Transcript
Patagonia Health 0:05
Hello and welcome to the Patagonia Health 2022 health IT Webinar Series. Today's webinar topic is public health 3.0 My name is Amanda Gerard, Marketing Associate here at Patagonia Health, and I'll be your moderator for today. If you are not familiar with the good webinar platform, please take a moment to look at your screen. Look out for the communications box located on the right side. All attendees will be muted throughout the presentation, and this communications box is your way to let us know if you have a question or a comment. Please type your questions in the Questions section of this box, and we will like to have you take part in our conversation today. So we will be addressing your questions with our presenters. The red arrow on the left side of this communications box allows you to shrink or expand it as necessary.
Patagonia Health 1:09
Today's webinar topic is public health 3.0 why it is important and what it means for public health agencies and health IT system developers. This is going to be co-presented by Ashok Mathur, founder and CEO of Patagonia Health, and Rajiv gash, founder and CEO of Health Words.
Patagonia Health 1:34
Ashok is the founder and CEO of Patagonia Health. Thanks for joining us, Ashok. We're excited to have you. Ashok founded Patagonia Health with a deep understanding of healthcare, IT marketing, and the emerging software as a service business models. He has many years of experience in the space, and he serves both public health and behavioral health with our EHR company. One of his current passions is to bring innovative technologies to help public health departments achieve their vision of public health 3.0
Patagonia Health 2:11
Ashok, I'll turn it over to you now.
Ashok Mathur 2:12
Thank you. Amanda, I’d love to introduce Rajiv Ghosh. He's a founder and CEO of Health Roads, a healthcare IT consulting company based in California. He's very unique. He's got tremendous vision. He's a thought leader in public health, while he's also got on the ground reality of what's going on in the public health department day to day. He's been a director and Technology Advisor of social HIE, an innovative solution, which was implemented in Alameda County, California. He's the only fellow with the Office of National Coordinator for Health IT, and he writes weirdly about different things in public health. We are fortunate to have Rajiv here today to talk about public health 3.0 Next please.
Rajib Ghosh 3:10
Thank you. Thanks. Ashok, appreciate the opportunity to be here with you today to talk about public health 3.0 with our audience. It's a very emerging topic at the moment, but our assessment is that as the decade rolls into the next part of it, it will become a pretty commonplace concept. But before we do that, I wanted to still add a couple of things about what we do, so that from the audience standpoint, you have a good understanding of where we are coming from. Health Roads is a Health IT consulting company based in Northern California; we primarily work with local government agencies, community-based organizations, and public entities to advise on technology and strategy alignments. We also help them with the RP development for electronic and digital health technology system procurements, for example, Electronic Health Record system, case management system, health information exchange systems, data analytics systems, telehealth HMIs or Homeless Management Information System and as well as grant management and other kinds of activities that are done on the social care side, we also work on the implementation services of those systems. So this gives us a breadth and depth of understanding of how technology systems can actually work in a public health setting.
When we talk about the county, these are local health and territorial health care agencies. So we work both from the vendor side and see if the system vendors would like to utilize our services. But we mostly work with implementation oversight, as on behalf of our local agency, government, and territorial agency clients, and we cover the entire spectrum of health and human services, starting from healthcare to housing and social care. So that's really a little bit of background information of health firms and where we are coming from. So with that said, let's jump into a few slides that I have put together a show for our audience to really orient everybody about the concepts of public health. So, Amanda, if you can just stay on the previous slide for just one more minute, I just wanted to give a roadmap idea. So as you can see, this road map basically suggests that public health in general is evolving. It has been evolving from centuries, actually, from the 18th century, 19th century. And in the early phase of it, the primary focus was on prevention through treatment, and moved into the, you know, 2.0 as we call it. If the previous one is 1.0 or the early emergence of it, but 2.0 is really it's about government, governmental public health, culminating in more like accreditation movements. So, but what it did is, it created a tremendous uneven public health capacity at the local level. So we have seen that in the later part of the 20th century, and even in the earlier part of the 21st century.
So from that what we are now moving towards, which has been in in the conversation, in the discussions, in in publications and and, you know, in the in the circles of pundits and all that stuff is about public health 3.0 which is really driven by the focus on the social determinants of health. And as this concept, as this understanding, emerging more and more that a large part of our health is attributed towards the social determinants in which we live and spend our life, that has slowly become a centerpiece of this movement, if we will, about public health 3.0 and along with that, because social determinants is, by definition, it is various aspects of a social life of a person. So it is multi-sectoral by definition, and therefore this multi-sectoral and multi-system based approach is really giving the main foundation of our public health, 3.0 if you will. Let's move to the next slide now, thanks Amanda for that.
