Leveraging Health IT to Strengthen Patient Engagement

In the spirit of moving innovation forward, I found relevance in the following article about engendering trust using healthcare technology.  In the crossfire of my own struggles with technology, I can appreciate the very salient points outlined by the author.  Specifically, he asserts that healthcare IT can be the lever for improving the physician-patient relationship through the following means.

In the first instance, he points out that technology can help a physician provide SMARTER care.  With escalating numbers of insured patients attempting to be seen by a shrinking provider pool, new delivery methods must be sought to meet this demand.  While the article addresses wellness and preventative care, it is a natural extension to mention patient’s interest in mobile visits.  Incorporating SMS, video and email into the physician toolbox is tantamount; however, certain touch points require a face to face interaction…and the mobile visit solves this dilemma.  In fact, I would dare say that all mediums should be utilized to ensure that the patient’s particular learning mode is engaged and the provider’s message is reinforced.

Secondly, healthcare IT can optimize physician workflow and remove administrative shackles draining resources and diverting attention from the more complex tasks at hand – treating chronically ill patients.  As noted, “technology can take over for clinicians when it comes to some of the more benign data capture and aggregation roles.”  While this can cover items such as first time visit paperwork, it can also be employed for personal health records, population health management, as well as the patient”s & provider’s modification of the medical record.  And by lightening the physician’s load, they are free to pursue clinical partners and engage them in community health and prevention efforts.  At minimum, in celebration of National Public Health Week, there should be a focus on data exchange for immunization and prevention.

Thirdly, one of the core means of establishing trust occurs through the delivery of personalized messages in a format most conducive to each individual patient’s learning and retention style.  Using technology to engage patients and stay connected during their care demonstrates concern and establishes trust – an integral component to the healing process and a competitive edge for a practice seeking to maximize efficiency and minimize cost.

Last, but not least, the author stresses that technology must be implemented in a safe and secure manner in order to protect and preserve the relationships with one’s patients.  Specifically, “being aware of the security of the larger ecosystem of which an organization is part is a way to quell data loss and enhance the trust of patients.”  Perhaps one of the most difficult things to do today, but arguably should not be forgotten in the quest to do no harm.

 

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

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Designing Healthcare Innovation

By now you know that I have a distinct interest in healthcare innovation, so it should come as no surprise that an article about the recent Healthcare Experience Design Conference caught my eye.   Kicking the day off with a battle cry from Dr. Jacob Reider, chief medical officer at the Office of the National Coordinator for Health IT, he challenged the crowd, “to help this industry do better”.  And by better, he is referring to development of user friendly processes for patients and providers alike.

Albeit, being a do-it-yourself techie hamstrung by programs on a regular basis, I was encouraged to hear that this conference stretched beyond the traditional confines of user-centered design to include workflows, patient engagement and population health.  Having designed a website myself, I can appreciate the tips outlined for engaging individuals in the digital realm; however, what I found most intriguing was Nir Eyal’s discussion about how people choose to engage with habit-forming technology.  According to Eyal, “the key to developing habit-forming technology is to understand end-users’ “internal triggers” – the emotional drives that motivate them – and develop technology that begins as “vitamin” and then “turns into a painkiller.”

Cassie McDaniel, of the Centre for Global eHealth Innovation at Toronto’s University Health Network also pointed out that examining research, usage patterns and prototyping are key elements for user-centered design.  And similar to the role that technology has played in the modernization of healthcare service delivery, McDaniel suggests that user-centered design bears the potential to catalyze the healthcare innovation movement.

One company, breaking down barriers to patient engagement and collaboration, is currently employing user-centered design. Iora Health, an accountable care organization (ACO), maintains its own team of designers and developers that routinely visit member practices to work with clinicians and staff to rethink the relationships between people, processes, IT and health reform. As a result, physicians now project the EHR onto a screen for patients to view/query and provide access to OpenNotes, thereby allowing individuals to access and update their charts.  With the onset of meaningful use stage 2 and the voices of the impatient growing louder, will this impetus be enough?  While I suspect that they have merely scratched the surface, time will only tell how far these right brain thinkers push the needle for transformation.

 

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Engaging Specialty Practices in the Patient Centered Medical Neighborhood

Building on last week’s post about embracing change for healthcare transofrmation, it was intriguing to learn about the NCQA’s new patient centered medical home program for specialty practices.  Kicking off  March 25, the Patient Centered Specialty Practice (PCSP) recognition highlights specialty practices committed to access, communication and care coordination as “neighbors” that surround and inform the medical home and colleagues in primary care, according to NCQA.  And I regret to say that I missed the informational webinar, including an NCQA advisor and guest speaker from one of the local healthcare systems.

