Assessment of Health IT and Data Exchange in Safety Net Providers: Final Report Appendix. Background on San Francisco and SFCCC

01/01/2010

Eight community health centers founded SFCCC as a non-profit 501(c)(3) organization in 1987 to pursue a dual mission: to advocate for local community health center patients and reduce operating costs for centers through group purchasing.  Since its start, SFCCC’s mission has expanded.  According to its current mission statement, the consortium “develops programs and advocates for policies that increase access to community-based primary care for all San Franciscans, targeting the uninsured and underserved.”

Increasingly, SFCCC has focused on helping health centers access and leverage IT tools to improve their ability to coordinate care and improve quality.  Among the IT initiatives that SFCCC supports in some form or another are the Lifetime Clinical Record (LCR) housed by the San Francisco Department of Public Health ( DPH), an eReferral system built through the LCR, an installation of i2iTracks chronic disease management system ( CDMS) and other initiatives.  Beyond the initiatives supported directly through SFCCC, we also provide information on IT initiatives that are being pursued on an individual basis by clinics that are part of the consortium.

SFCCC employs 28 full time staff and 22 AmeriCorps VISTA volunteers and includes ten health centers or clinics (some are not FQHCs).  SFCCC has established strong partnerships with the SF Department of Public Health ( DPH) as well as the major safety net hospital in San Francisco, SF General.  The consortium serves an administrative role as the institutional grantee for the Ryan White Care Act and for the Health Care for the Homeless (HCH) program, subcontracting with eight partner health centers and the Department of Public Health.  They also run a workforce development program, continuous quality improvement programs and disaster planning initiatives, and provide development, public relations, a policy program, some advocacy and lobbying at all levels of government. In total, SFCCC members serve roughly 65,000 patients each year and combined revenues exceed $33 million annually.

In general, SFCCC serves as a convener and forum for brainstorming for its members, creating ties between members through its work. Priorities for the consortium change across years.  For example, the consortium focused on an eReferrals last year, but has since moved on to focus on supporting Healthy San Francisco, a county-wide program to manage information on eligibility and enrollment in public insurance or health care subsidization options.  Other areas of involvement include quality improvement, technical assistance and EHR planning. 

Exhibit 1 depicts how SFCCC is governed by a 10-member board (with two additional members emeriti).  Board members are the Executive Directors (or equivalent) of the consortium’s 10 member health care providers.  SFCCC members are diverse. Three members are Section 330 Health Centers, four are FQHC lookalikes, two are free clinics and one is an Indian Health Service Clinic.  A number of these centers receive funding as faith-based initiatives.  Others serve very specific populations such as lesbians and transgender individuals.  In most cases,  differences among members manifest themselves in different eligibility requirements and funding sources.

Exhibit 1: SFCCC Membership and Governance Model

Exhibit 1: SFCCC Membership and Governance Model longdesc=

Governance and Membership

As depicted in Exhibit 1, SFCCC is governed by a 10-member board (with two additional members emeriti).  Board members are the Executive Directors (or equivalent) of the consortium’s 10 member health care providers.  SFCCC members are diverse. Three members are Section 330 Health Centers, four are FQHC lookalikes, two are free clinics and one is an Indian Health Service Clinic.  A number of these centers receive funding as faith-based initiatives.  Others serve very specific populations such as lesbians and transgender individuals.  In most cases,  differences among members manifest themselves in different eligibility requirements and funding sources.

NORC visited three SFCCC member health centers: Glide Health Services, South of Market Health Center and Lyon-Martin Health Services.  Glide Health Services was founded in 1997 as a partnership between the Glide Foundation (a local faith-based organization), the University of California San Francisco School of Nursing and Catholic Healthcare West/Saint Francis Medical Center (a local hospital).  Glide is a nurse practitioner-managed primary health care teaching clinic serving roughly 6,000 patients each year.  Glide largely serves homeless patients and patients with HIV/AIDS and serves as the health care service provider for HRSA HCH and Ryan White Care Act grants that are  administered by SFCCC.