Rajib Ghosh 8:04
So in the next slide, what I'm going to talk about is, again, these are called, or rather, we call this a kind of five main pillars of public health, 3.0 if we will. So it actually calls for an enhanced and broadened public health practice that actually goes beyond the traditional public health department departmental functions that we are accustomed with in one.or two.or in that phase right where the cross sectoral collaboration is really inherent to this particular vision. It calls for the public health leaders to become, or assume the role of Chief Health strategists, to drive the workforce towards that, towards that, higher achievements, if you will, with the skills, with the skills and capabilities that are needed. And also it calls for technology solutions, which is really one of the things that we want to talk about here. So you see that there are five pillars: workforce, infrastructure, partnerships, data analytics and sustainable funding.
And each one of them, I mean, are these are not really created to created for the sake of creating silos in the Public Health Public Health operations, but these are kind of interdependent one drives the other, and each one has to be followed and implemented to get the best benefit out of this framework. So public health 3.0 is a framework, and this framework can be implemented through systems and also through processes, organizational changes as well as leadership changes, because the idea here is that the public health leaders will be leading from behind, rather than leading the front, and kind of enabling all of these, all of their workforce, to really do all of these, all of the all of this cross sector. Work that we thought I just mentioned. So it's a multi sectoral, community based organization. Not only adds to the public health but it takes it further. And this workforce development, or workforce is not just only public health members or public health staff members, but also it includes the CBOs, and that is only possible when the public health leadership is more open to this public private partnership.
And I just talked about the role of a chief strategist, you will, chief health strategies, which is really the leader of the Public Health Department. You know, this framework expects that is the evolution of that leadership role. Infrastructure, obviously goes without saying. So building a network of public private organizations is at the core right of this pillar. And so it systems and other systems that are empowered by or enabled by these IT systems in collecting multi sectoral data, doing bi directional exchanges. Outreach and marketing capabilities are really core of this infrastructure. And then, if you have that, then you can actually go and talk about partnerships, strategic partnerships, with many, many organizations, collaborations for data interchange with labs, health plans, homeless, resource centers, hospitals, etc. And then once you have all of that in place, that means you have a workforce who understands this relationship. We have the infrastructure which can enable this. You have the partnerships that can actually enforce this, or really make sure that these things can come to a question you go into the data analytics and which is really more on the population health management aspect of it. And you know, none of these concepts are new that I'm talking about today.
I don't think it is new to any of you. You know, those of you who are in this public health space for a long time, this is preaching to the choir, but I think the public health 3.0 is really weaving these different things together into more of a coherent approach towards public health, not really doing in a little bit of a siloed way that are only focusing on compliance and reporting. It goes way beyond that. Sustainable funding is last but not the least. Now, sustainable funding means that, and obviously, public health will receive funding from, if you're a county based organization, there is funding from the county budget. You know you might be getting funding from the state. So there are and there are other foundations and other funders who are available to do that. So many times, what we have noticed is that you have taken up a Public Health Department, have taken up a project, taken up initiative, and then after two years, three years, when the funding disappears, that project has kind of fallen by the wayside. And I think that is a challenge that every public health leader has faced and and again, that's how this whole thing has been designed.
I mean, you know, there are some aspects, there are some programs, some funding, which have been continued over years, but a lot are not, and those are really kind of caused temporary triggers. So the question is, looking for this sustainable funding and making sure that you force this relationship and partnership for longer term grants and investments would be the key in upholding this public health 3.0 concept. So these are the nearly five things that you know really constitute what we call public health 3.0 let's go to the next slide where I'd like to give you a little bit of a current state of the public health EHR systems, if you will, because that's one of our focus area today, that public health Electronic Health Record system. We are seeing that many counties and many you know, are health departments. Public health departments, they're trying to buy or replace their old systems, which have been in action for the last decade or so, and suddenly they wanted to upgrade to a new system. And part of it is that all systems are really focused on a few things only. It's a data entry system, really, that's what it was, and it is, if those of you still have it, it's client data, Program Specific Information, billing information, etc. So that's really a data capture and then report out of it, which is really going back to this public health 2.0 concept, that it's more about accreditation, more about compliance reporting. And that's really the goal referral processes whenever it happens, because it has started to step into the public health operations for a long time, whether it's be the HMI with the housing providers homeless shelters or labs and other places, many times, or other social care centers, it is about paper. It is a paper based referral process, even between hospitals and public health referring people or health plans and public health. Used to be a very rudimentary method of referral, and then very little capturing of social determinants, because the systems really don't capture social determinants very, very well. And there are many reasons for that.
