As described above, OCHIN commenced practice management software “go-lives” with several consolidated health centers in late 2002 and early 2003. OCHIN established independent service agreements with these “integrated practice management (IPM) partner” health centers. These agreements describe the Epic-related implementation services that are to be provided by OCHIN, including:
- access to the centrally maintained practice management software application as users under an ASP model
- consultation with health centers on necessary technology upgrades
- provision of ongoing training and user support for health centers
- administration of automated electronic claims submission through OCHIN and McKesson, a data clearinghouse vendor selected by Epic.
In addition to shouldering the cost of start-up at their site(s), under these agreements, individual IPM partner health centers are required to pay a $1.04 per-encounter fee for use of OCHIN services. This is a subsidized rate; the actual estimated cost per visit is $1.75 per-encounter.
The current IPM partners are comprised of four smaller stand-alone consolidated health centers and three clinics affiliated with county health departments. These IPM partner clinics differ substantially across important characteristics such as total number of annual encounters, demographic characteristics of patients served and payer mix. The largest health center, Multnomah County based in Portland, experiences close to a quarter million encounters per year, while the smallest health center — Ochoco Community Health Services, located in the rural geographic center of the State — experiences fewer than 2,000 encounters per year. Although each of these IPM partner health centers came to OCHIN with different technical infrastructure characteristics, varying levels of systems expertise, and distinct support needs, they had similar reasons for partnering with the consortium including those described in the bullets below.
- Billing. According to our respondents, the single most important factor motivating their decision to join OCHIN was having access to the reliable billing component of the Epic practice management software. As one center’s Executive Director phrased it, “practice management is all about billing.” The need for streamlined, reliable billing processes is particularly critical in light of expectations from BPHC that health centers maximize revenue generated through billing payers wherever possible.
- Reporting. Consolidated health centers benefit substantially from grants administered by government and charitable foundations that require regular reporting on grant activities. To maintain Section 330 grants for example, consolidated health centers are required to submit Uniform Data System (UDS) reports providing aggregate data on encounters, payer mix, revenues and other key operational and administrative measures. For this reason access to practice management software such as Epic with expanded, customizable reporting functionalities was a draw for health centers who decided to participate in OCHIN.
- Local Training, Support and Collaboration. Many of the respondents reported problems with using regional or national practice management vendors that provided no local access to user support and training. OCHIN offered local and on-site training opportunities and better responsiveness through a team of locally-based technical staff.
- Future EMR Prospects. Many consolidated health centers mentioned their interest in OCHIN is related to its planned implementation of an EMR system. Several health centers were especially pleased with the idea that Epic would be the EMR provider because of compatibility with Epic’s practice management software.
Several of the health centers that chose not to become IPM partners were still interested in some form of collaboration, especially with the data warehouse and the EMR. Non-Partner respondents highlighted several reasons for deciding not to participate, including satisfaction with existing systems and costliness of Epic. Some health centers expressed concerns regarding the long-term viability of OCHIN. Many of the non-IPM partners are still involved in the OCHIN collaboration and have some input on the direction of future OCHIN ventures such as the data warehouse or EMR. The few centers we spoke with who were not involved with OCHIN at all were very small or were located in the less densely populated Eastern portion of the state.