Had I attended the webinar, I would have been better prepared to query the CEO of a hospital within the same healthcare system at a recent American College of Healthcare Executives (ACHE) function.  Interestingly, we had a lengthy conversation regarding the system’s desire to exchange data within the area; however, the CEO noted that current system architecture made it challenging enough to simply share information amongst health system participants.  With one of the key tenets for the PCSP recognition being timely exchange of data, this is a bit of a conundrum.  While the Direct project offers a simple solution, the ultimate goal will be to facilitate and encourage physicians to search for records in efforts to keep all parties abreast of the care plan.  And while this is a tremendous step, we also noted that retail & urgent care clinics, solo primary care practices and free-standing care centers need to get in on the game too.

I also see a need for ancillary providers to be included as well.  Not only would individuals benefit from the opportunity to view x-rays but, more to the point, visualizations, similar to the one here.  While Physical Therapists do an excellent job engaging patients in discussion, they would have far greater impact with the ability to illustrate their points on an interactive tablet app.  And thinking out loud, wouldn’t it be great for individuals to be able to reference the same app at home – to review the information and implement “their’ steps in the care plan?

 

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Embracing Change for Healthcare Transformation

With thousands flocking to Chicago for the annual ACHE Congress on Healthcare Leadership, many were interested in learning more about the strategic initiatives, aimed at delivering ‘high value’ healthcare, manifesting here, there…suddenly everywhere.  Speaking to the increased recognition and velocity for change, Sabrina Rodak highlights six key themes that were no doubt ubiquitous at this moment of metamorphosis for healthcare, and more to the point, the hospital industry.

Building on a recent article in Health Affairs, “Decline In Utilization Rates Signals A Change In The Inpatient Business Model”, Rodak notes that keeping patients healthy through preventive and primary care services, and out of acute care facilities whenever possible via population health management is the new mandate. By focusing on care delivery in the right place at the right time with the right quality, cost, and access, leaders in this new era will transform the health of the system, as well as the nation.

In order to succeed, six fundamental requirements have been defined:

1. Culture. Hospital leaders need to focus on delivering value rather than only acute-care services.  Proponents believe that happy, engaged providers and employees have a more positive impact on patient experience, versus those that do not.

2. Physicians and care delivery. Hospitals will need a strong physician platform to reduce utilization and cost and improve value. In concert with local, affiliated physicians and allied health providers, hospitals and health systems are moving closer to this goal through a variety of care coordination innovations.

3. Communication and HIT. Hospitals need to develop health IT systems to communicate with providers across the care continuum and analyze data to increase value. And with the onset of stage 2 meaningful use, having the tools to define and eradicate potential conflict between patient expectations and evidence-based medicine becomes tantamount.

4. Facilities. Hospital leaders should consider investing in outpatient settings instead of building costly hospital facilities.

5. Contracts. Hospital leaders need to encourage payors to participate in value-based initiatives to support providers who are delivering value. Nimble, forward thinking organizations are exploring a variety of collaborative measures in order to jointly address care delivery innovation.

6. Transformation. Hospitals need to start preparing for a value-based care model now by eliminating clinical variation, reorganizing services and reducing costs.  Checking out the ACHE Congress Management Innovations and Circle of Life winners gives you a small sample of the transformations en route and poised to come.

While measured steps are being taken for positive outcomes, critics of the Health Affairs article argue that this is meaningless activity for those lacking health insurance, mired in sub-optimal social health circumstances and facing a dangerous precipice with potential changes in Medicaid funding. Right, wrong or indifferent, there is one consistent theme – the time is ripe for change.  And as the outgoing ACHE Chairman, Gayle Capozzalo, points out – we, as healthcare leaders, are no strangers to change.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

HIMSS 2013: Mayhem or Magic?

With the closing of the HIMSS13 annual conference, I am reminded of the question posed previously – can health ITs newest ideas reduce cost, improve quality and facilitate patient engagement?  In lieu of the recent sequestration events, continued emphasis on value-based purchasing and a still troubled economy, the battle will likely wage uphill.   On a positive note, providers continue to join the ranks of the digital world in terms of medical records and care coordination…but at an alarmingly slow pace.  And while patients are becoming more interested in accessing and sharing their healthcare data, numerous obstacles plague their efforts.