It's not that you are not deliberately not capturing it, but the systems are not geared towards that. So this is the current state of many of the electronic health record systems so, Amanda, let's next slide. And in the next slide, what I wanted to talk a little bit about is what should be a future state of public health, Electronic Health Record system, given the public health 3.0 framework. And as I mentioned in the very beginning, we have seen this unfolding, this public health 3.0 movement in that direction. It all started in the later part of the last decade, in theory, you know, in publications, as I said, in the federal government, and other other thought leaders. But it's actually getting enabled as more and more this decade is progressing. So what are the core things that we are talking about here? You know, first of all, digitization of paper documentation. So, you know, unless you can capture data into your system in a discrete, digitized manner, you cannot do a lot of other things, like sharing, like data analytics, like, like, you know, understanding your the cohort of your vulnerable population that needs more greater focus or
Rajib Ghosh 16:31
enrollment requirement, and then the core reporting, those things will always be there. But then these additional emerging features, which is really, you know, outreach management to your clients. The clients are there. They need help, but not necessarily. They will engage with the public health department on their own. Even when they have been told by the insurance company that you need to go and talk to your public health or their primary care facility, they may not do that. So that requires a client, outreach management, engaging these clients over a period of your enrollment. If it's a one year long program that you need somebody to be enrolled into, you need to keep that person engaged so that your staff members are able to provide the right level of service and the outcome that you're looking for, multi sectoral data and referral management goes without saying. We talked about that already, that it has to be multi sectoral coordination, and that's the only way the new public health, or the public health 3.0 is going to factor into the public health operation. And the core of it is interoperability, because if you systems cannot interoperate with other systems, it gets really, really difficult to do this kind of a multi sectoral data and and and collect that information needed for your your own analysis, analytics, which is just not reporting, it is really understanding and the population health management level, what's going on with your population.
And last, but not the least is, you know, public health has always been and it's becoming increasingly mobile. I mean, public health departments have to deploy people and their staff members on the streets for the street outreach to vulnerable communities, homeless populations in during the pandemic, we have seen a lot of that, that a lot of lot of the workforce was deployed on the streets to really go to the homeless shelters, to the embankments, and then really find out, you know, or provide collect information, provide vaccination and you know, or doing some tests In in those areas, and collecting their consents, collecting the other data in a mobile device, and which has been really one of the major things that we have noticed in many of our engagements, and hence, usability, everybody expects that the systems are not clunky anymore. Systems are like iPad. You know, systems as if I use my app on my iPad or my iPhone or any other smartphone. So these are the requirements that are emerging and public health, the health IT systems, the electronic health record systems, will have to cater to these things. And I'm seeing that more and more some of our clients are asking for these things from their vendors that you need to have, and if the vendors cannot provide that in our existing systems, they would like to change it next slide. So this slide essentially is, kind of bringing all of this home. What are the key takeaways from this conversation? And I would like you to have these takeaways. And then kind of two things I wanted to highlight here, and we sort of talked about this, that health equity has been really one of the driving factors. It's always been. It's becoming even more important now, and I think the pandemic. Nick has in our work that we are doing as Health Words, with our engagements, we are seeing that nothing bothers the public health staff members, their leadership, or maybe the County Board of Supervisors, more than this question that, are we delivering healthcare in an equitable fashion, and what do we need to do to really tackle, you know, in any sort of lack of equity that might be existing in our service delivery? And so one of the things to achieve that is really to get to the social determinants of healthcare across the clinical community. And that's a recognition that is happening across the clinical community, across our population. We need to understand that and be able to have this information available at our fingertips, if you will. To that end, the American Medical Association, they have introduced something, a toolkit for the clinical community, for their members, which is called steps forward, as you see here.
So that's basically how to improve outcomes beyond the clinic walls. So they are recognizing that clinic walls are not the limiting factor when it comes to healthcare. Maybe it's just a start, and then you have to include other things into the intervention to really produce the outcome that the condition is looking for. And that includes a lot of things in a patient's daily life, including economic policies, social norms, political systems. All of those things are really, really key. And this is, this is what you know. Dr Ansel was the SPP of community health and equity in the university, in a medical center at Rush University. He kind of summarized this well, you know. And I think this is a realization that all the public health professionals are probably having or had before already, and it's kind of reinforcing that, but that's basically what it is. If the country has to get the health improvement broadly then, then there is no other way but to marry what we do in the office with the work of the organizations might be able to do in the communities to improve the conditions under which people are living, and I think that's really the key, and this is probably what I would recommend, what I emphasize as the changes is happening in the public health work, which used to be a lot more okay, I have this, whether it's asthma program, a diabetes program, or maybe an SUV program, or we Have a health care program, whatever I've been doing, but but the question then becomes, is that, how is there a way by which I can change the conditions in which the people are living in the community?