South of Market Health Center is a health center, serving the South of Market and Tenderloin neighborhoods.  Founded in 1973, South of Market has grown to provide comprehensive dental care and primary care at two health center sites.  The center serves roughly 5,000 patients annually, 60 percent of whom are homeless and uninsured.  Roughly 40 percent of the centers funding comes from the federal government while the remaining 60 percent comes from third party payers and Medi-Cal reimbursement.  Overall 73 percent of SMHC patients are uninsured, 17 percent are on Medi-Cal and 10 percent are Medicare beneficiaries.

Lyon-Martin Health Services was founded in 1979 by volunteers who saw a need for a provider to meet the needs of lesbians who had experienced discrimination in other health care settings.  Originally a research project sponsored by UCSF and San Francisco General Hospital, Lyon-Martin services roughly 2,400 patients, 80-90 percent of whom are uninsured.  Services include primary care, behavioral health, gynecology services, services for HIV positive women and services for transgender individuals.  The center employs a medical director (another physician sees patients on a volunteer basis), a physician’s assistant, four medical assistants, four front desk workers, and various other staff. The center’s budget totals roughly $1 million, split into three roughly equal parts: government funding, reimbursement and development.

IT Functions Supported by SFCCC

San Francisco City (and county) is a particularly interesting case study to learn about health IT and the safety net.  Aside from SFCCC members, a number of other organizations provide care for the underserved in San Francisco.  Section 17000 of the California state code mandates that counties provide care for indigent residents.  Thus, the SF DPH runs individual safety net health care sites around the city.  Other providers, including Magic Johnson Clinics, also provide for the underserved in the area. Outside of primary care, San Francisco General Hospital (“General”) provides inpatient care for many of the underserved in the area.

As noted above, SFCCC works in close collaboration with other entities in the city on IT issues. Though many of the systems efforts originate through SF DPH, SFCCC serves as a primary driver for health IT in San Francisco and among its members.  In addition, SFCCC facilitates quality improvement initiatives, provides support services in the areas of IT technical assistance and advocacy and helps secure grant funds for its members.  SFCCC hosts and supports a number of IT applications, each with a specific use and purpose.  Exhibit 2 below presents major IT community-wide applications currently being employed by safety net health centers in San Francisco.

Exhibit 2: Community-Wide Health IT Applications

Application Host Users Funder Purpose
Lifetime Clinical Record (LCR) /Invision San Francisco Department of Public Health (DPH)/Siemens All DPH health centers and SFCCC centers Various, including HCAP, ISDI, Tides and Kaiser Permanente The DPH care record. SFCCC health centers use it to access hospital and specialty care records and add notes from SFCCC visits
i2i Tracks SFCCC Some SFCCC centers and DPH centers (all have access) Kaiser Permanente Serves as an electronic disease registry and population health management tool
One-e-App The Center to Promote Health Care Access (the Center) All Healthy San Francisco medical home sites (some of which are SFCCC centers), State Department of Human Services, San Francisco Health Plan California Health Care Foundation (initially), City and County of San Francisco (ongoing) Determines eligibility and transmits enrollment materials electronically for Healthy San Francisco and Medi-Cal
eReferral SFCCC SFCCC centers, San Francisco General, specialty clinic providers CalRHIO/City and County of San Francisco Streamlines referral process between LCR users using a basic email system

Other applications are specific to health center members.  These include the HIV/AIDS patient registry for Ryan White Patients (CareWare), Preventing Heart Attacks and Stroke Everyday (PHASE) registry sponsored by Kaiser Permanente and other population specific applications.  Most clinics and health centers also have electronic practice management systems (PMS) and some have adopted electronic health records (EHRs). EHRs currently in use include: NextGen (at North East Medical Services) and Centricity (joint EHR/PMS at Glide Health Services).  SFCCC PMS applications include HealthPro (South of Market Health Center) and Misys (Lyon-Martin Health Services).

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