So, how do we find trifecta – where cost reduction, quality improvement and patient engagement peacefully co-exist?  After stumbling on a conversation with SETMA’s Larry Holly, I am reminded of a key overarching principle – perhaps the fulcrum – being the distinct need for both provider and patient behavior change.  As Dr. Holly shares, while healthcare data and technology have evolved at lightning speed, many of the processes associated with utilization have not.  In order to facilitate population management and patient engagement, systems must promote data exchange, add value to clinicians’ diagnostic/therapeutic processes and strengthen relationships with their patients.  Without these capabilities, even the highly customized EMR and mobile applications currently in existence will fail; instead igniting the angst and ire of their users.

Dr. Holly goes on to point out that organizations need to look internally to find the creativity and energy for change while continuing to leverage external experts in this field and others.  And according to Warner Thomas, Oschner Health System CEO, one such field to explore is the airline industry.  With costs spiraling out of control, the airline industry has been forced to automate and reengineer their processes in order to stay competitive – all in the midst of improving customer satisfaction.  A slippery slope, to say the least.  Healthcare, an inherently conservative and compassionate industry, has enabled  patients and providers seeking to maintain status quo.  And while there a select number of healthcare systems that have partnered with vendors to disrupt this mentality, it will be interesting to see how this theme carries over to the annual meeting of the American College of Healthcare Executives, premiering shortly at Chicago’s Palmer House Hilton.

Reading a quote by Arthur C. Clarke, “Technology, properly applied, is indistinguishable from magic.”, I am reminded that healthcare IT is one part art, one part science.  With the opportunity to realize Warner Thomas’ goals – better quality, lower cost and happier providers – the question is, do you believe in magic?

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Collaborating for Care Management Innovation

With the onset of sequestration, Texas stands to lose funding for Head Start services, children’s vaccines and meals for seniors.  Add to this potential losses in law enforcement and education funding, one can see that programs, once aiding children, seniors and the homeless by keeping them out of the emergency room, might cease to address this critical need.  Compound these losses with the pressure being exerted by value based purchasing, and the dilemma becomes magnified tenfold.  As if accountable care organizations, medical homes, hospitals and healthcare systems did not have enough on their plate, one wonders where they will find the resources to supplement these activities?

One enterprising non-profit has tackled this challenge head-on.   Billed as a nine-year old strategic initiative with a mission to improve the quality, capacity, and accessibility of the healthcare system for vulnerable populations in the City of Camden, the Camden Coalition has analyzed local healthcare system claims data for the purpose of building a repository and sharing data with regards to this typically transient population.  In addition, they operate several health project initiatives that demonstrate a collaborative approach to improving care delivery and patient outcomes in their area.  And by building relationships with executive leadership of the hospitals, social service/public health agencies, state government agencies, leaders at the statewide Medicaid health plans, and policymakers, they have taken a discretely modern approach to healthcare delivery.

Current innovative initiatives garnering attention include the Coalition’s Care Management and Care Transitions programs, aimed at reducing hospital utilization by directing outreach to the ‘high flier’ population whom frequently lack appropriate access to primary and mental health care.  Designed to target high cost, complex patients for improved care transitions and care coordination, the Coalition is steadfastly working to move these patients into a medical home model.  Upon presenting at the emergency room, patients are divided into one of two groups:  a) those with no primary care access and significant mental/social issues and b) patients with more stable primary care and mental health status.

In the Care Management program, patients meeting specific criteria receive assistance from a social worker, a health outreach worker/medical assistant and a nurse practitioner with primary/specialty care coordination, applying for government assistance, finding temporary shelter and enrolling in medical day programs.  Through stabilization of their social environment and health conditions, the team’s ultimate goal of finding a primary care medical home for the patient can begin.

Patients participating in the Care Transitions program are enrolled in and receive assistance from embedded care management nurses and health coaches from one of two Camden Federally Qualified Health Centers (FQHC) – CAMcare and Project HOPE.  On the path to becoming patient-centered medical homes, these FQHCs are fostering better care transitions and coordination with their hospital and health system partners.

These bold programs have been facilitated by city-wide use of health information exchange and electronic health record use for this targeted population, thereby allowing providers to share information and analyze data for additional care coordination.  Data analysis also remains integral for the monthly Care Management Committee meeting, held at rotating hospitals, in order to review and refine current processes for these programs. And by bringing together emergency room physicians, hospitalists, specialists, social workers, and nurse discharge planners across the city, more efficient and effective discharge planning and care coordination can help decrease utilization and improve safety, experience and ultimately, quality of care.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Transforming Medicaid via the Medical Home Model

With the March 1^st sequestration deadline looming, the budget battle continues. Facing potential cuts to public health and reduced federal relief, ignoring Medicaid expansion could be hazardous to a state’s health.  At least, some states have come to this conclusion.