Because that is integral to the outcome I'm looking for, and so I will end with the statement here from Not, not from me, is the director of a who, when he said that recently that this next 10 years, this this decade, essentially is going to be the decade of action. So we have been thinking about all of these things so far, but maybe the pandemic has accelerated our time frame, our time within which I have to make, take an action and execute it right? And there are enough opportunities out there to really fund some of those things, both from the federal government and other places. And now it's the time to really think about this in a very holistic way, that what do we all need to do to get to the point where we wanted to go, whether it's a, you know, healthy people 2030, agenda, or whether it's my strategic plan that the health department has for the next five years, or whether it is a preparation for the next pandemic, or, you know, a raging pandemic which is already there, which is the opioid crisis. How do we tackle all of these emerging, current challenges and future or emerging challenges, if we don't have this whole infrastructure, and by infrastructure, I don't mean to say the technology infrastructure. It is the human resource infrastructure, it is the Policy Infrastructure. How do I actually put all of that together so that we are not caught off guard whenever the crisis hits? So I guess this is probably my update of a show, yes, so that's, that's, that's really, I'm just setting the stage here so that we can get more questions, questions from you about some of these things that you just heard. Or I'm hoping you know if Ashok has any questions for me. I'll be happy to respond to,
Ashok Mathur 25:03
Yes, I think Amanda would be able to, you know, let us know what questions come in. But Rajiv, it's exciting to be in public health 3.0 and with COVID, as you said, things have changed quite a bit. We can accelerate what we are planning to do, and actually we can do it now. So the question is, you know, we have a lot of county health departments joining the webinar today. What should a county health department do to evolve public health 3.0 and also talk to us about, you know, how it will be different for a large Metro Health Department? What's the mid size versus rural? How are things different? Because they have different dynamics.
Rajib Ghosh 25:42
Yeah, that's, that's a very good question Ashok, and I think we, you know, let me try to address it, and then maybe some follow up questions from the audience, which we will try to address during this session today. So the first thing i i have to, I have to say that again, I might be pitching to the choir here, but, but the there was an idea that was there for very long is that it is better to build something, because no system can actually meet our needs and and I have seen that, you know, people have kind of threaded together their own things and systems. I think the needs of today are so complex, and we cannot forget that we have to do all of these things in the context of privacy and the emerging security and other issues that obviously all IT systems have to be compliant with. So it is something that the counties should consider buying so they should buy systems which are produced by other vendors, because they have the resources to do something that is compliant and future proofing their system. So buy, not build. That will be my first thing for all county members that are here. Then there is leverage. I mean, again, you know, we need to look around. So one of the things that the county can, the county, the Public Health Department, the staff, can right away, do is, many times what we have seen is that the requirements for anything new or anything has been triggered by, oh, we got a fund, we got a we got a grant funding, and then we need to and then our current system doesn't do that, so we have to go and either get a system or Build something using Excel access. Part of it is financial. Obviously, we totally understand that sometimes that's the problem. But what it does is that approach essentially fragments the entire space.
So your technology solutions that you have will always be targeted for a very teeny part of your operations, and there is a big chance that it's not going to be interoperable with anything that you already have or forget about anything outside. And so I think the main thing is taking a holistic approach. We are seeing it in some counties where they are thinking about their five year plan. And if you already have a five year plan for a health department or something that might have come down from the Board of Supervisors of the county. I think that's the first thing you need to consider. What are my goals? What are our goals for the next five years? Any system that you plan to buy should not be bought for less than five years. I would say that most of the time. Given the life cycle of these systems and the investment that needs to go in there, we should talk about a decade, almost, you know, maybe seven, eight years. We should not take these things lightly. So try to analyze your environment, what the needs are, whether it's a rural county or it's an urban county or a semi urban, semi rural county. I think that this particular need is regardless of where you are located. I think what changes is perhaps the amount of funding available. But I've seen that some of the rural counties are great. Great at creative solutions making. And they kind of look at local partners, who else they can partner with, how they can collaborate and find a solution that might meet their needs. And we cannot forget that the needs are probably, in many cases, greater in a rural county than probably in an urban county.
You know your clients might be getting, let's say, as an example, hospitalized out of state, or maybe in an urban Metro, many, many hundreds of miles away from your county. And you probably want to. To know what is happening with that client when the client is discharged, is the client going back to another homeless shelter or the client going back to a skilled nursing facility? And you need to be notified of that. And it's a simple case of an interoperability where you should have that ability to receive in your system and notification that the client has been discharged today and somebody can follow up. So I think assessing your current situation, looking at the strategic roadmap that the health department has, is the first thing that the counties need to do. And if you know, as I said, if in this space, it's not, it's not a bad idea to seek help if you need to. Sometimes you are completely occupied with your day to day operations and stuff. This kind of holistic approach may not be available, may not be possible. So you know, if you need help, I think that's something you should ask for. And then try to come up with the, with your vision for the system, what you want the system eventually to do. And then from there, you can try to pare it down based on, okay, I don't have, I don't have so much of a budget, I need to think about what else I can do in a creative way. So I think that's probably the progression. How I see
Patagonia Health 31:30
it. Rajiv, it looks like we have a question in regards to how important it is to have this tech to support these initiatives. We have one from Sean asking, Could you talk about public health care, staff, transformation, recruitment and training so that they're going to have the basic data and IT literacy that they're going to need?
