Community Health Center Information Systems Assessment: Issues and Opportunities. Final Report. Health Choice Network History

10/30/2005

HCN, headquartered in Miami, Florida, originated in 1994 as health centers in and around Miami became increasingly concerned about provider consolidation and the movement towards mandatory Medicaid managed care.  In addition, health centers were motivated by sharp increases in immigration from Latin America and in the prevalence of HIV/AIDS, which placed growing demand on their services even as they operated in an increasingly difficult business environment.

Developing the network model. The original HCN membership consisted of three health centers in the Miami metropolitan area: Community Health Center of South Dade, Inc., Economic Opportunity Family Health Center, Inc., and Family Health Center, Inc.  Camillus Health Concern, Inc., joined within the first year of operation. This original group prioritized fiscal consolidation and joint investments in IS. The network also began exploring the possibility of forming a managed care organization. The network’s original IS strategy involved providing only direction and management on a network level, allowing each health center to maintain their existing administrative applications. Following the resignation of the network’s IS director in 1996 and a subsequent independent assessment, the network decided that true improvements and economies of scale could only be achieved through a broader approach including the use of common, centrally administered applications for accounting and practice management.

Also in 1996, Family Health Centers of Southwest Florida (FHC) in Fort Myers joined the network, expanding the reach of the network beyond Miami and bringing the network a new senior executive, Kevin Kearns, who had served as the Director of Finance & MIS since 1992. Kearns became the network’s new CIO/CFO and quickly moved to implement a networked accounting and financial system based around Best Software’s Platinum for Windows, as well as the Medical Manager practice management system. The network’s new IS strategy, implemented by Kearns, involved the expansion of network-based applications to include all health center software, including email and general productivity software. Also, in 1996, the network decided against forming a managed care organization, opting instead to negotiate a risk contract with an existing Medicaid managed care organization.

Maturity and expansion.  Concurrent with changes in the level of centralization and support, the network decided to establish affiliation agreements with member health centers that formally recognized HCN, and specifically Kevin Kearns, as their shared CIO and CFO. Under these affiliation agreements, health centers signed on to participation in an integrated delivery system (IDS), agreeing to consolidate their financial and administrative operations even as they remained distinct institutions.  To improve financial stability, the network’s fiscal department implemented a centralized billing system in 2001. This system serves members of the IDS Affiliated Members as well as Network only members.

In 1998, HCN met with the CEO of the New Mexico Integrated Services Network, a group of 6 health centers, who wanted to save costs by outsourcing IS systems and services rather than building them internally.  The New Mexico centers could not effectively run their billing and tracking systems, nor attract staff who could, and had heard of HCN’s successful IS services, and felt that contracting out would be easier than building their own.  The  New Mexico ISN health centers agreed to engage HCN through “purchase of service” contracts for the purpose of administering their IS systems. There are four other health centers in New Mexico that are not part of the ISN. The two biggest centers in the New Mexico network did not participate because they wished to develop their own systems, and the two smallest could not afford to join.  HCN entered into a similar arrangement with a health center network in Utah around two years later.  Working with these two remote partners posed some initial challenges to HCN’s IS team, including how to reach such remote locations in the New Mexico desert, and hiring additional support staff to cover the time differences, but on the whole has shown that geography is at most a minor limitation in today’s technology marketplace. 

Faith-Based Initiatives.  Health Body, Health Soul is a combined faith-and-community-based program working to promote healthcare and disease prevention in African-American and Hispanic communities, particularly those with lower incomes, operated by HCN and six member centers, with participation from  ten ‘lead-faith’ partners and over 100 Florida churches.  HBHS currently targets pediatric asthma, diabetes and lung, prostate, breast and cervical cancer, and has partnered with member centers to provide pneumococcal and influenza vaccinations for seniors in Florida. 

Formal partnerships with academic institutions, including Florida International University and University of Miami Medical School, are being explored for possible collaboration on research activities, in addition to ones already in place with the H. Lee Moffit Comprehensive Cancer Center and University of Miami Sylvester Cancer Center.

Moving to clinical applications. Today, HCN has ten network member health centers in Florida as well as contractual relationships with health center networks in New Mexico and Utah.  Network health centers treat over 346,000 patients annually, including over 200,000 in the Florida centers, over 100,000 in the New Mexico centers, and over 46,000 in Utah centers.  Over the past three years, the network has successfully pilot tested an EHR system, secured grant funding to support a wider roll-out, and begun implementation of the full-featured EHR (WebMD’s OmniChart Suite) in several Florida and New Mexico health centers.

To facilitate EHR adoption and implementation, the network has recently brought on a part time Medical Director who works closely with existing clinical quality committees. In addition, respondents noted that the network has renewed its focus on public health priorities including educational efforts around prevention and elimination of racial and ethnic disparities through partnership with the State, faith-based organizations and commercial entities.

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