West Virginia's Partners In Health Network Regional Collaborative Services
- Need: Coordinated approach to healthcare delivery in central and southern West Virginia.
- Intervention: Creation of a nonprofit organization that focused on quality and collaboration.
- Results: With an ability to provide services that meet the evolving needs of patients, providers, and communities, the organization provides unique services, such as a credentialing service and web-based data sharing care management tool.
Partners In Health Network (PIHN) provides various centralized services for rural healthcare providers and organizations in central and southern West Virginia. Initially conceptualized in 1994 and organized as a nonprofit membership group, its vision was coordinated approach to rural healthcare and services. PIHN's mission focuses on quality healthcare delivery, collaboration, and meeting the evolving needs of patients, communities, and its member healthcare providers and health systems. Its membership network includes over 35 hospitals, community medical centers, free clinics, and Federally Qualified Health Centers (FQHCs).
PIHN provides 2 major services to its members: credentialing and verification services and maintaining a web-based data sharing system, CAPGate. In addition, PIHN assists with the area's Coverage to Care program that provides information to the lay public for accessing health care. PIHN is also involved with the Appalachian Pulmonary Health Project (APHP), a pulmonary rehabilitation program active in multiple locations in the state.
Credentialing Verification Organization
Certified in 2010 by the National Committee for Quality Assurance (NCQA), PIHN offers credentialing services for both PIHN members and non-members. Healthcare credentialing requires verification of the training, skills, and certification of healthcare practitioners to gain practice privileges in clinics and hospitals. It also requires direct contact with multiple organizations such as medical training programs and previous employers in order to verify a provider's information.
The service is offered to both the medical professionals seeking privileges in multiple facilities and the multiple facilities granting privileges to these professionals. Additional value is gained from the service functioning as single department that performs the duplicative and repetitive tasks associated with initial and re-credentialing needs. The service not only offloads the time-intense aspects of verification, it navigates the wide variety of unique requirements of insurance companies and healthcare organizations.
CAPGate is a sustainable tool resulting from PIHN's 2001 Health Resources and Services Administration Healthy Communities Access Program grant. Maintained by PIHN, CAPGate is a secure, HIPAA-compliant, web-based data sharing care management tool. It is most often used by member Community Health Centers and FQHCs and contributes to efficient patient care coordination. Patients are offered a choice about sharing their information in the database and permission is recorded as part of a Protected Health Information consent. The tool has additional capabilities allowing users to create reports, data graphs, and charts.
Another feature allows hospitals to enter CAPGate-enrolled patients' inpatient data, again allowing for enhanced care coordination. Hospitals interested in this feature enter into a legal agreement with PIHN and the providers' electronic health record system must include specific interoperability functions.
Credentialing is a highly utilized offering and is financially sustainable due to operating as a fee-based service. Multiple facilities in multiple states, including non-PIHN members, use the service.
CAPGate has proved to be an essential data collection tool for a variety of purposes. It has been used for for several past PIHN projects and currently is utilized for the APHP project. Additionally, the tool is used for PIHN's Centers for Medicare and Medicaid Services Innovation Center Accountable Health Communities model grant which is exploring "whether meeting health-related social needs reduces the overall cost of healthcare and increases health equity."
Creating a credentialing service includes specific investment in staff training and should include the NQCA certification process.
CAPGate is a customized PIHN product. Since it is a web-based data system, any interested user in any state could subscribe. Third-party audits focusing on cybersecurity are required and liability insurance is a necessity.
Contact InformationTom Kuhn, Program Consultant
Partners In Health Network
Federally Qualified Health Centers
Licensure and certification of health professionals
June 28, 2019
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