with community health centers and physician practices was once merely on the radar, it’s now a top priority. New payment models and looming federal mandates have made care coordination vital — and that’s where Access comes in. “Care coordination is what we do,” says Julie Bonello, who is leveraging her past experience as a hospital CIO to lead the organization through a dramatic transformation and position it as a key partner to a dozen hospitals. In this interview, she talks about building an IT team from the ground up, her strategy for retaining top talent, and what’s next for CIOs.

Chapter 1

• About Access Community Health (35 care centers, provider service agreements with 12 hospitals)
• “Care coordination is what we do.”
• Epic since 2009
• HealthCura ACE — 1 year of planning
• 3 different levels of risk stratification
• Community provider portal
• IT as an enabler — “There is no magic bullet.”

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Bold Statements

Care coordination is what we do. It’s really very much embedded in our mission, vision, and values.

It’s optimizing the roles of our care team to now include care coordinators and nurses to really follow up on care longitudinally — not only when the patient is in the health center, but pre- and post-visit as well.

When we sit down with our partners — our hospitals — we work on a service level agreement together. So while we’re using technology to support care coordination. Technology isn’t the driver; it’s the operational workflows and service to each other for the patients that we share.

I wouldn’t say that they create our processes; they definitely don’t. But they allow us to accelerate what we do, and so we’ve spent a lot of time here making sure IT is on the front end of all discussions regarding workflow processes for care.

Gamble:  Hi Julie, thank you so much for taking the time to speak with us today.

Bonello:  My pleasure, Kate. I’m excited to talk with you.

Gamble:  Great, so can you start off by giving our readers and listeners some information about Access Community Health Network — what the organization does, how it’s structured, and things like that?

Bonello:  Access is located in Chicago and the surrounding suburbs. We are one of the largest federally qualified health center networks in the nation and one of the largest primary care physician groups in Chicago. As an FQHC, we provide primary and preventative care in 35 health centers. We cover 1,700 square miles in two counties in Illinois: Cook and DuPage. We serve 175,000 low-income individuals and families. FQHCs serve the underinsured or uninsured.

We’re a standalone ambulatory provider, and we have affiliated provider service agreements with hospitals, specialty partners, diagnostic services, community support organizations, and other clinical service providers, like Walgreens. We’re the largest private provider of Medicaid primary care in the state. We have 108,000 Medicaid patients, and recently we were awarded the opportunity to form a Medicaid Accountable Care entity called HealthCura where we will be enrolling up to 70,000 of our Medicaid patients in a value-based reimbursement accountable care entity model.

Gamble:  That’s something definitely want to get into a little bit more. How long has the organization been around?

Bonello:  The organization has been around since 1991. We started on the campus of Mount Sinai Hospital here in Chicago. Then as an FQHC organization, you need to be independent, so while we remained on the campus until 2009, we expanded our health centers across many other medical delivery areas. But we started in 1991.

Gamble:  Talking about the continuum of care and how that concept is really evolving, especially in recent years and recent months, I just wanted to get a few thoughts from you on this changing environment we’re seeing.

Bonello:  It’s pretty fascinating, actually. For Access, because we’re a standalone ambulatory organization, care coordination is what we do. It’s really very much embedded in our mission, vision, and values. We manage 10,000 referrals every month, and we have well-defined affiliation agreements with our hospital specialists, diagnostic services, and community support organizations. For example, with HealthCura, we are the lead organization for the Accountable Care Entity and our relationships within the ACE  includes 11 hospitals, 1,000 specialists, 7 behavioral health organizations, and the list goes on.

Gamble:  It’s interesting to see how things have evolved. Maybe it was something where it was on the back burner for a while but really seems to have taken on a faster pace with all the changes we’re seeing in the industry.

Bonello:  Right. I would say that even though it’s been a part of what we do, there have been really two parts of our evolution. When I came on board in 2009, we started our Epic Electronic Health Record journey. But when we did that, it was concurrent with our patient centered medical home journey. We made our EHR strategy pretty simple to understand, and we aligned it completely with patient centered medical home standards. Our strategy was to implement the record, implement the patient portal, and then implement the community provider portal. The organization really understood how to leverage the Epic toolkit alongside the care team approach under the patient centered medical home. I would say that was the first evolution — that was from probably 2010 to 2013, and we’re continuing to certify our health centers and patient centered medical home.

The second part of our evolution has been just recent with our creation of HealthCura, the Accountable Care Entity because now, our care model and our care coordination strategy really include care coordination workflows that are based on three different levels of health risk. So we use claim and clinical data to stratify our patients into three different levels of risk, and then based on their care plan, our care coordinators follow up on care based on that risk.

It’s really optimizing the roles of our care team to now include care coordinators and nurses to really follow up on care longitudinally — not only when the patient is in the health center, but pre- and post-visit as well, and during different transitions of care when they’re an inpatient or an ER patient.

Gamble:  And the ACE is in the early stages right now?

Bonello:  It is in the early stages. We spent probably a year designing our care coordination workflows, our risk stratification methodology — all of the risk screening tools, our health assessment, and our care coordinator dashboards to be used for the three different levels of risk for our patients. In addition to that, we had to build out also our chronic care registries.

Gamble:  In setting this up, how closely are you working with the partnering hospitals?

Bonello:  We are working closely with partnering hospitals, most specifically in two areas — the first with our community provider portal, which will allow hospitals to look at our patient records. It will allow the hospital to communicate with the primary care provider and the care team, and it will allow the hospital to schedule follow-up visits. So we’ve identified a particular workflow of functionality for hospitals to participate in the care of that patient using this particular tool.

The second part has been working with the hospitals in defining the continuity of care document sharing based on different workflows for transitions of care. When we sit down with our partners — our hospitals — we work on a service level agreement together. So while we’re using technology to support care coordination. Technology isn’t the driver; it’s the operational workflows and service to each other for the patients that we share that we work on in defining the service level agreement.

Gamble:  Now you’ve had partnerships in place with the hospitals for a couple of years, right?

Bonello:  Many years.

Gamble:  Is that something that has changed or evolved in recent years as hospitals are facing more mandates as far as creating that continuum of care and being able to meet various measures?

Bonello:  We’ve always have had strong relationships with hospitals. We’ve always had that very strong relationship with hospitals because we are a standalone ambulatory organization, so we’ve always had to make sure that our patients can get the care that they need. But I would say in the last 3 or 4 years, the relationships have become stronger for care coordination. Everyone really gets it. We’re working with many different hospitals on our workflows, on our referral workflows, on our discharge process, on our access to care, and to eliminate unnecessary ER admissions — how do we work on that together? That’s really what we’re trying to do now with the service level agreements. Every time we do that, we really have a team of people that make up the group working on the service level agreement.

Gamble:  Who is usually included in that?

Bonello:  Operational owners from both organizations — it includes physician participation, and it also includes IT. Our IT tools right now, I wouldn’t say that they create our processes; they definitely don’t. But they allow us to accelerate what we do, and so we’ve spent a lot of time here at Access making sure that IT is on the front end of all discussions regarding workflow processes for care.

Gamble:  As I’m sure you know, that’s one thing that often comes up as a roadblock — just getting the workflow to a point where it does work for everyone. And it’s tricky, because there’s no magic bullet for that.

Bonello:  There’s no magic bullet, and we’re really talking about a changing care model. And so if we all work together and know that and pilot different workflows, we’ll be able to move the needle.

Chapter 2