New visions in urban healthcare

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Constant innovation is keeping G-Health Enterprises ahead of the curve—and the pandemic

Finding ways to keep urban communities healthy when resources are often scarce, costly, and difficult to justify on a balance sheet gives rise to innovation. For Buffalo’s G-Health Enterprises, it is the bedrock upon which they are building an integrated primary care-meets-public health system to rival those in cities far greater in size.

Twenty-four years ago, Dr. Raul Vazquez was in a private practice in Buffalo’s Lower West Side neighborhood. He founded G-Health Enterprises to make healthcare more accessible for the city’s most vulnerable residents, providing hope and critical access to services, and changing the way patients and providers think about the practice of care.

G-Health Enterprises encompasses several affiliates: The Greater Buffalo United Accountable Healthcare Network (GBUAHN), The Greater Buffalo United Accountable Care Organization (GBUACO), Urban Family Practice and The Greater Buffalo United Independent Physician’s Association (GBUIPA).

As many healthcare organizations struggled to adapt to the COVID-19 crisis, GBUAHN’s forward-thinking approach to technology, outreach, and care is proving to be a tremendous advantage to the community. “When I opened up my practice we knew about the social determinants of health, and we were doing things back then that people are just doing now,” Dr. Vazquez told BOSS.

Improving Outcomes

In shifting from a traditional healthcare system that responds to cases to a proactive, prevention-based system of health and wellness, GBUACO is on the leading edge. A Medicaid certified Accountable Care Organization—the first of its kind in New York—GBUACO operates a value-based payment system for its providers that focuses on the “triple aim” of improved health, improved patient care, and decreased costs.

The group instituted programs to get patients to appointments, pharmacies, and grocery stores, as well as an ongoing wellness program. “We put in about $1 million in exercise equipment,” he said. “We put in a kitchen, a nutritionist, a chef, and a training center, and I didn't know if that was going to be practical. It became a very important piece of what we do. We had close to 200 people coming there a week. As a result, people lost weight, their chronic diseases were managed better, they felt better, and their mental illnesses got better.” The group partnered with Endeavor Health Services to support behavioral health in the community as a key aspect of primary care.

“The referral system was also important,” he added. In the inner city, as many as 40 to 60% of patients referred to health care services can’t get to them. “Having transportation and a closed network made it easier to work around that. There’s been a drastic, sustained reduction of patients in the ER as a result of that. There was a 67% reduction in ER visits after the first year that’s been maintained for six years, and an 80% reduction in inpatient care as a result of using care coordination. That’s been maintained for six years.”

Working closely with insurers, the organization developed a medication assistance and treatment program that vastly reduced the cost of managing chronic disease, HIV-AIDS, and substance abuse. In-home medication dispensaries boosted compliance and helped keep patients out of the ER as well. “We were working with the insurance companies so we had all the claims data. We knew more about hospital costs than the hospitals themselves. We knew costs across the whole spectrum with regards to specialist care and what procedures were being paid for,” he said.

Data gathered from 2016-18 showed a combined savings for the period to be $746,000 for ER services, $323,000 for inpatient stays, and almost $2 million in pharmaceutical costs. “On the quality side, we saw an increase of 16% during that time for diabetics, 11% increase in preventive eye exams, 11% increase in colorectal screening, 6% in A1C testing, and a 5% increase in breast cancer screening. So there was a lot of activity taking place during that time.”

Inroads in Telehealth

As an ACO, G-Health’s affiliates were crafting valuation agreements with insurance carriers in 2017 and proposed the creation of a telehealth team. “In telehealth you have the task of a 1.0 version and a 2.0 version. The 1.0 version works fine with electronic records and video; the video patient gets a link and that's good for a little bit. Eventually you need to really listen to that individual’s lungs, their heart, and actually see them. The 2.0 version is where the TytoCare virtual at home visit comes in.”

That innovation was adopted by G-Health in 2018. The handheld exam kit is used by a nurse in the patieInt’s home while the doctor is linked in by video. “For the future we’re looking to innovate that information through AI to help us with diagnostics so we can use the data to help manage the individual. That's the piece that most people aren't doing. You need that piece to manage chronic conditions. You want to innovate with knowledge; you just don't want to use the technology because it won't help if you are not innovative everywhere.”

On March 20, 2020, G-Health’s systems for medical care and care coordination shifted completely to telehealth. “We get about 2,000 calls coming through the system. We’re able to get a lot of care coordination over video, we’re robocalling groups of people with chronic diseases to get symptomatology from them, as well as COVID-19 screening.”  In just two months, the organization tested 1,000 people out of a population of roughly 30,000. Contact tracing is conducted through existing apps.

“During pandemics we've always depended on health departments and hospitals, and how those two work together. They're not equipped for these types of attacks. It’s not what these systems were created to handle. And so the corona situation broke the system. Their IT informatics were not very good,” he mused. “You've got to continually innovate to change what you need to change.” Thanks to G-Health, what’s changing in Buffalo is a fresh paradigm for better health for all.