Navigating the complexities of care team design with the PHMI business case tool

Comprehensive Community Health Centers’ CEO David Lontok shares enlightening moments using PHMI’s business case tool.

Can you share a little about your CHC and why you’re excited to be part of the PHMI? What are your hopes?

We have been serving the under-resourced and those with low income in Los Angeles County for the past 20 years. Four years ago, we initiated a project in some ways similar to the PHMI which we called our Care Model Initiative. Our intent was to introduce more supported patient visits, engaging additional care team members to address the full range of patient needs. Now, with PHMI, CalAIM, APM and other value based care initiatives underway, we see how our Care Model Initiative dovetails and supports overarching efforts to provide more resources to patients not only at the point of care, but also before and after their visits. It’s exciting to be part of this larger statewide initiative, and paving the way for CHCs statewide to have access to tools and resources which will enable their transformation efforts.

I understand you’ve been using the business case tool as part of the pilot phase. Can you tell me a little about the tool itself?

It’s an Excel-based tool, and using it begins with inputting your organization’s baseline data such as revenue, labor costs, payer mix, visit information, etc. I think most CHCs will find that the information needed is readily available and easy to populate in the tool. Once the baseline data is in, it’s easy to play with different scenarios to evaluate variations in care team composition. For example, in our case we don’t currently have onsite pharmacists. We were able to look at the impact of adding a clinical pharmacist to our care team, what that would do to our cost basis, and how it would impact visit production.

What are its key features?

Aside from capturing your own baseline data to assess the impact of potential changes, the tool has a series of tabs that provide staffing recommendations and care team simulations. The tool also provides recommended models of care and explains the impact of each. The real power of the tool is its flexibility because it allows you to model various care team algorithms to determine what works best for your organization’s setup. Another great feature were recommendations for patient to staff FTE ratios.

What have you learned in using it?

It was enlightening to play with the different scenarios. For example, we looked at the impact of adding a case manager or an outreach person, what it would do to our costs. It validated our assumptions in those areas, and challenged our assumptions in some other areas. It also provided line of sight on the number of additional staff needed based on the size of our organization and how those staffing additions would impact our cost structure.

How do you plan to apply what you’re learning?

It’s given us a target to aim for. We’re getting ready to develop our next 3-year strategic plan, which includes moving our care team design work forward. We’re looking at potentially bringing in a panel manager, nurse care managers, and additional community health workers based on the needs of our clinics and our organization. Using what we learned from the business case tool will help us make data driven strategic decisions.

Can anyone use the tool?

Yes, you don’t need to be a CFO or a data analyst to use it. The tool is self-explanatory and has built-in instructions on how to use it. In our case the data needed by the tool was readily available and data input only took a few hours. From there, we spent time playing with the scenarios and the related costs, which was fairly easy to do too.

How do you see it being useful across PHMI and beyond?

For CHCs, the tool provides a foundational starting point and the framework to model how you can transform care within your own organization. Beyond PHMI, this tool also helps us illustrate to purchasers what it takes and how much it costs to provide care to those we serve.