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The Quadruple Aim
Quadruple Aim

A Conceptual Framework

Improving the U.S. health care system requires four aims: improving the experience of care, improving the health of populations, reducing per capita costs and improving care team well-being. HITEQ Center resources seek to provide content and direction aligned with the goals of the Quadruple Aim

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Resource Overview

  • Rationale
  • Challenges
  • Approach

Mobile health (mHealth) tools have the potential to play a pivotal role in fostering a sense of greater patient engagement within underserved populations. By facilitating patient use of mHealth applications in collaboration with electronic health record (EHR) and personal health record (PHR) systems there is an opportunity to empower individuals to take a more active role toward managing their health conditions.

The proliferation of consumer mobile health applications and devices is creating new opprotunities for engaging patients in their care and leaves little doubt as to the impact that these tools will have on the way that people manage their health, health information, and health communications with their care providers, family and friends. This shift to increased self-management of health by consumers will change a patient’s relationship with their doctor and the way healthcare is practiced.
The current laws and standards in place to ensure patient’s privacy and health information security will need further review to determine whether mobile health technologies create unique situations that are not yet addressed. This poses many challenges for health centers as to how best to support patient use of these tools and ways in which to incorporate them into their own clincial support systems.

Mobile health characterizes a shift in the point of care for the patient. The point of care has classically been located at the hospital or clinic. Mobile health is beginning to shift this model so that the point of care is more frequently a matter of where the person happens to be located at that time, consequently providing opportunities for more timely care. It is also important to note that these tools help to increase the accessibility of Healthcare to populations where direct access to Healthcare professionals is limited and so health management is more frequently left in the hands of the consumer.

The tools provide in this resource cover a range of different mobile health tools, strategies, and guidelines for consideration as Health Centers seek to leverage these technologies to better engage and activate their patients.

Mobile Health Resources

Telehealth Policy during Coronavirus/ COVID-19 Pandemic

Updated 11/16/2020 with NIST Guidance on Securing the Telehealth Remote Monitoring Ecosystem

We are adding additional telehealth information, including policy and regulatory developments, relevant to coronavirus/ COVID-19 pandemic as it impacts health centers as it becomes available. Please see the resource links below.

 

  • CMS Loosens Restrictions on RHC and FQHC Telemedicine Services – COVID-19 Updates

    • Published by BKD on April 10, 2020.
    • Key Information: Coding and regulatory requirements for implementing telehealth in accordance with CMS's loosened restrictions. Effective March 27, 2020, the CARES Act removed restrictions in place prior to the COVID-19 emergency, and now allows FQHCs to serve as distant site providers for telehealth audiovisual (but not audio-only or telephone) visits, and these can be rendered to new or established patients. CMS also added 80 codes to the existing list of eligible telehealth (audiovisual) services.

 

  • Telehealth Coverage Policies In The Time Of COVID-19 to Date

    • Published by the Center for Connected Health Policy, updated regularly in March and April 2020.
    • Key Information: Telehealth waivers under Medicare and Medicaid are in place, as well as DEA actions permitting prescriptions for controlled substances via telemedicine. Scroll to the bottom of the page for FQHC specific information.

 

 

 

 

  • Telehealth and Telephone Visits in the Time of COVID-19: Sample FQHC Workflows

    • Published by the Center for Care Innovations, March 24, 2020.
    • Key Information: Many health centers and safety net clinics are switching their scheduled in-person visits to telephone or video visits, this resource provides some sample workflows and guidance for how clinics are making this transition, including examples from eClinicalWorks, NextGen, and OCHIN Epic. 
    • An appointment rescheduling flowsheet from a health clinic is available from NEMJ.

 

  • COVID-19 Public Health Emergency Response and 42 CFR Part 2 Guidance

    • Published by the Substance Abuse and Mental Health Services Administration (SAMHSA) on March 19, 2020.
    • Key Information: There has been an increased need for telehealth services, and in some areas without adequate telehealth technology, providers are offering telephonic consultations to patients. In such instances, providers may not be able to obtain written patient consent for disclosure of substance use disorder records. The prohibitions on use and disclosure of patient identifying information under 42 C.F.R. Part 2 would not apply in these situations to the extent that, as determined by the provider(s), a medical emergency exists.

 

  • State Data and Policy Actions to Address Coronavirus

    • Published and updated March and April 2020 by Kaiser Family Foundation.
    • Key information: This site is tracking state-by-state policy actions such as state waivers of cost sharing for COVID-19 testing, state waivers of prior authorization requirements, early perscription refills, and expanded marketplace insurance enrollment.
    • Other important sources of state information are Medicaid Federal Disaster Resources which includes details on each state’s 1135 Waiver as approved by CMS and the Center for Connected Health Policy's tracking of COVID-19 related state actions.

 

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Acknowledgements

This resource collection was cultivated and developed by the HITEQ team with valuable suggestions and contributions from HITEQ Project collaborators.

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