Despite this, the state with the largest number of uninsured seeking medically necessary healthcare chooses to stand tall.  With emergency relief in mind, House Bill 10 was introduced in the Texas legislature this past week to address a shortfall in Medicaid and the Children’s Health Insurance Programs.

As one reporter for the Texas Tribune pointed out, “the federal government is offering to pay all of the costs of expanding the Medicaid program to some of the state’s uninsured population for three years, then to pay 90 percent of the costs for several years after that. Texas could, according to a report commissioned by Texas Impact, an interfaith public policy group, spend $15 billion over the next 10 years and pull down $100 billion in federal funds as a result. (So), here’s the business question: Why leave that kind of money on the table, especially if it’s going to be spent elsewhere if Texas opts out?”

While the article goes on to point out that federal monies would provide relief to local taxpayers currently subsidizing uncompensated care and potentially turbocharge the state’s medical economy, what I found most intriguing was the statement about running healthcare like a business.  Having just had a similar conversation with a colleague from the finance industry, I lamented that healthcare is a unique industry, dangerously siloed with imminent challenges to data access and ultimately, provider alignment – U.S. healthcare’s primary economic engine.

Now, some might argue that alignment becomes null and void in the absence of an adequate number of providers to address the incoming flux of under and uninsured persons.  Imagine instead, the opportunity to increase the number of providers by establishing advance practice nurse led clinics for participation in medical homes.  Equipped with patient registries, data analytics and health information exchange, physicians become liberated to focus on chronically ill patients and specialist provider coordination.  And perhaps the most galvanizing of all, instead of penalizing patients for visiting the emergency room, engage them in their care by developing a personal contract with specific achievable goals, provide a personal health record (PHR), mobile apps and texting to help monitor their health while keeping them incentivized via a loyalty program that offers redemption for health related items.

Not only is it the right thing to do, but by embracing this transformational change… perhaps savings similar to Chemung county’s Medicaid Medical Home could be achieved.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Collaborating for Community Health Innovation

With the recent Super Bowl festivities and Fat Tuesday fast approaching, New Orleans conjures up images of pomp, circumstance and regalia.  While the ragin’ Cajuns will always welcome celebration, the reality of everyday circumstance pales in comparison to these high dollar, high revenue activities.  As noted in The 2013 Healthcare Informatics Innovator Awards: Co-Second Place Winner: The Louisiana Public Health Institute, New Orleans is beset by poverty and poor health status.  And with the onset of Hurricane Katrina in 2005, these difficult situations were magnified.

As noted in the article, one entity that has taken purposeful steps to improve the health of the people in this community is the Louisiana Public Health Institute (LPHI).  Established in 1997, the LPHI’s mission is “to promote and improve health and quality of life in Louisiana through diverse public-private partnerships with government, foundations, community groups, academia and private businesses at the community, parish and state levels.”  After applying for participation in the federal beacon communities project, the group was granted Beacon status and awarded a federal grant, under the auspice of the Crescent City Beacon Community (CCBC) initiative.  Armed with $13.5M, the group is working steadfastly towards the development of a metro area-wide patient centered medical home (PCMH) model.

Tackling dual goals of community quality improvement and long-term healthcare investment, the group is developing a foundation for a patient-centered, accountable, community-wide focus for care.  In order to achieve these goals, they are redesigning care management, employing the new role of care manager to facilitate communication between physicians, administrators and patients in the 20 federally qualified health centers (FQHCs) in the metro area.  And through the use of health information exchange (HIE) and electronic health records (EHR), these re-engineered teams aim to connect patient visits from the ED, hospital, primary care and specialty physician office.

