In this section we summarize health center experience using software and other systems resources currently available in Virginia. In particular, we describe their experience using the MegaWest practice management software, their very early experience using REACH’s MORE Access, and overall organizational interactions with CCNV, ComCare and REACH. We begin with discussion of health centers’ experience with CCNV and ComCare on an organizational level.
CCNV/ComCare Participation. Despite recent turnover in leadership at some health centers, many of the centers’ leadership, particularly for those centers that are CCNV shareholders, were very familiar with the history and evolution of CCNV and ComCare. Many small to mid size health centers interviewed credit the presence of the consortium as the primary reason they currently have an adequate platform for conducting basic practice management functions such as administrative reporting, scheduling and billing. While these health centers report having substantial challenges associated with their use of MegaWest (described in greater detail below), they attribute these problems primarily to a lack of adequate resources for the consortium.
Importantly, however, some health centers interviewed expressed substantial concern with the organizational orientation of CCNV and the usefulness of the services it provides. In particular, one of the larger consolidated health centers in the State reported recently discontinuing use of ComCare for access to practice management software, citing escalating costs to participating health centers, inadequate responsiveness around core issues such as reporting customizations and too much system downtime. This health center, and another larger health center that we did not interview, are both currently working directly with Companion Technologies for access to the same MegaWest software instead of using ComCare as an intermediary.
The health center we spoke with indicated their current arrangement affords them greater control over data maintenance, reporting and connectivity issues. While this has required substantial investment by the health center (they recently created the position of CIO), they sees it as a necessary step for assuring return on investment in information systems resources over time. Leadership from this center believes there are important efficiency concerns in Virginia where distinct entities with separate leadership, direction and funding seek to provide services to health centers. They suggested that, under this model, the health center community spends too many resources on defining organizational and legal boundaries or dealing with administrative issues and not enough time on addressing their own needs.
Experience with MegaWest. Many health centers interviewed suggested the importance of having access to a practice management platform to facilitate basic administrative activities and reporting to federal sponsors. While all stakeholders (including CCNV leadership) acknowledged that MegaWest was not an ideal solution, the majority of health centers interviewed felt that the MegaWest system was adequate in meeting these basic needs at an affordable price. In the bullets below we summarize health center experiences with using MegaWest for basic practice management functions. We note that these comments come largely from the health centers that access MegaWest using the circuit to the central software server maintained by ComCare.
- Scheduling. Most health centers report that the MegaWest system is used for scheduling patient visits at their health center and that it performs this function adequately. One important critique offered by health centers was that summary schedule data is not readily available from the system. While there is a process for pulling up a presentation of all appointments scheduled for a particular time, the process is clumsy and requires a non-trivial level of training in order to master. Many of the health centers report having inadequate resources to afford training offered through ComCare and Companion Technologies.
Billing. In Virginia, like elsewhere, having a systematic and automated process for developing encounter-specific reports and generating bills is the critical reason for information systems investments. All of the CCNV partners who access Megawest through ComCare utilize the software’s billing component; the majority reported satisfaction with the module’s performance. Three centers felt that the Megawest billing component worked “as well as any other system” and had experienced no problems with delayed payments. These centers were grateful that CCNV handles the billing, since they no longer had to dedicate a full FTE to that task. Another center, although generally quite pleased with the billing component, expressed the desire for an electronic payment posting functionality.
In addition to using MegaWest as their billing platform, some health centers completely outsource their billing function through CCNVs Central Billing Office. An executive director from one of these centers reported dissatisfaction with the necessity of outsourcing billing functions (this arrangement was in place prior to his heading the health center) and noted that Medicare and Medicaid payments sometimes took 80 or 90 days to arrive “when it should only take 60.” In addition, this center’s respondent reported that the system occasionally failed to catch wrong or missing data elements, leading to inaccurate claims submissions.
- Reporting. Reporting capabilities, especially around UDS reports, are vital to all safety net health care providers. The Virginia health centers we spoke with indicated that reliable reporting functionality was one of their top priorities for practice management systems and information systems in general. According to most of the ComCare-affiliated centers, the Megawest system does not always perform as well at reporting as it does with scheduling and billing functions. These centers rely solely on Megawest to do UDS programming, and a few described the system as “not user friendly” and difficult to manipulate. These comments are likely related to the fact that data on the MegaWest server is not stored in a relational database format, substantially increasing the complexity reporting tasks.
One rural health center reported having problems identifying the relevant “dictionary” fields to pull specific information from, and another related that identical reports run at different times occasionally produce non-identical output. Two health centers indicated that they had no problems with their UDS reporting other than the minor issues arising every year when the report specifications are changed, but had trouble with more advanced reporting functions. One rural center sometimes relied on other health centers with more in-house expertise to run these reports for them. Training on these advanced capabilities is available but involves large fees that smaller centers are often reluctant to pay.
Experience with MORE Access. REACH experienced a few problems throughout its development, but it appears that its stakeholders now generally believe it is on track to provide useful and desirable functions. Early problems stemmed from a number of resource issues related to health center involvement in the initiative. For example, health centers were not always fully involved in the software development process. In addition, the initiative was hindered by recent changes in leadership at 50 percent of the core provider partners — a massive turnover that affected CCNV activities as well. This turbulence resulted in a decrease of health center knowledge about REACH and MORE Access, and the organizational leaders had to devote extra time and resources to re-educating health center staff about the REACH initiative and its IT project.
However, the MORE Access project seems to now be on firmer ground and working to establish itself in the Richmond safety net community. REACH leaders are planning to expand to additional organizations in need of eligibility determination systems and other components of the MORE Access software, but as of yet are only in the preliminary discussion stages with the interested entities. While our REACH respondents declined to comment extensively on partner satisfaction with MORE Access because the system is still being implemented, they thought that satisfaction levels were generally high and that the participating providers were optimistic about the program’s potential. This impression was confirmed by the health centers we spoke to who participated in REACH — they believed that REACH’s activities would be extremely useful to the centers’ functioning, and praised the “niche application” model of REACH as an “instant benefit” that would help both the uninsured population and the centers themselves.