Rajib Ghosh 31:51
Yeah, that's a great question, Sean, and thanks for asking. So if you remember the first pillar I talked about, of the five pillars, it is the workforce, and then no operations, no no operations, whether it's a public health operation or maybe a health system, operations can really sustain themselves or be successful unless you have the trained personnel to really do that. What we are seeing in many places is this, and then there is no, no denial that the workforce, the scarcity of skilled workforce, is an issue. And you know, we might, we have to acknowledge that, that this is an issue. The systems that we are thinking would be needed for the future are getting increasingly complex, and if we cannot have the trained workforce to go with it, then we have a mismatch, we have a misalignment. And so what I would recommend is, and I'm recommending, and not just I'm saying it here, but I'm also recommending to my other clients that you need to start thinking about, you need to start considering, considering training as a key component of your operations. In many other public health departments, what I have noticed is there are two kinds of training available. One the vendor who installed the system, let's say Electronic Health Record system, has done some training at the time of the implementation, and then there is no other training available. And then what happens is, you know, if you need training, you know the you know somebody coming in new you know will be asked by somebody who has been using the system, whatever he or she knows will be imparted to the new person, and there may be huge gap there, because the most of our systems today are going to evolve over time.
You know, most of the system gets in a six month to a one year upgrades, and sometimes those are significant upgrades, if those upgrades are part of already packaged into your into your pricing model, then you are getting it, but you don't know how to use it, and that's a big gap, right? So I think considering training as a key component is really key. We recommend that at the time when you were thinking of changing a system, if you are then we need to, we need to start thinking about developing the, what we call a super user, concepts, you know, developing some work, developing some folks who are knowledgeable enough about the system workflows in a public health setting. It is a little challenging. That is because every program has its own specific workflows and whatnot, right? I think the more important piece is you need to identify a few, few people in the public health department, or the health department, who is aware of all these different functions and features that the system offers in terms of configuring some of these functions and features to meet a. Specific workflow in a program that is fine. I mean, you know, not everybody will have knowledge of 30 programs that public health is running, perhaps right, but they will know that well you have a broad calendaring function, and here is how you can access it. Here is how we can make it available to other staff members, they will be aware that there is a secure messaging function with which you can communicate with everybody. Here is a mess. Here is a method by which you can send a text message out to our clients as needed. So these kinds of technology enabled features everybody will have to have. I'm not everybody.
I'm sorry, this super user group that I've talked about, they need to have that knowledge, and you need to invest, as a county, as a public health department, in developing that super users, because they are going to be your ongoing trainers when your vendor goes away, and the system is a couple of years old, they will have to be they will have to keep up with the upgrades and training. You know, in the epic world that I'm quite familiar with, they have a concept called a site specialist. And an epic made it a point that if you don't have a site specialist, that means somebody who knows about the system very well. Then, then that's not gonna work. So you need to have, you need to identify people who understand, who will get, not will get information from the vendor that here are the changes we have rolled out in this upgrade and trained on that, and then they will be able to impart that knowledge to their colleagues. So I think we have to think about it. That's where I know it is not a very easy thing when we talk about public health, but we have to shift our mind.
Patagonia Health 36:55
Yeah, staffing and public health is always a big issue and a topic that we talk a lot about, also funding. Kristen has come in with a comment I wanted to see if you want to add on to she said that flexibility in funding is also a must, and we really need to get away from categorical grants.
