Case Study 1 - Georgia Community Health Center
Study authorized by insurer to determine the efficacy of FQHC based patient centered home outreach service in the engagement of patients and the reduction of certain key health metrics in that engaged population. Primary population health metrics, including reduction in hospital re-admissions, reduction in mean and individual hypertension measurements and reduction in mean and individual A1c levels.
Process:
- 200 patients identified upon discharge as lacking identified primary care physician. Patients were designated to the study protocol
- FQHC was assigned sole responsibility for all member engagement, and convening individuals to patient status for designated primary care activites
- FQHC assigned responsibility for reduction in readmissions for individuals and the assigned population
- FQHC assigned responsibility for reduction in aggregate and individual hypertension metrics for the assigned population which engaged with the facility
- FQHC assigned responsibility for reduction in aggregate and individual blood sugar metrics for the assigned population which engaged with the facility
Metrics/Goals:
- Engage 20% of assigned member population, and convert to FQHC patient status
- Reduce patient hospital readmission by 10%
- Achieve reduction in hypertension levels below 140/90 for 10% of designated population
- Achieve reduction in A1c levels below a baseline measurement of 9 for 8% of designated population
Results 12 Months:
- Engaged 36% of designated population as patients of FQHC. Note, this study included no patient incentive for engagement
- Reduced readmissions for designated population by 50%
- Reduced hypertension levels for 45% of designated population to benchmark
- Reduced A1c level for 10% of designated population to below benchmark
Back to Case Studies
