CCHN and its members offered insights into financing models and returns on investment during our conversations with them. Because many of the health centers in San Diego are new to relying on federal grants, these health centers have potential private sector donors and use these contacts to support IT investments. Health centers noted that local foundations such as Tides offered important financial support for Health IT initiatives. Most health centers' payer mixes were heavily weighted toward Medicaid (MediCal) which offers some enhanced reimbursement for use of health IT by Federally-Funded Health Centers through scope of service adjustments to the base payment formulas.
Health centers noted the importance of creating economies of scale through their affiliation with CCHN. As one health center leader put it, "we need economies of scale; we can't do it on our own." CCHN, along with CCC, offer important opportunities to take advantage of group purchasing discounts and certain IT consulting services that may be out of reach if provided by other service providers.
Return on investment was not frequently mentioned in health center leaders' discussion of EMR systems. One health center pointed to patient safety as a potential area for return on investment, but generally felt that there was "no reason to measure ROI." Another center indicated that implementing an EMR had slowed them down considerably and that payers had not increased reimbursements for using an EMR (aside from minor adjustments to MediCal reimbursement). This severely limited this center's ability to produce a return on their investment and, more broadly, justify expanding their limited EMR implementation.
CCHN members are notable in that they have implemented different applications and information systems along different timelines. Some health centers can describe evidence of changes in quality of care, efficiency and provider satisfaction. For instance, the health center that implemented NextGen reported that they had reached 90 percent compliance with some clinical guidelines after implementation, including greater adherence to recommended frequency of conducting foot exams for diabetic patients.
Another center looking toward implementation of i2iTracks and an EHR listed provider satisfaction and recruitment efforts as primary motivators for pursuing more robust health IT applications. At the network level, CCHN is looking to digitize the chart review process that currently occurs by hand. Currently, many member health centers look to CCHN to perform continuous quality improvement functions, such as chart reviews. Moving to an electronic system could help streamline and enrich the network's quality offerings.
The one health center that has recently moved to an EHR noted that it had seen a measurable improvement in meeting quality targets since implementation. After a year of having used NextGen, this center is now meeting 90 percent of its process metrics in diabetes (e.g., compliance with foot exams and HbA1c test) and has improved metrics in other areas. While there is limited anecdotal evidence about increases in quality of care, health centers noted that costs and efficiency had not improved measurably. California allows for limited MediCal reimbursement based on quality reporting and improvement, but health centers report that such payments are not large enough to motivate health IT adoption. (Again, note that this was pre Recovery and Reinvestment funding).