Rajib Ghosh 37:15
Yeah, the flexibility of funding is really, that's what I call, that's what the public health I mean, the Public Health Fee panel framework calls as a sustainable funding so, and this has been one of the culprits of the way some of the behaviors and some of the some of the approaches have been developed over the years within, within the space of public health, right? So what I would say is that there is always going to be a large chunk of money going to be available, especially right now with the introduction of the Cares Act. Cares Act, you know, the Coronavirus, aid, relief and economic, economic and what is the other one? Let me just quickly take a low economic security Sorry, I had to make a couple of cheat sheets for me just to make sure I said it correctly. So this one, which was introduced and went into effect in 2021, I'm sorry, 2020 and signed into law. This has allocated a large chunk of funding for health care, public health in general. Then there is the American rescue rescue plan, which is really the $1.9 trillion funding that President Biden signed that allocated about three $50 billion for cities and states and other US territories, with the 50 billion just for COVID, COVID 19 testing, and another 47 billion for vaccination distribution. So a large chunk of money could be utilized. And the good thing is that some of this funding is one time off, obviously, but could be utilized in making sure that you get you invested in a certain thing, whether it's purchasing a system in a couple of specific head counts, perhaps. So some of these things, not all, but some of these things could be utilized in that way. There is another thing I'm seeing that it's kind of emerging as a sustainable funding, and that is, it's a Medicaid 1115 waiver. So what is that you know some of you already know. So maybe I'm repeating this, but just for others who may not know this. So the Social Security Act has a 1115 section, 1115 which allows the Secretary of Health and Human Services to really evaluate novel or novel pilots and programs which are meant, which which are, which can produce outcome in healthcare and for the Medicaid population, and then many of the public health departments, if not all of the public health departments, that's your core focus, right? You are. Your core focus is Medicaid populations. In some places you are also.
Taking care of some of the undocumented populations, perhaps, yeah, so it depends, but I think that's the Medicaid population. So this allows this funding, and then state, typically, states have the ability to to create their own programs. Typically, it's a five year program, and there is an extension possible with CMS for another five years. So almost a decade long. Funding source. And when we are seeing this in California, where my company is based, we are seeing this in action, you know, translated into a very novel pilot called Whole Person Care, which, which, which really brought this whole public health 3.0 concepts into in together, and now that that is being utilized to transform the whole Medicaid healthcare through a California Advanced Medicaid Medicaid improvement program called Cal aim. So we have seen that in action in Maryland, in North Carolina, in other places, you know, they have created their own. The state has created their own, you know, 1115 waiver program. This could be a good source of funding, you know, because, as I said, the advantage is that it's five years. Could go into 10 years, you know, if the approval, if the renewal happens, that's a pretty long funding source, right? The third thing is, I am seeing that the funding is which is coming up, which is in the managed care health plans are becoming one of the key conduit of distributing public public funding, public public plans, public health plans, or maybe commercial health plans operating in the Medicaid business, we are seeing that the money is being distributed through them. And, you know the public health department or or in the health department of the county, sometimes working with the managed care health plans in managing some of the programs. But the advantage is that this funding source is, again, it's a long term so you're working with the health plans directly to get reimbursement for your services, along with the other reimbursement, like the state. If you are doing work with the state, we are seeing this in California, which is called a targeted case management, which is, again, it's the same thing. The state actually funds the county and the Public Health Department 50% of all the costs of care.
So these are the kind of things that we need to think about. And how do we and obviously I'm not the best person on that, but your grants department, your finance department, would be ideal to really weave in a strategy which will create a more sustainable funding strategy, rather than and of course, there will be sparks of foundation funding on funding from some specific programs and stuff like that. Those will always be there, but there needs to be an underlying foundation funding strategy that needs to be there. And these funding strategies can cover for your recurring expenses for implementing this new technology, as well as improving your workforce training situation. Workforce development funding is also another source, right that I think public health departments should also look into. But again, you know, these are the kind of ways by which the funding could be made more sustainable and longer term. And actually,
Patagonia Health 43:41
I'm going to turn this next question over to you, Ashok, and then we can go on to your portion of the presentation. Janie, would like to know what Patagonia Health is doing in regards to driving state and federal cooperation to build continuity between county state and federal grant programs.
Ashok Mathur 43:59
Excellent. Thank you, Rajiv. You know Amanda. You can go to slide next slide, and I'll give you an overview of Patagonia Health, just to build on what Rajiv was saying in terms of sustainable funding, we have noticed, once we implement electronic health record software, we see 15 to 20% increase in collections at the county health department have. So the money which really belongs to the counties, but somehow the systems they have to collect are not efficient systems. So a lot of money is actually left on the table. So we see that consistently, the money which you should be getting, but you're not getting because the technology is not helping you. The current technology, in terms of Patagonia Health, I do a brief introduction. A lot of you may know who we are already, but we are based in Cary. North Carolina. We are an electronic health record software company. We provide a web based easy to use, easy to learn software. And since 2012 we have been focused primarily. On public health. So we have learned a lot from the public health department. They have actually taught us what they need, and we are able to build the solutions they need, and through working with health departments, and now we are deployed in 150 health departments across the country, in 27 states, and growing, and what we have heard a lot to release with the past one to two years, especially since pandemic started, a lot of talk about public health 3.0 since we are focused on public health, this is our bread and butter, we have a pretty solid product already, and which will provide you the foundation for public health 3.0 over the past one or two years, we have actually built some of the things Rajiv has talked about. But you know, public health 3.0 is a long effort, and we have a road map, pretty robust road map to continue to build public platforms and continue to extend our platform to be public health 3.0 so we I'll talk about that, and Rajiv talked a little bit about this.
