2003 Model Practice Application (Public)

Health Track MIS

El Paso County Department of Health and Environment

The program used technology to build a community-wide network aimed at providing expanded access to care. The target populations for this project are the low income uninsured and those who are underinsured. The goal is to expand and enhance the integrated health care delivery system that coordinates service for the uninsured and underinsured to increase access to care, eliminate fragmentation of services and develop additional community health care resources. The project implemented a Web-based, HIPAA-compliant data system to coordinate services, share information, and manage the eligibility submission and determination process for federal and state medical benefits (Medicaid, CHP+, CICP) programs for the uninsured and underinsured. Problems with the current information flow between provider organizations were addressed in Health Track’s design by adding a visit screen with a medical alert and medical outcome data.

Access to health care is a critical problem in El Paso County (EPC), where the number of low-income uninsured and underinsured is estimated at 90,000. A number of organizations currently provide care, but the articulation and processes between these different organizations are not well defined or efficient. In addition, the community does not have a clear understanding of how many of its residents are uninsured and underinsured, and the specific demographics of these groups are unknown. Moreover, the collaborators realized that, to meet the health care needs of the uninsured and underinsured, the existing resources must be used more effectively and efficiently. Finally, the partner agencies identified the need to develop new resources to expand care for the uninsured and underinsured, but they recognized that there would be no new funding. The issue must be addressed and solved within this community.

This innovative technological solution is the product of 10 independent organizations joining together to design, implement, and incorporate into their workflow a Web-based, HIPAA-compliant system that supports and tracks the collection of public health benefit applications, eligibility determination, and basic health information for all organizations to access as needed. The partners signed a Master Business Associate Agreement, which specifies the way the system will be used and provides for an oversight committee with power to discipline and expel.

The HRSA-funded Community Access Program (CAP) grant was awarded to the El Paso County Department of Health and Environment (EPCDHE) on behalf of the collaborators (Community Health Partnership, Inc.) in September 2001 for $1.2 million and 2002 for $805 thousand. The EPCDHE serves as the fiduciary agent. In consultation with project staff hired for the CAP grant (Community Health Planners and Lead System Project Manager), the department’s Project Director, makes decisions related to daily operations and directs the activities. EPCDHE supports the HT servers and the administration of the system. The Community Health Partnership, Inc., (CHP) is the umbrella organization to which the collaborators belong. Partners include several local and county health agencies, which are continuing to identify other organizations that contribute to care for the uninsured and underinsured. The integrity of the community partners' role was assured through the decision making process.

A consensus process was used to ensure that Health Track would meet partners’ requirements. This was a critical element of the decisions related to the development of the Health Track software. Representatives from partner agencies worked with the Interlink Group, Inc. on articulating and approving the design of the software. The five early adopter agencies approved all critical elements and the remaining user agencies participated in the final review sessions. The Community Health Planners prepared and distributed documents for partner review and provided follow-up on issues. In addition, the Community Health Planners met with agencies one-on-one regarding the development of Health Track. This collective decision process was used to address such issues as HIPAA compliance, security, the addition of summary visit information to the system, and reports to be generated from the system, as well as overall design.

CAP grant funds provide community-wide infrastructure enhancements that will support improved access to care for the low-income uninsured and underinsured. The Health Track system was based on the application tracking system (App-Track) created by Denver Health and Hospital Authority (DHHA). The purpose of App-Track is to increase the number of eligible clients successfully completing the Medicaid, CHP+, and other payment source application process. Health Track extended App-Track from a system serving a single organization to a community-wide, multi-agency application. To accomplish this broadened role, the partners converted the system to be Web-based, added functionality for HIPAA compliance, and added a patient mini-medical record that features a medical alert function.

The development costs for this improved functionality was $800 thousand the first year, and enhancements totaled $300 thousand during the second year, all funded by the CAP grant. One of the most important improvements is that duplicate data entry is eliminated, an enhancement that will encourage Health Track’s incorporation within EPC health system for the uninsured.

The CHP partner agencies anticipate that increased enrollment of uninsured in Medicaid, CHP+ and CICP will generate revenue by decreasing the total uncompensated care. That revenue can support additional care for the uninsured and underinsured. Through improved use of the system, organizations will be able to collect revenue for services previously written off due to the self-pay status. With DHHA implementation of App-Track, in the first six months, $1 million was collected that previously could not be billed. Health Track in EPC anticipates a similar financial impact, but it is yet to be demonstrated. Through use of the mini-medical record and the improved communication by providers, EPC anticipates improved coordination of care, and less duplication and fragmentation of service. The result should be improved health status for this population.

In the improved collection of fees, and decreased cost of delivering coordinated care, the system will most likely pay for itself many times over. Upgrades and maintenance expenses are minimized due to the licensing arrangement with DHHA. EPCDHE covers the annual cost of day-to-day administration of the system and its maintenance. When the system requires replacement or major up grades, the partners using it will share the costs.

The Health Track system became operational December 2002. Reports generated by the system are shared monthly with the CHP. It is interesting to note that the supposition about the employment status of the uninsured is demonstrated by the data collected: 3 out of 4 uninsured clients are employed. The businesses most likely not to provide health insurance are in the service and construction sectors. It did not take many days of being on the system before one of the hospitals encountered their first client who had already been to the FQHC applying for benefits. The coordination and communication between agencies took a dramatic leap forward that day! An evaluation firm has been engaged to provide guidance in developing the evaluation plan, tools and interpretation of the findings. It is anticipated that the impact and process of HT will be fully examined. A report of the findings is expected in August 2003. The return on investment experienced by DHHA will be measured for the EPC partners. ROCI (Return on Community Investment) is another measurement strategy that is being explored.

A collaborative effort of this magnitude can be successful when the executive leading the organization is fully committed and communicates that commitment to the team that is assigned to carry out project. This commitment must be restated periodically. A Community Health Partnership (CHP) type of collaborative effort must be fairly mature to support shared decision making and assumption of responsibility by unrelated organizations for a major project such as HT. The leadership must be skilled, patient, and mature. The vision and philosophy must be clearly articulated and supported consistently by all the collaborators. The design decision-making process that was used is fairly time consuming; however, less involvement by the organizations would impede adoption.

The system runs on two Windows 2000 servers located on a secured network. An SSL Web server certificate and adequate firewall protection would be required. Staff time is required to manage these systems and to administer the Health Track application. Each installation would need to analyze their requirements for disk space, processor power, and bandwidth.