Community Health Center Information Systems Assessment: Issues and Opportunities. Final Report. Health Center Network Background and Objectives

10/30/2005

The efforts studied here are part of an ongoing trend toward health center network activity beginning in the mid-1990s.  Although health center networks have existed in various forms for decades, several motivating factors have encouraged network formation and activity over the past 10 years. Health system changes such as widespread provider consolidation, the movement towards Medicaid managed care, and policies that require health centers to maximize collection from third party payers have created new incentives for network formation to help health centers adapt, often through collaborative adoption of IT. In addition, several Federally-funded programs, described above, have encouraged network formation and network-level investments in IT. Exhibit 3 found on Page 14 summarizes key activities of health center networks we spoke with for each of the seven case studies.

Given their common origins and requirements, Section 330 health center networks strive to achieve similar goals, ranging from improved operational efficiency on an individual health center level to improved health of the safety net population as a whole. Four of these major goals and their relationship to IT are outlined in the bullets below.

  • Financial viability. As described above, health centers face increased pressure to reduce cost of operations, maximize revenue from third party payers and generally exert greater control over their financial status, partly due to the trend towards Medicaid managed care contracting. Networks provide a forum for health center Executive Directors and CFOs to discuss opportunities to save money through collaboration. Some networks have engaged in joint purchasing programs or worked to start Medicaid managed care plans. Establishing robust administrative systems to increase efficiency and third party payments across health centers has been a central focus of many networks, including those investigated as part of this study.
  • Administrative reporting. Related to the need to streamline administrative activities is the need for health centers to be able to efficiently and accurately produce a range of reports required for day to day management of their operations as well as those mandated by funding organizations (e.g., the UDS). Helping health enters produce standard and custom reports through use of IT is a central goal for the health center networks investigated as part of this study.
  • Disease management and clinical outcomes improvement. Given their role in treating vulnerable populations, health centers have always prioritized quality of care and outcomes improvement. Motivated in part by Federally sponsored programs such as the Health Disparities Collaborative most health center networks studied prioritize the adoption of health IT to improve clinical outcomes.  Four of the studied networks use EHR systems (one site rolled out EHR subsequent to our site visit) to enhance the availability of accurate information at the point of care, helping clinicians make informed decisions. 
  • Coordinated care and public health collaborations. As a coordinating body, several networks seek to coordinate the activities of their member health centers and, in some cases, other providers. Several of the networks seek to collaborate with regional primary care safety net providers in order to promote population-based healthcare, facilitate the secure exchange of patient data across the region to coordinate care, and quickly identify actionable public health issues.  None of the networks studied has achieved such a region-wide coordinated system but several indicate that this remains an important goal to pursue in the future.    

Although networks by and large form for similar reasons and with similar goals and governance structures, there are important characteristics that distinguish some network models from others. The seven networks we studied represent various organizational and service delivery models. Key areas of variation include horizontal versus vertical collaboration, the extent to which networks have centralized functions previously operated at the health center level and the role of partnering community health stakeholders. We found that these structural components of health center networks often drive prioritization of network objectives as well as key challenges and success factors.  An overview of networks investigated and key activities of each are summarized in Exhibit 3 below.

Exhibit 3: Health Center Network Overview
Networks Investigated Network Model Key Partners and Members Ongoing or Planned Activities Major Revenue Sources
Oregon Community Health Information Network
(OCHIN)
  • Non-profit
  • BoD of HC leadership
  • FT CEO/CIO and staff

 

  • Over 20 health centers in OR
  • Some CA and WA health centers
  • Oregon Primary Care Association
  • State and local health departments
  • Networked practice management application (Epic)
  • Roll-out of EHR using Epic scheduled for Fall of 2005
  • Master patient index with over 40,000 patients
  • Data warehouse to be built from the existing MPI
  • HCAP program
  • User fees
  • Non-Federal grants
Health Federation of Philadelphia
(HFP)
  • Non-profit
  • BoD of HC leadership
  • FT CEO and staff
  • PT consultant CIO
  • 7 health centers in Philadelphia
  • Philadelphia Department of Public Health, Ambulatory Health Services
  • Community data warehouse
  • EHR pilot project with one health center member
  • Program coordination and collaboration support
  • SIMIS grant
  • Foundations
  • Philadelphia Depts. of Public Health and Human Services
Community Care Network of Virginia
(CCNV)
  • For-profit
  • BoD of HC leadership
  • Health center members are also shareholders
  • FT CEO, CIO, managerial staff
  • 17 health centers in Virginia
  • 3 private participating providers
  • Virginia Primary Care Association
  • Networked practice management application (MegaWest)
  • Credentialing, central billing office and administrative assistance
  • Start-up money from members
  • Membership fees
  • ISDN grant
  • Commercial activities
Southeastern Kentucky
(SKYCAP)
  • Non-profit
  • Managed by PT staff at different community partners
  • 1 Healthcare for the Homeless clinic
  • University of Kentucky Center for Rural Health
  • Health care providers
  • Faith-based organizations
  • Academic institutions
  • Local health departments
  • Community client tracking system
  • System connects social service and health care providers
  • HCAP program
  • Foundations
  • Healthcare for the Homeless grant
Boston HealthNet
(HealthNet)
  • Non-profit
  • Based out of Boston Medical Center
  • BoD of leadership from BMC, health centers, CareNet
  • 15 health centers in Boston
  • Boston Medical Center
  • Boston CareNet
  • Boston HCAP
  • Networked EHR (GE Logician)
  • Network data warehouse (practice management and HER data)
  • Community level quality improvement program for diabetes
  • Medicaid managed care plan and tracking program for uninsured patients
  • HCAP program
  • ISDI grant
  • Private donation
Community Health Action Network of New Hampshire
(CHAN)
  • Non-profit
  • BoD of HC leadership
  • PT CEO, CIO
  • Shared staff between network and health centers
  • 5 health centers in southern NH
  • NH Dept. of Health & Human Services
  • Bi-State Primary Care Association
  • Networked EHR (GE Logician)
  • Plans for networked practice management (GE Centricity)
  • SIMIS grant
  • State funding
  • Private donations
Health Choice Network of Florida
(HCN)
  • Non-profit
  • BoD of HC leadership and clinical representatives
  • FT CEO, CIO, Senior Vice President, and staff
  • 10 health centers in Florida
  • 2 contractual relationships with health center networks in NM and UT
  • Academic institutions
  • Faith-based organizations
  • State public health entities
  • Networked practice management (Medical Manager, WebMD)
  • Networked EHR (roll-out in process with WebMD OmniChart)
  • Full networked computing services
  • Centralized billing office, common CFO
  • Membership fees
  • ICT grant

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