So the key thing we see is different from the typical EHR. If you look at EHR in the middle of this picture, there are five different bubbles or things you need to work on to go beyond EHR as typical EHR to become a public health 3.0 technology solution. Rajiv already talked about plant outreach management. You already do that at the local health department. You do education programs, you do food banks and all kinds of stuff. You're already reaching out to the community, but that's on a paper based method, and you are engaging the clients. Maybe you're doing an asthma training or diabetes management so on, yeah, but you are that's, again, on a paper based system or an ad hoc spreadsheet system. And the big thing really, is population health. As Rajiv talked about, you can only do population health if you're aware of what the population is and typically, the EHR system does not capture all the things you need to know to manage your community better. And we have seen across the country, in North Carolina, in Virginia, other states, we see a reference systems coming up where you tie all the agencies together, where you can actually electronically communicate the information with different agencies, so you can provide the whole care to a community member, whether it's homeless, domestic violence or so on. And of course, interoperability is built into the Patagonia system, we connect immunization agency labs and so on. And that's just part of what we do, and we need to extend it further into the community. Next slide, please. Amanda, some of you may already familiar with this chart. Really a lot of research on the health outcomes really depends more than just on the clinical care we provide, whether it's in a primary care office or county health department or hospital, the individual behavior, for example, health behaviors of individuals really determine. 40% of that work determines the outcomes. So the question really at the population health level, in public health level, is, what can we do? And what can you know?
Question for us in Patagonia, what can we do from technology point of view, for you, to address the health behaviors, whether it's for tobacco cessation or, you know, drug abuse, or we are already doing lot of work on preventive screenings and immunization, but what can we do to reach out more and increase the uptake of that through a technology point of view, we also know that the education and housing and lack of transport are factors. All of these factors do impact the population's health, and we are looking at that from a technology point of view of what we can do to help the next slide, please. If you know, from a if you start thinking about a typical electronic health record versus a public health 3.0 record, the three areas really we look at which are different. One is technology. Electronic Health Record needs to have a broader understanding of the client. For all the reasons Rajiv mentioned, right? You have to understand the social determinants of health. If you don't know that, there's not much you can do with the population. So the typical EHR would not have those capabilities, because a typical agency doesn't need that, but county health departments, you do need that information. And then another thing is to as we talked about, the ability to engage with community members. You know, that's really important. What we call that as a client, they are not patient, but are a client. You are trying to educate or outreach, but you want to be able to engage them in an efficient and seamless manner. You know, the current method of calling and emailing and random stuff is not traceable, and you can't improve them. Outcomes. And you know, the other thing is, we want to be able to provide the services which exist, whether it's for housing or transportation or domestic violence. You want to be able to connect the client to those services efficiently and track how that's happening. So these are the things we look at from a technology partner.
These are three things we need to worry about. How do we evolve from the current system of EHR, which is really taking care of patients in the clinic, and now broadening the scope to public health, 3.0 Next slide, please. Amanda, some of you may have seen this. We have, you know, based on the request from our customers, we have been capturing social determinants of health for the past one or two years already. This is an example. In fact, this example came from a state which is going through Medicaid transformation, which, you know, Rajiv mentioned that there is a shift in payment from fee for service to pay for performance. And part of that, you know, there's a math core measure which has come up with the court preparation. It's a big acronym. And what he's saying is that, in addition to capturing the demographic which any EHR does, you need to look at broader things like farm worker status, veteran status, and so on. You need to look at family and home today in our EHR. We do look at the family income for sliding ski scale processes, but we want to understand housing, status, stability and neighborhood where they live in money and resources. You know, if they are struggling with employment or they're struggling with transportation. You need to know that so you can direct them to the right services and provide them those services. You also want to be aware of not just the medical condition they come in for, but social and emotional health. Are they stressed? Do they have a support system when they get back home? And other measures which are in the preparation toolkit or screening capture are things like incarceration history, refugees status, domestic violence. So we have built this measure in as part of EHR. So if you start this is step one, capturing the data about your community and your clients. We already had that, and we have done this similar capture in different formats, depending on the state and the customer's needs. As you know, each health department may have slightly different needs; they may not use this particular tool kit. So we built that in encounter notes and home visiting notes as well.
