Healthy Clinic Program Helps Colorado Rural Clinics Build Stronger Foundations
by Jami Schumacher
The Healthy Clinic Assessment (HCA) program is helping
rural clinics build stronger foundations and focus on
quality improvements, according to Jennifer Dunn,
director of programs for the Colorado Rural Health
Center (CRHC), which runs the HCA.
This voluntary and free process begins with on-site
interviews of clinic staff and partners. The HCA looks at
basic business operations (telephone protocol, check-in,
check-out, visit preparation, accounts receivable and
accounts receivable follow-up), compares current clinic
operations to industry-accepted best practices, and
identifies gaps in operations. At the end of the workday,
CRHC staffers provide a debriefing about what they have
heard and learned.
Later CRHC staffers return with findings. “We
put together an action plan on where they need to make
improvements, and what they are doing well,”
explained Michelle Mills, CRHC CEO. “This
strengthens the foundation of the clinic and allows them
to focus on bigger, greater things like quality
improvement, collecting data in disease registries or
working on gaining Patient Centered Medical Home
The Patient Centered Medical Home (PCMH) model seeks to
replace episodic care with deliberate and coordinated
care. The aim is a care model that is patient-centered
with more effective, efficient, coordinated and
Of the 104 clinics that have gone through the HCA
process, two of them have gained PCMH status. Yuma
District Hospital and Clinics was one of those, despite
having little knowledge about PCMHs prior to working with
CRHC. Yuma CEO John Gardner said that achieving NCQA
Level 2 Medical Home certification took considerable work
and significant changes to organizational culture.
Gardner went on to say, “This has been a great
opportunity for our two clinics. I am thankful that CRHC
invited us to participate in the project.”
Once the HCA action plan—a report customized to
a clinic's individual needs—has been presented,
the clinic decides its next course of action: do nothing
with it, execute the action plan, seek to gain PCMH
status or partake in the CRHC's iCare (Improving
Communication and Readmission) program.
“HCA is just a stepping stone so rural clinics
are not quite as worried about just keeping their doors
open,” Dunn said.
Mendi Choat, clinic director at the Mt. San Rafael
Hospital Clinic in Trinidad, Colo., said that the
hospital found the HCA so helpful that it has gone
through the process several times. They used the first
HCA as an opportunity to set improvement goals for the
year. “One of the primary reasons for
undergoing it every year was to see if we had made
improvements in the areas identified the prior
year,” Choat said. This allowed the clinic to
determine if their new processes were working or if
adjustments were needed. The HCA then provided an action
plan for the upcoming year.
As a result of the HCA, Choat said, there were
“opportunities to improve systems and processes
in billing and registration.” Specifically, Mt.
San Rafael Hospital Clinic staff worked on patient flow,
scheduling, scripting for registration team members,
upfront collections, assignment of billing duties, and
educating providers on how to match time spent with
patients with their corresponding provider coding levels.
“I would highly recommend this process to
another clinic,” Choat said. “It
essentially provided us with access to a free consultant.
It also provided us with education on best practices. As
a rural health clinic, we otherwise would not have had
access to this expertise and feedback.”
The HCA supports the Institute for Healthcare
Triple Aim for health systems to focus on improving
the experience of care, improving the health of
populations and reducing the per capita costs of health
As the focus on reporting for quality and outcomes
continues to increase in the healthcare industry, rural
clinics are positioning themselves successfully for the
future. CRHC has the goal of having all Colorado rural
clinics achieve 90 percent or higher on the HCA,
indicating efficient and sound operations.
“Our hope is that the clinics will want to move
forward for the betterment of the clinic and the
community,” Mills said.