Moving beyond the physical exchange, the group also remains intently focused on improving clinic processes for meaningful use of the shared data.  Instituting regular visits with community stakeholders has allowed for providers to share protocols and other tips for delivering safe, quality healthcare while maximizing workflow.  As a Healthcare Informatics Innovator winner, LPHI has successfully leveraged healthcare technology for community quality improvement.  And while my hat is off to Dr’s Anjum Khurshid, director of the LPHI’s Health Systems, Eboni Price-Haywood, co-ED/CMO for Tulane Community Health Centers and Maria Ludwick, associate director LPHI’s Health Systems, I would be curious to know how they are engaging other providers – pharmacists, schools, social services, long-term care, first responders, etc – and most importantly, patients, in the design process?  Sounds like a great opportunity for the pending 2013 HIMSS conference, coming soon to the Ernest N. Morial Convention Center, located smack dab in the heart of New Orleans.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Seeing Red for Heart Health

According to the caption, “heart disease still kills more women than all cancers combined”.  And in celebration of National Wear Red Day, the American Heart Association (AHA) wants to know how you will make a difference?   Poor heart health can lead to congestive heart failure, one of the leading chronic illnesses estimated to represent 75 percent of the $2 trillion in U.S. annual health care spending.

Current healthcare delivery systems developed around acute visits and crisis management have not been successful in meeting chronic disease care needs. Based on brief and infrequent patient-provider interactions, these models do not provide the sustained support necessary to maintain the healthy lifestyle changes critical to prevention and management of chronic diseases. To better meet the needs of these individuals, care systems must explore new ways to define collaborative care for living well with chronic disease.

Partnering with local and national non-profit organizations has, and will continue, to offer avenues for awareness, education and prevention.  The American Heart Association’s Go Red For Women campaign- described as a passionate, emotional, social initiative designed to empower women to take charge of their heart health – reflects this opportunity.  Not only does it challenge women to know their risk for heart disease, but it also encourages women to utilize AHA tools to take action for personal risk reduction.

According to the AHA Go Red For Women website, the group turns science into materials and tools that healthcare providers and decision-makers can use to help women. Great idea, wouldn’t you agree?  Now, after seeing the article outlining Heritage Health’s interest in working with UCLA and Open mHealth, I am wondering if there isn’t an opportunity to collaborate on production of a chronic disease app?  At the very least, a Go Red For Women mobile app could deliver a personal heart health dashboard, as well as, messaging and alerts regarding symptoms, diet, exercise, lifestyle and AHA events.

With funds raised by Go Red For Women supporting educational programs, increasing women’s understanding about their risk for heart disease and supporting research to discover scientific knowledge about heart health, this seems perfectly APPropriate to me.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Empowering Healthcare Improvement with the Community Needs Assessment

With President Obama’s second inaugural speech calling for a reduction in rising healthcare costs, the need for reassessment of health and social service delivery in the physician’s office, medical homes, accountable care organizations, urgent care/retail center, community clinics, hospital, health system and COMMUNITY ring louder.  For the good news, the Journal of American Medical Association recently published a study demonstrating that quality improvements within the community helped reduce hospitalizations and readmissions for the Medicare population.

With the help of CMS funded Quality Improvement Organizations (QIO), community wide interventions were coordinated between hospitals, nursing homes, home health agencies, physicians, hospice organizations and senior centers, resulting in roughly 5.7% reduction in hospitalizations and readmissions for fourteen diverse areas.

And while it is critically important to continue the investigation and sharing of best practices for hospitalization and readmission reduction, I was also intrigued by Ted Eytan’s recent post, Pioneering Idea: Your Patient’s Community Health Needs Assessment on the Desktop.  Reminiscing about his ‘community oriented primary care’ instruction in medical school, he introduces a new community health assessment platform available online at http://www.chna.org along with his thoughts about how to utilize it.  As a futurist, he suggests that information could be integrated into a patient’s medical record for analysis and discussion.

With ten Community Oriented Primary Care Centers currently administered by Parkland Health & Hospital System, I began to wonder if having this type of data available for patient discussion would be beneficial?  Already fluent in patient registries and predictive analytics for increased prevention and better outcomes, this sounds like the perfect storm for the Parkland Center for Clinical Innovation.

And for those remaining physician practices, accountable care organizations, medical homes, hospitals and healthcare networks delivering healthcare on a daily basis, could this information be made available to patient and provider alike on one’s website, app, iTriage – or better yet, a game created to crowdsource ideas for improving community status?

As Ted aptly puts it, morphing from a health advocate to a “health activist” requires innovative ideas like the one above in order to, one day, become part of a human development system, designed to help all people achieve their life goals through optimal health of the individual, family, community and society.

Physical Inactivity (Adult)

This indicator reports the percentage of adults aged 18 and older who self-report no leisure time for activity, based on the question: “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”. This indicator is relevant because current behaviors are determinants of future health and this indicator may illustrate a cause of significant health issues, such as obesity and poor cardiovascular health.

 

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website