Community Health Center Information Systems Assessment: Issues and Opportunities. Final Report. 3.1 Boston HealthNet Organizational Structure and Roles

10/30/2005

As described above, this site visit focuses on health center experience working with the BHN network of BMC affiliated health centers. BHN serves primarily as a coordinating body. Each of the BHN health centers operate as stand alone institutions, supported through Section 330 provisions and private donations. Consistent with Section 330 rules, each health center is governed by a board of directors that oversees the activities of an executive director and senior management team. Following the merger that created BMC, BHN was created to bring together the 15 health centers that enjoyed strong institutional relationships with the old Boston City Hospital. In this convening and coordinating role, BHN manages projects funded through corporate donations and federal grants to assist BMC and its health center partners. In the decade since its formation as a subsidiary of BMC, BHN has successfully initiated and maintained a series of programs related to improving access to care, health care quality and efficiency among its 15 health centers and BMC. In the bullets below, we describe BHN initiatives that relate to IS development and support.

  • Community Health Automated Record Technology (CHART). The CHART program grew out of a major, one-time corporate donation to BMC and BHN to support implementation of Logician electronic medical records (EMR) software in 8 of the 15 BHN consolidated health centers. Following the announcement of this donation, CHART was created to acquire and implement the EMR applications in health centers across BHN and then foster use of the EMR to support community-level improvements in health care.
  • Boston Healthy Community Access Project (HCAP). Concurrent with the EMR donation, BMC and BHN applied for a BPHC HCAP grant. The grant outlined opportunities to support, enhance and leverage the burgeoning IS resources at BHN consolidated health centers, notably EMR, to improve quality and efficiency of care provided to uninsured patients. In practice, activities of the HCAP project have focused on helping BHN health centers manage diabetes care, reduce inappropriate ED utilization, improve mammography screening rates and generally maximize benefits from having EMR. HCAP funds have also supported the development of a data warehouse which includes claims-based data on 80,000 uninsured, or recently uninsured, individuals to support the mission of the CareNet initiative described below. 
  • BMC CareNet Plan. CareNet is a program developed out of BHN that tracks care received by uninsured individuals in BHN health centers. CareNet works to assure that each patient maintains a primary care “medical home” and that BHN centers are appropriately reimbursed for care to the uninsured from the state’s uncompensated care pool. Following the award of the Boston HCAP grant, described above, CareNet has served as the organizational home for BHN-wide data warehouse project.
  • BMC HealthNet Plan. BMCHP is an independent Masscheusettes Medicaid managed care organization operated through BMC and BHN.  BMCHP facilitates care for over 100,000 Medicaid recipients throughout Massachusetts. Because of ongoing shifts in eligibility among families, there is substantial overlap between patients whose care is tracked by CareNet and patients enrolled in the BMCHP health plan.

We should note that although each of these bullets represent distinct initiatives or organizations from the funding and operational perspective, BHN and BMC work to assure appropriate coordination and collaboration across programs. For example, while CHART had primary responsibility for implementation of the EMR, funding from the HCAP program played in instrumental role in incorporating EMR use in everyday practice of the health centers and ensuring a smooth transition from paper to electronic records. Also, although the CareNet plan pre-dates the HCAP initiative as the entity responsible for monitoring care to uninsured populations, this activity has been considerably aided by the data warehouse established and maintained using HCAP funding.

In addition to serving as the organizational home for the CHART project and fostering the development of each of these initiatives and affiliated organizations, BHN maintains an overall Board of Directors comprised of leadership from BMC, affiliated health centers, CareNet, Boston HCAP and the BMCHP. This board effectively brings leadership together to maintain a robust, coordinated program of initiatives and organizations to enhance safety net care provided by BMC and its affiliated health centers.

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