The Colorado Rural Health Center (CRHC) is helping rural health clinics (RHCs) in the state improve business operations and move into quality improvement activities with their Healthy Clinic Assessment (HCA) program.”

With HCA, we go in and do a basic assessment of operations of the clinic,” said Michelle Mills, CRHC CEO. “Then we put together an action plan on where they need to make improvements, and what they are doing well. This strengthens the foundation of the clinic and allows them to focus on bigger, greater things like quality improvement, collecting data in disease registries, or focus on gaining patient-centered medical home (PCMH) status and other care transitions. We’re trying to create synergy for all the things we do for folks. It’s exciting.”

Three CRHC staffers are assigned to work specifically with the clinics. The HCA is a four-to-six hour process that is done on-site. CRHC staffers interview all clinic staff and providers, and then present a de-briefing at the end of the workday about what they have heard and seen. Mills said that CRHC staffers later return to the clinic, going over their findings and helping them put together an action plan.

“So far we’ve done 80 HCAs over the last four years,” Mills said. “We have a little over 50 federally-certified RHCs and over 50 rural clinics in Colorado—so we still have a ways to go. It’s a voluntary process—clinics don’t have to take part. And they don’t have to do anything with the data we provide them. It’s a free service, an initial touch to help them move forward. But our hope is that they will want to move forward—for the betterment of the clinic and the community itself.” Mills said that the HCA supports the goals of the Affordable Care Act because it focuses on making sure that rural communities there are prepared to move toward the Triple Aim (increased access, improved quality and reduction in cost).

Clinics that want to can go on to the next step, CRHC’s iCare (Improving Communications and Readmissions) project, which has the goal of reducing readmissions. Right now, Colorado hospitals and clinics enrolled in iCare are concentrating on collecting data and putting systems and processes in place to improve quality.

“Of those we’ve helped make improvements with HCA, 15 are participating in iCare,” Mills said. “And two in our state have achieved PCMH status. We hope that all clinics sometime in the future will move toward PCMH, but it’s a long road and takes a huge amount of commitment. But while they’re doing this, we’re also helping all the clinics and hospitals achieve Meaningful Use Stage 1 status.”

John Gardner, CEO of Yuma District Hospital and Clinics, said that the HCA helped his organization make big improvements in the last four years. “CRHC approached me asking if we would be interested in participating in the Safety Net PCMH project funded by the Commonwealth Foundation,” Gardner said. “Honestly, I really did not have much knowledge of the PCMH movement and determined that it was worth exploring. After much work, and significant changes in our organizational culture, we were certified as an NCQA Level 2 Medical Home. This has been a great opportunity for our two clinics. I am thankful that CRHC invited us to participate in the project.”

Mills will be presenting information on the HCA program at an Institute for Healthcare Improvement conference on improving patient care in March.