Located in Missoula, Montana, All Nations Health Center is one of 41 Urban Indian Health Programs across the U.S. Founded more than 50 years ago, the clinics focused primarily on social services and limited behavioral health for their first 48 years.

However, in 2018, to achieve holistic, comprehensive wellness for the Missoula AIAN community, the provider organization added primary-care services to its existing behavioral health and dental services, and attained federally qualified health-center (FQHC) status.

THE PROBLEM

"At the start of 2019, we were on the search to replace our Indian Health Service (IHS) electronic health record system, Resource and Patient Management System (RPMS), with a better EHR," said Skye McGinty, executive director at All Nations Health Center. "Reason being, our RPMS was very outdated and difficult to use.

"Our staff members wanted an EHR they could navigate without a lot of training or assistance, and following a demo of Greenway's EHR and practice-management technology, Intergy, our staff was eager to move forward."

Another major challenge for All Nations was maintaining the revenue cycle. Previously, it had not focused on third-party billing, particularly for behavioral health. So the organization was looking for a revenue-cycle-management vendor that could not only help with reporting but that truly understood the needs of an FQHC, which has very specific reporting requirements.

"For months leading up to the implementation of our new EHR and RCM technologies, we worked with our partner for two to four hours a day."

Skye McGinty, All Nations Health Center

So, All Nations opted for Greenway Revenue Services.

"We knew we would benefit from their expertise and that the company would be able to offer various reporting capabilities that supported the data needs of our specific patient populations," McGinty said.

PROPOSAL

To continue to provide support to the urban Indian community it serves, All Nations knew it needed an EHR that featured a user-friendly interface and required little training or instruction.

"We were attracted to Intergy for this reason, as it was clear the technology would enable us to improve efficiency, save time and enhance the patient experience," McGinty explained. "Greenway also had recently announced upgrades to the solution that were of interest to our staff, such as streamlined navigation to reduce clicks, modernized user interfaces, back-end optimization to improve performance and responsiveness, and more.

"Our previous EHR was not very user-friendly and required expert-level navigation to pull adequate data," she continued. "Our teams didn't have the bandwidth to learn how to navigate that system without serious distractions from their day-to-day patient care, which caused friction points all along the data-collection and data-reporting pipeline."

MEETING THE CHALLENGE

The COVID-19 pandemic hit healthcare hard, but FQHCs in particular have faced many challenges as a result. While many primary-care practices shifted to a virtual-care model to continue seeing patients at the onset of the public health emergency, FQHCs had operational challenges and financial limitations with virtual care.

In many cases, providers had not used virtual care before and struggled to find the proper codes for each service. Additionally, with limited virtual waiting rooms, providers were not able to keep up with the same patient volume. Further, their patients were not familiar with the technology.

As a result, many FQHCs were limited in their abilities to continue serving patients, which had drastic impacts on the bottom line.

"Interestingly, our team set the day of implementation for Intergy on March 25, 2020 – less than 10 days after the state of Montana shut down as a result of the pandemic," McGinty recalled. "Despite the quick change to move the kickoff to remote in the middle of the pandemic, our clinic didn't miss a beat.

"We knew we needed to move forward with the implementation in order to keep the practice afloat and continue providing quality patient care," she continued. "And, despite a remote implementation, we were running at 100% productivity by May 2020, compared with the average six-month time it takes practices to build back up to full productivity."

Deploying Intergy with a cloud-secured option also brought about many benefits, including that All Nations was able to implement seamlessly while many of its staff were remote. Hosted services also give the organization more peace of mind with 24/7 monitoring, nightly backups and added security protocols that minimized stress around HIPAA compliance.

Also, the organization is able to make software upgrades and complete its reporting needs much more easily.

"In addition to implementing Intergy, we also added Greenway Revenue Services, which helped us maintain business continuity, create additional revenue streams and improve patient outcomes," she added.

RESULTS

Despite a 4.5% initial reduction in revenue because of the pandemic, All Nations saw an overall 150% increase in revenue for 2020, compared with 2018.

In addition, monthly billing increased 88% since it began using the new EHR and revenue technology – from $8,000 to $15,000 – and the organization increased collections by 75% and expected to double 2020 receipts by the end of 2021.

ADVICE FOR OTHERS

"When seeking any new technology partner, my recommendation would be to focus on 'pre-work,'" McGinty advised. "For months leading up to the implementation of our new EHR and RCM technologies, we worked with our partner for two to four hours a day. While the pre-work was extremely thorough, it paid off in terms of a seamless transition and an improved experience for our providers going forward.

"I also recommend working with a partner that has deep expertise in your specific specialty," she continued. "In this case, we knew our selected partner had over 20 years of experience working with Indian and tribal health clients, serving 30 Indian Health and Urban Indian Health Centers, in addition to over 100 FQHCs, community health centers and rural health clinics."

It's critical not to select just any EHR, but one that will meet a practice's specific needs – and that has the ability to provide a seamless experience from training to go-live, she concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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