Value-Based Person-Focused Care

TACHC supports health centers by promoting practice models that deepen integrated care, improve clinical quality, and transform practices to transition from volume to value. Value-based care considers upstream factors including social determinants of health and adverse childhood experiences, addressing them along with providing access to quality clinical care. Health centers know and understand that patient-centered care is best addressed as a team, integrating various services to address patients' needs holistically.

TACHC provides training and technical assistance to prepare health centers for successful implementation and growth of value-based care, which ranges from quality incentives to alternative payment methodologies. TACHC is actively working to ensure the full range of value-based care options are available to health centers, and that they are prepared to thrive in a VBC environment. For more information email us.

Health Center Controlled Network (HCCN)

TACHC manages a Health Center Controlled Network (HCCN), which allows its members to exchange information and share best practices to bolster the use of health information technology (HIT) in support of the quadruple aim: enhance the patient and provider experience, reduce health care costs, and improve patient outcomes. TACHC’s HCCN includes approximately three-quarters of community health centers in Texas. TACHC provides training and technical assistance to HCCN members related to security risk assessments, reducing provider burden through HIT (such as Project ECHO), value-based care, population health, and addressing social determinants of health.
TACHC’s HCCN oversees a centralized data repository from a variety of clinical sources. HCCN members receive access via the HCCN Portal to individualized quality reporting, graphics, and analysis of their clinical data. To join the HCCN, or for more information, email us.

Telemedicine/Telehealth

Telemedicine/telehealth uses digital information and communication technologies, such as computers and mobile devices, to provide access to health care services and care management remotely. Telemedicine/telehealth allows health centers to provide increased access to care for their patients, but requires new workflows, redefined business models, and rethinking clinical processes with patient needs and resources in mind. Due to the digital divide, telemedicine has uncovered challenges for medically underserved communities, such as technological and cultural barriers. TACHC works with health centers on best practices and initiatives to overcome these challenges and expand access to quality care. TACHC also supports health centers by advising on technology, compliance, billing and coding considerations, workflow design, and patient experience. For more information, contact TACHC.

Remote Patient Monitoring (RPM)

RPM allows providers to monitor a patient’s chronic conditions outside the walls of the clinic, increasing care coordination and improving patient outcomes. RPM tools include blood pressure monitors, scales, and wearable devices (such as continuous glucose monitors) that can communicate data back to the care team. Even if patients lack internet access at home, health centers can still engage in certain types of RPM.

As the health care delivery system expands beyond traditional in-person visits with a provider, TACHC delivers training and technical assistance to help health center care teams broaden their service delivery options. For example, TACHC is conducting a pilot program with a RPM call center in order to improve access to care and quality for patients with hypertension, diabetes, congestive heart failure, and COPD, while also addressing the social determinants of health. Additionally, TACHC offers a group purchasing option to members for RPM and nurse call center services. For more information, contact TACHC.

TACHC's Quality Axis Program

The Quality Axis Program (formerly OC3) supports health center practice transformation, focusing on removing unnecessary delays for patients, redesigning the clinical care system to maximize efficiencies, and improving health outcomes. This program is designed with workflows that are up to date and relevant in preparation for a value-based care environment. Upon completing the program, participants can apply and institutionalize quality improvement (QI) strategies to increase access, efficiencies, and quality of care in their health centers.

Quality Axis has three participation tiers available to meet the needs of member health centers. The first tier, “Quality Axis Institute,” is a stand-alone course geared towards health center staff who need to learn the basics of quality improvement or need a refresher. The second tier is a 12-month learning program for 10-15 health centers trained as a cohort. Each health center team comprises executive leaders, clinicians, administrators, and front-line staff, who develop the skills needed to lead QI efforts within their organizations to improve outcomes and move toward value-based care. The third tier provides customized coaching support for advanced teams working on complex QI implementation. All Quality Axis tiers and learners have access to blended learning activities via the TACHC Learning Hub. Click here for more information on this great program or email us.

To learn more about the experience of health centers in the 2022-23 Quality Axis cohort, view this documentary:
Charting Progress: Transformative Journeys in Texas Health Centers to Advance Diabetes Care

Patient-Centered Medical Home (PCMH)

Adoption of the PCMH model is associated with better patient outcomes, reduced mortality, fewer preventable hospital admissions, improved patient adherence to treatment, and lower health care spending. PCMH is foundational to succeeding in value-based care. TACHC offers PCMH training and technical assistance to health centers seeking initial recognition, or looking to sustain their existing certification.

TACHC has compiled PCMH resources, including examples of documentation for PCMH requirements. For more information, email us.

Trauma Informed Care (TIC)

By providing primary and preventive care to vulnerable, medically underserved, and uninsured people, health centers uncover many events and conditions that may have resulted from exposure to trauma (i.e. displacement due to disasters, immigration, homelessness, active shooter experiences, adverse childhood experiences, etc.). In a trauma informed environment, health centers act as bridges to healing when individuals seek care and attempt to access well-being through medical, dental, behavioral health services, or addressing substance use.

Created in 2019, TACHC’s Trauma Informed Care (TIC) Program is a prevention strategy aimed at creating lasting change for patients, staff, and communities. The Trauma Informed Care Program offers a universal approach that ensures all patient engagement incorporates fundamental trauma informed care principles: Safety, Trust, Choice, Collaboration, Empowerment, and Cultural, Historical, & Gender factors. For more information, email TACHC.