To say that HealthTeamWorks is on the move is an understatement. Just recently, the 501c3 nonprofit received a $175,000 grant from Health Forward Foundation to build an advocacy coalition in Kansas City. Though its priorities aren’t yet set, the coalition will work to optimize the use of local hospitals’ community benefit funds to help area organizations support and address patients’ health-related social needs in the Kansas City area.
And earlier this summer, the nonprofit announced a leadership change, along with a merger with Iowa Chronic Care Consortium (ICCC) slated to complete by the year’s end. HealthTeamWorks CEO Cecilia Saffold said their vision, mission, and strategies remain unchanged.
“This transition represents an exciting move forward as unified nonprofit organizations offering a suite of aligned population health, community well-being and organization development services,” Saffold said. “In this case, the whole is greater than its parts as HealthTeamWorks’ approach to healthcare delivery redesign and ICC’s expertise in Clinical Health Coach and Community Health Worker training round out the key components healthcare organizations need to deliver better patient care and succeed in alternative payment models.”
A look back
HealthTeamWorks began in 1996 as the Colorado Clinical Guidelines Collaborative. The organization developed clinical guidelines to help primary care providers improve quality and equity of care delivered in their practices. Shortly after the group’s inception, leaders realized that guidelines are important, but couldn’t be implemented by practices without strategic direction, change management, and targeted training. The organization shifted to provide facilitation and workforce development for clinical practices under the auspices of HealthTeamWorks.
ICCC was created in 2002 and today trains clinical health coaches and community health workers to bring personalized health improvement strategies to people where they live, focusing on communities and rural areas where there is often a drastic lack of access, in part due to health professional shortages.
The organizations share a dedication to increasing health equity and access through empowering and training members of the healthcare and public health workforces. They have worked together for years, partnering to build population health solutions to meet the holistic needs of patients. Then, last fall, HealthTeamWorks and ICCC began the process of becoming a cohesive team with one mission: to strengthen communities by creating culturally responsive, high-quality healthcare via performance improvement, organizational development, and training.
In this new role, one of Saffold’s priorities is providing seamless execution of the nonprofit’s strategic objectives – an acuity that she spent years cultivating in various capacities. Saffold’s decades of social justice work began at the Chicago-based National Center on Poverty Law, now known as the Shriver Center. As a housing litigation paralegal, she worked to keep families together and housed when public housing developments were closing. From there, she moved to Bethel New Life, working to turn vacant lots, buildings, and brownfields into sustainable housing and mixed-use developments.
In 2009, Saffold returned home to Kansas City and transitioned into the healthcare space, working in group purchasing for the Kansas and Missouri Hospital Associations. There, she helped small healthcare practices negotiate fair electronic health records contracts and worked with critical access hospitals to improve their supply chains and emergency preparedness. In 2012, she became a project manager at TransforMED, a subsidiary of the American Academy of Family Physicians. That was her entry into helping to build new models of clinical care for primary care practices that included improving information systems, and practice flow, implementing outcomes-based quality and safety practices, and increasing the use of ancillary services and care management, among several other value-based, patient-centered improvements to quality care delivery.
Saffold’s commitment to public health, high quality care and patient safety bridges her professional calling to her civic participation. She has worked for environmental justice for a decade as a Brownfield’s Commissioner appointed by the Mayor of the City of Kansas City Missouri. Cecilia collaborates with the other founding members of Uzazi Village’s Community Expert Review Board to advocate for improved Black maternal infant health outcomes by amplifying Black womens’ experiences, influencing equitable research and ensuring culturally congruent care. Currently, Saffold serves on the board of directors for KC Health Collaborative (KCHC) and the Colorado All-Payer Claims Database (CO APCD) Advisory Committee.
In collaboration with the board of directors and staff, Saffold helped refine the organization’s three-fold strategy that was initially adopted in 2020 and will be the focus moving into 2024. Using the staff’s on-the-ground experience and years of work in the community and with primary care providers, HealthTeamWorks’ strategic focus includes: helping primary care practices transition to the use of alternative payment methods (like bundled and value-based payments); increasing primary care resilience; bridging the gaps between clinical organizations, public health entities, and communities. Each pillar of the strategy relies on HealthTeamWorks’ commitment to guiding providers, organizations, and other institutions to incorporate health equity into policies, procedures, and protocols.
Shifting the payment paradigm
Though it might seem unlikely that an organization with expertise in helping primary care providers increase their use of alternative payment models would also be dedicated to health equity, Saffold said the two are intrinsically linked to their mission.
“Our national investment in health is inverted. We spend more than 18% of GDP on our healthcare system but get some of the worst outcomes dollar for dollar,” she said. “A big part of the misalignment is what we pay for—the things we prioritize within our healthcare system—we’re not making sure that people stay healthy or return to optimal health when they experience illness.”
Shifting the way healthcare organizations are paid is meant to inherently change the way in which they deliver care. Fee-for-service models are often criticized for driving high levels of health professional burnout with high patient volumes and billable services tightly packed into each day. Where as, alternative payment models place the focus on quality and healthy outcomes.
For instance, in an APM, if a primary care practice is treating a patient with diabetes, the group may receive one payment or a monthly fee for the course of that person’s care. With positive outcomes, the practice retains that full payment and may earn additional incentives, while poor outcomes may result in repayment of a portion of the upfront and monthly fees. This serves to encourage the practitioner to support that person in remaining as healthy as possible through less expensive, but highly effective, solutions like group counseling, medication management, and connecting patients with food pantries or even food as medicine programs that provide low-cost connections to healthy foods. A patient effectively managing their blood glucose means they are healthier in the long run, reducing hospitalizations and other costly interventions in the healthcare system.