Ashok Mathur 52:36
Next slide please. Amanda, this is my last slide. Really, what the big change is from a technology in electronic health record point of view, is referral management, right? Today, a client may come in, say for immunization, but you may want to send them to the maternal lab. So today, you can actually internally transition a patient in the health department to another program or another service in the health department. But that big change with public health 3.0 is you have to go outside the walls of the health department and deal with patients. So we have built based on the feedback and collaboration with our customers, county department, we have built ability to refer the patients or clients, from patients to external agencies and similarly, external reference coming in, we are trying to make the process efficient and seamless. At the moment. You know, we are not all there, but a lot of technology solution, not just with Patagonia Health, but there are other companies like Unitas and so on, who are building these reference systems will plug in and share the information and make it easier for you all to you know, achieve your vision of public health, frequent, zero, as I said, we have already built some capability, but we are in the beginning of this journey, but we have a robust road map. We are looking for ideas from you. What do you need? What would help you? So please let us know, and we will collaborate with you and to build it out, we as a company, are committed to build public health 3.0 as I said, public health is our bread and butter. That's what we do, and that's what we want to focus on. Amanda. That was my last slide. We can just take any questions, if there are any,
Ashok Mathur 54:35
While we wait for questions, I did have a question for you, Rajiv, you know we are at the end, at the point where somebody has decided to get an electronic health ecosystem, right. But how can you help? Because public health 3.0 is such a big thing, and I think you alluded to in terms of, where do you start, right? They're all busy in the county doing their day to day job. I. Can you and your company help?
Rajib Ghosh 55:02
Yeah, so Health Words is fully dedicated right now, in a big way, in enabling our clients and future clients to accomplish that. So what we can do is we can come in, we work with. First of all, we start out with, as I said, our main input is, if the county already has a five year strategic map that might have been created in 2020, the health department might have won. So we actually, our work actually starts there. We look at that. We look at the trends, the macro trends that are emerging, public health, 3.0 the core directions guidelines of Healthy People, 2030 we just kind of went beyond 2020, now. And we also look at what the federal roadmap for interoperability is recommending. And then we kind of start off with, we recommend that our client help, let us create what we call a vision document for them, if they don't already have that many times, this vision is fragmented, and you know, many people in the leadership, they have bits and pieces of it. Our job is to really take that and also amalgamate all of that with our knowledge of the industry and the trends long term friends, and kind of create a EHR vision document that hopefully will serve the county, not just for their immediate system implementation or system procurement, but also planning for the future. So that's the first thing we do. We also help them with understanding, with benchmarking them with respect to other similar kind of counties, goals and best practices, and workflow analysis. These are all really building blocks towards understanding and making sure that they can buy new systems, which several of them are doing, but it's done in a very cohesive way. So that's how we can help. We can also create RFPs if you are planning to buy systems. We have a very robust process of doing that, collaborating with all our clients and their staff members, and we have done that for several counties.
Patagonia Health 57:18
This is such a robust topic, I feel like we probably need to do a series on this, but we are reaching the end of our webinar. But I do want to take one last question from Sean, who's responsible for the legacy systems integration for the public health 3.0 EHRs, as well as building these digital pipes to the external resource entities?
Patagonia Health 57:42
Who is responsible for that integration for public health? Three pointers,
Rajib Ghosh 57:47
yeah. So if you are, if you already have a system that is maybe that is capable of doing this, I'm assuming that's, that's what the situation is. In that case, you can approach your vendor. Who is that system that you wanted to join, maybe with the Health Information Exchange, or maybe you wanted to create an interface with other community based labs that you send your clients to for testing, maybe a TB control program, testing and stuff like that. So if your system is capable, then the vendor will have the ability to do that many times. You know, the vendors have their proprietary reason for not letting any other third party kind of coming in and doing those things for for you, but they'll be happy to work with you to do those things in some situations, I would say that you can also build these bridges with old school style that I export certain things, and I have my IT department do this, and I will let send that information over to the other system, and vice versa. So we can do it that way. It's not real time. I mean, it's hard to build it in real time. It's an error problem. It takes time because it's all custom work. But that's another process. That's another thing that you can do if your IT department is willing to lend support for that. But as we are seeing it more and more, even the reporting requirements for many other brands and other programs are becoming very standard based integration, and that's where all systems don't play very well, unfortunately.
Patagonia Health 59:33
All right, well, we have reached the end of our webinar again. We are so thankful we're able to have you come on with us. Rajiv. Rajiv. Ghosh, everyone visiting from Health Words, if you would like to reach out to him for more information, you can visit his website@healthroads.com you can also email him personally at rajeev@healthroads.com and if you would like to get in touch with us here at Patagonia Health Our website is Patagonia. Health.com and you can reach out directly to Ashok at Ashok at Patagonia, health.com thank you so much, both of you for joining us as presenters today. It's been a pleasure and a wealth of knowledge.
Ashok Mathur 1:00:13
Thank you. Thanks everybody. Thanks everybody for attending. Thank you. Amanda,
Patagonia Health 1:00:18
Alright, everyone. Have a great day, and we will have a recording of this available on our website in the next couple of days. So if you'd like to get more information, you can also check it out there.
