Cross-Sector Care Activities and Technological Capabilities of Federally Qualified Health Centers in Michigan

Abstract

Health systems and medical practices are taking a greater role in providing social care. Federally Qualified Health Centers (FQHCs) lead these efforts, offering a model for using technology to manage care and exchange patient information. This study describes Michigan FQHC services, partnerships, and technological capabilities that support the delivery of social care. Methods. Theories and frameworks from public health and information science were applied in mixed methods research. A sample of Michigan FQHCs (n=15) were recruited into the study. Quantitatively, a health information technology (HIT) capability practice survey was developed. Semi-structured interviews were then conducted with FQHC leadership, clinicians, and staff (n=24) to explore workforce and technological factors associated with developing care management and partnership data activities. The analyses of the survey and interviews addressed three broad research questions: (i) What preventive and social care services do FQHCs deliver, and to what extent are those services provided in partnership with other organizations? (Chapter 2), (ii) What information infrastructure is available to support these services? (Chapter 3), and (iii) What are the facilitators and barriers to providing preventive and social care? (Chapter 4). Results. On average, Michigan FQHCs delivered eight (M=7.9, SD=3.6) cross-sector services. Most Michigan FQHCs addressed public health prevention (n=12, 80%). For behavioral healthcare, the majority of FQHCs (n=10, 69.3%) delivered both mental health (MH) and substance use disorder (SUD) services. There was one health center that delivered all 10 social care services studied. Most provided at least 3: food assistance, transportation, and domestic violence. FQHCs formed collaborations with health systems, mental health agencies, and local health departments to improve communication, care quality, and data management. FQHCs also integrated services and developed partnerships to ensure patients accessed a broader range of preventive services and social care (Chapter 2). Michigan FQHCs developed HIT infrastructure to digitally exchange patient information. Data was typically shared with maternal and infant health (n=5, 33.3%), mental health (n=5, 33.3%), and substance use (n=6, 40%) providers, but FQHCs had not developed similar capabilities with the social care sector. FQHCs leveraged health care and government investments in HIT as a strategy to circumvent non-automated types of data sharing (Chapter 3). Interviews revealed Michigan FQHCs participated in community-wide activities to establish value-based practices and quality care initiatives using shared data and technology. Study participants discussed that their involvement facilitated data management, digital information exchange, and quality improvement efforts. Ultimately, however, limited housing services and inadequate behavioral healthcare created barriers for Michigan FQHCs to refer patients to local resources and treatment (Chapter 4). Conclusions. Developing information infrastructure and technological capabilities to manage patient social needs and improve care quality is necessary but insufficient. Investments in both technology and human capital are critical to create a social care infrastructure. Building on the evidence gained from FQHC partnership activities offers insight into policy changes and investments needed. This study provides foundational research to support future investigations of how community health information exchanges and collaborative data practices can be leveraged to deliver high-quality care and improve outcomes.