HEALTH CENTER CONTROLLED NETWORK - HEALTH COALITION ADDRESS: 1310 REDWOOD WAY, SUITE 135, PETALUMA, CA 94954-6514 PROJECT DIRECTOR NAME: COLLEEN PETERSEN, DEPARTMENT DIRECTOR, HEALTH INFORMATICS OFFICE CONTACT PHONE NUMBER: (707) 285-2969 EMAIL ADDRESS: CPETERSEN@RCHC.NET WEBSITE: WWW.RCHC.NET FUNDING REQUESTED: $625,000 PER YEAR FOR THREE YEARS CURRENT HCCN GRANT #: H2QCS30258 PARTICIPATING HEALTH CENTERS: 16 FQHCS WITH 70 TOTAL SITES. ON BEHALF OF LOCAL HEALTH CENTERS, REDWOOD COMMUNITY HEALTH COALITION (RCHC) IS PURSUING COOPERATIVE AGREEMENT FUNDING PROVIDED BY HHS HEALTH RESOURCES & SERVICES ADMINISTRATION. RCHC HCCN IS AN EXISTING HCCN GRANTEE LEVERAGING HEALTH IT AND DATA TO INCREASE PARTICIPATION IN VALUE-BASED CARE FOR PARTICIPATING HEALTH CENTERS (PHCS). THE RCHC HCCN REPRESENTS HEALTH CENTERS ACROSS MARIN, NAPA, SONOMA, YOLO, SOLANO, MENDOCINO, NEVADA, PLACER, SAN FRANCISCO, SIERRA, SHASTA, SISKIYOU, AND SANTA CLARA COUNTIES. RCHC WILL LEVERAGE FY 2022 FUNDING TO MEET THE DIVERSE NEEDS AND SUPPORT PHCS TO LEVERAGE HEALTH IT AND DATA TO DELIVER HIGH-QUALITY, CULTURALLY COMPETENT, EQUITABLE AND COMPREHENSIVE PRIMARY CARE WITH SPECIFIC FOCUS ON IMPROVEMENTS IN CLINICAL QUALITY, PATIENT-CENTERED CARE, AND PROVIDER AND STAFF WELL-BEING. HCCN OBJECTIVES ARE TO INCREASE THE PERCENTAGE OF PHCS: - THAT SUPPORT PATIENTS AND FAMILIES' PARTICIPATION IN THEIR HEALTH CARE THROUGH EXPANDED USE OF INTEGRATED DIGITAL HEALTH TOOLS. - WITH FORMALLY DEFINED HEALTH INFORMATION AND TECHNOLOGY POLICIES AND PRACTICES THAT ADVANCE SECURITY TO PROTECT INDIVIDUAL PRIVACY AND ORGANIZATIONAL ACCESS. - THAT USE PATIENT-LEVEL DATA ON SOCIAL RISK FACTORS TO SUPPORT PATIENT CARE PLANS FOR COORDINATED EFFECTIVE INTERVENTIONS. - WITH SYSTEMS AND STAFF ALIGNED WITH SUBMITTING DISAGGREGATED, PATIENT-LEVEL DATA VIA UDS+. - WITH THE CAPACITY TO INTEGRATE CLINICAL INFORMATION WITH DATA FROM CLINICAL AND NON-CLINICAL SOURCES ACROSS THE HEALTH CARE CONTINUUM. - THAT USE DATA STRATEGIES, SUCH AS USE OF PREDICTIVE ANALYTICS WITH DATA VISUALIZATION, TO SUPPORT PERFORMANCE IMPROVEMENT AND VALUE-BASED CARE ACTIVITIES. - SUPPORT PROVIDERS AND STAFF IN ACHIEVING AND MAINTAINING PROFICIENCY IN THE USE OF DIGITAL HEALTH TOOLS. - THAT IMPROVE HEALTH IT USABILITY AND ADOPTION BY PROVIDERS, STAFF, AND PATIENTS. - THAT UTILIZE A HEALTH IT INNOVATION. - THAT ENHANCE THE QUALITY AND COORDINATION OF HEALTH SERVICES BY FOCUSING ON IMPROVING THE FUNCTIONALITY OF DIGITAL HEATH TOOLS IN ONE OR MORE OF THE FOLLOWING AREAS: 1) SUPPORT RELATIONSHIPS BETWEEN PROVIDERS AND STAFF WITH PATIENTS, THEIR FAMILIES, AND THE COMMUNITY; 2) SUPPORT HIGH-FUNCTIONING CARE TEAMS; 3) INTEGRATE CARE DELIVERY ACROSS SYSTEMS AND COMMUNITIES; 4) MAKE CARE MORE EQUITABLE. THE 16 RCHC HCCN PARTICIPATING HEALTH CENTERS SERVE OVER 257,584 PATIENTS, INCLUDING 157,386 ON MEDICAID AND 47,447 UNINSURED. FIFTY-SEVEN PERCENT OF PATIENTS ARE LATINO, 30% ARE BEST SERVED IN A LANGUAGE OTHER THAN ENGLISH, OVER 71% HAVE INCOMES UNDER 100% OF POVERTY, AND LESS THAN 6% HAVE INCOMES OVER 200% FPL.