HealthTeamWorks understands the major barriers to the uptake of alternative payment models in primary care, including staffing, aligning different payer contracts, and building a multi-disciplinary team before reimbursement is in place to support that team. COVID-19 brought a mass exodus from the healthcare workforce, leaving many practices woefully short staffed. It’s difficult to align delivery requirements across multiple payment models with a skeleton crew, so HealthTeamWorks assists primary care offices in transforming their processes and practices to reduce burnout and utilize staff to their highest abilities. For instance, HealthTeamWorks may analyze workflows in a practice to ensure there isn’t too much burden on any care team members. If some people are overworked, they determine how to task shift to lighten the load.
“Oftentimes, activities aren’t allocated to the correct person,” said Cynthia Molina, HealthTeamWorks’ director of organizational development. “This can reduce job satisfaction for some of the team. So being able to leverage the medical assistant more or their nurses can not only alleviate these tasks for the providers, but it may also give the other team members tasks that make their job far more fulfilling.”
Much of HealthTeamWorks’ depth of knowledge in the value-based contracting space comes from a decade spent assisting practices and systems taking part in Centers for Medicare and Medicaid Innovation (CMMI) Center models. These models offer best practices and lessons learned to practitioners transitioning to alternative payment models and dissemination of outcomes to improve care delivery broadly. Specifically, through these models HealthTeamWorks has helped providers meet data reporting requirements; review core measures to improve care; assess gaps in health technology and implement strategies to address those needs; and implement key care delivery requirements to increase quality, improve patient experience and manage cost.
But that’s not all. The nonprofit also helps practices use the data gleaned to make actionale improvements to patient care. Sometimes this includes coaching on how to implement patient-centered care delivery models, and even facilitating peer-to-peer learning networks.
The second focus is to increase primary care’s resilience. Between the pandemic closing offices and large health networks buying primary care practices, Saffold said it’s more important now, than ever, to ensure that primary care groups are prospectively funded and intrinsically linked to their communities.
“We are working on ways to help practices navigate all of that,” she said. “We want to help providers avoid being drained by delivering care in a system where primary care is totally undervalued.”
HealthTeamWorks developed their Interactive Change Package (ICP), which focuses on six key aims for transformation: high quality, exemplary patient experience, appropriate cost of care provider and care team resilience, a thriving business model, and culturally responsive care. The goal is to help practices drive systems change.
“It’s based on the institutional knowledge we have to help our clients make the kinds of changes needed,” Saffold said. “Some of us have clinical microsystem experience, some have public health and social work experience, others have organized and fostered connections across communities. The best of what we have learned in the field is captured and documented in our ICP.”
Within these six areas, HealthTeamWorks defines evidence-based tactics known to yield results like increasing patients’ timely access to care, improving the patient experience, engaging patients and caregivers in their care, cultivating organizational culture, improving providers’ business acumen, and connecting organizations to their communities.
Another key component of improving primary care resiliency is HealthTeamWorks’ facilitated training for the healthcare workforce pipeline. This includes support for professionals in family medicine, internal medicine, and pediatric residency programs. HealthTeamWorks has developed and delivers quality improvement, care management, clinical health coach, and community health worker training.
Integrating behavioral healthcare into primary care is also a core component of building resiliency. This work is important because nearly three-quarters of all primary care visits include a behavioral health component – ranging from smoking cessation, substance use disorder, anxiety and depression to stress-related health issues. Many primary care providers are already prescribing and managing medications for depression and anxiety, but don’t have the same kind of training as a therapist or psychiatrist. And integrating behavioral health into primary care can increase equity by making treatments available to people of color and in rural areas where access has been a challenge.
“There aren’t enough clinicians in our country to serve the behavioral health needs in any setting, and I think there is an opportunity to start in primary care,” said Angela Schindler-Berg, HealthTeamWorks project and lead facilitator. “We know if people are diagnosed and caught early, their outcomes and quality of life are much, much better. I just don’t see healthcare getting any better or going anywhere without that.”
The third focus of the organization is bridging clinical, public health, and community – in an effort to actualize whole-person care.
Primary care providers can use their relationships with patients to conduct comprehensive psychosocial evaluations and link individuals to already existing community supports equipped to address their health-related social needs. HealthTeamWorks encourages providers to build relationships with community-based organizations already skilled in helping patients identify and get social needs met that impact their health.
Aside from understanding quantitative population-level health data, HealthTeamWorks recommends providers get information directly from their patients. They recommend creating patient-family advisory councils or including patients directly in quality improvement initiatives.
For Saffold, this recommendation is personal. “My grandma lived with us when I was growing up,” she said. “I remember making dishes that were the right carb count for my grandma, who had type 2 diabetes – something I learned from her care team. I recall my grandma, on many occasions, choosing between her insulin and her antidepressant medication. I don’t know if anyone ever had a conversation with my grandma about if she could afford her medications. And I don’t know if anyone in her care team would have been equipped with the resources to point her in the right direction to get support for the medications that she needed. But I know it would have changed her quality of life. It would have taken a tremendous burden off of her. And it would have improved her overall health outcomes. One way we want our work to impact primary care is by helping providers and care teams integrate patient voice. This will transform how healthcare is delivered, and the outcomes patients receive as a result.”
Learn More and Donate
To learn more, visit HealthTeamWorks.org and watch the video. Primary care practices and community-based organizations are also encouraged to sign up for a variety of free tools and resources designed to advance healthcare transformation. This giving season, please also consider making a charitable gift to support HealthTeamWorks’ mission. Donate today.