Forging regional collaboration among providers can be a feat in itself, but it still ignores some key organizations with costs to cut and benefits to reap for the overall healthcare information-improvement effort.
Consider Medicaid managed-care plans. The ability of providers to get fast, accurate information on patients covered by California's Medi-Cal program weighs heavily on how quickly hospitals and doctors get paid, says Philip Greene, a top official of the agency administering the program in Santa Barbara County, Calif.
Improving that exchange of information through the automation envisioned in a countywide initiative will save money for both providers and Medi-Cal administrators. "The cost of handling it on our end will be reduced," says Greene, deputy director of the Santa Barbara Regional Health Authority, which processes 70,000 claims per month. "We have no problem paying clean claims."
But beyond reducing the basic expense of handling paper claims, referrals and authorizations for treatment, the health authority wants to end the hassle of managed care as much as healthcare organizations do. "Our hope is not so much to reduce costs but to make it easier for providers to deal with us," Greene says. The agency administers benefits for 40,000 Medi-Cal beneficiaries on average, plus another 2,000 in other federally sponsored programs.
The county health authority is an "anchor," or presiding member, of one of four formal groups of healthcare stakeholders organized to advance their own particular information technology and network construction projects, all aimed at streamlining healthcare delivery.
The four "care data alliances" constitute the core of the Santa Barbara County Care Data Exchange, a year-old organization set up as a neutral body to coordinate countywide infrastructure, standards and applications of technology that would be beyond the ability of any organization to implement and pay for alone.
It seeks to balance clinicians' needs for comprehensive patient data with the proprietary business interests of competing organizations in the county and the preservation of patient confidentiality (See Eye on Info, Feb. 7, 2000, p. 32).
The alliance headed by the health authority officially includes the county health department, county medical society and three neighborhood clinics in Santa Barbara, but no hospital. Two other organizations collaborating in the health authority's group also are anchors of their own care data alliances: Lompoc (Calif.) Valley Community Health Organization and Sansum Santa Barbara Medical Foundation Clinic.
But hospitals are important in the scheme of things, Greene says. "Our goal is to eliminate as much paper as we can and to become as user-friendly to our contracted providers as possible," he says.
About 65% of claims already are handled electronically through the health authority's efforts during the past several years. Referrals and authorizations, however, can take a day or two of back-and-forth phone calls and paper forms to complete.
That's a problem for the county's four hospitals, because services must be authorized by a primary-care physician and the health authority before reimbursement is approved under contracts paying all-inclusive per-day rates. The authority has its own primary-care network, in which an enrollee chooses a physician who then acts as a case manager. The agency negotiates capitated payments from the state; total contract revenue have held steady the past several years at $109 million.
Last December, the three neighborhood clinics in the alliance began piloting a Web-based method of filing treatment authorization requests in which providers fill a form online, submit it electronically and get answers from a nurse by e-mail the next morning, Greene says. The vast majority are approved, so providers are cleared to proceed with needed care; meanwhile the authorization remains in the Medi-Cal billing system waiting for the claim. "It eliminates a few days and a lot of hands," he says.
On the clinical side of care delivery, the care data exchange's goal is to give providers "as ready access as possible to clinical data on a patient who's in front of them" -- whether it's the last test done, the insurance information that influences decisions or an immunization record kept by the public health department, Greene says.
If doctors could get such a level of access to spread-out information, "that would be nirvana," says Cynthia Bowers, M.D., director of the student health service at University of California-Santa Barbara. The internist, who's also president of the county medical society, manages the ills of the 19,000 students through the campus health center, which logs 45,000 patient visits per year and another 28,500 encounters covering health education.
Much of the care is handled within the clinic during the week, but doctors and nurses on staff also deal with hospitals and other care facilities off-campus.
The health center is open from 8 a.m. to 4: 30 p.m. Monday through Friday, which leaves all weekend for students to fall ill or get into scrapes that send them to a hospital emergency room. But caregivers can't get any information on those students over the weekend or at night. "The charts are here and the doors are locked," Bowers says.
The same problem works in reverse. A typical weekend of activity means a long line of students at the health center the following Monday, and most of them can't give much information about what's been done at the hospital, she says. Maybe a lab culture was ordered and taken, and "by Monday the culture is ready -- but I don't have it."
The university is participating in a care data alliance anchored by the Sansum Santa Barbara Medical Foundation Clinic, which also includes the three-hospital Cottage Health System, local pharmacies and Unilab Corp., a giant laboratory test facility serving California.
Unilab provides a narrow but weighty piece of a patient's overall clinical information, says Michael Skinner, vice president of medical information systems for the company's southern division. That service area, which extends from Santa Barbara south to San Diego, receives more than 30,000 specimens per night, and the vast majority of the test results from those specimens are expected to be reported back to doctors by 8 a.m. the next morning, Skinner says.
"Results delivery is a fairly significant component of cost," he says. For smaller provider customers, results are faxed or hand-delivered by courier. For hospitals and large medical practices such as Sansum Santa Barbara, the standard is a $1,000 teleprinter hooked up to the lab in Tarzana, Calif.
It's a throwback technology -- a form of dot-matrix printer long eclipsed by the laser variety -- but Skinner says it doesn't make sense to upgrade until healthcare begins tapping into the Internet age. Anything short of that would still be mechanical in nature, limited to a point-to-point connection and prone to proliferate paper, he says.
"The Santa Barbara project winds up being one of several strategies for solving the data challenges we have. It's the most aggressive by far but it's not the only solution."
Unilab had been waiting for the right time to move to Internet-based delivery, but officials "don't want to make too large of an investment in this technology too early," Skinner says. Less than three years ago, interest in the Internet as a delivery medium was virtually nil. A survey question on the subject, attached to the bottom of about 100,000 teleprinter transmissions, generated only about two dozen responses.
Last year Skinner tried again with the same question and got a "significant positive response," he says. "There was a clear, obvious and discernable change during those two years."
"The timing could not be better in Santa Barbara."