In San Francisco's Chinatown community, multiple generations of immigrant families face complex sociocultural challenges around accessing and optimizing their healthcare. Fortunately, the Chinese immigrant community has some healthcare providers with both clinical and cultural skills, in the form of the Chinese Community Health Care Association (CCHCA), an IPA-model (independent practice association) group practice whose independent physicians (200 member physicians and mid-level clinicians and another 100 affiliated clinicians) practice across well over 20 medical specialties. Not only do all those clinicians meet the patient care needs of the community, they do so in ways that are culturally skilled and aware.
As CCHCA’s leaders note on their website, “Chinese Community Health Care Association (CCHCA) understands you and your needs. Established in 1982 as a non-profit Medical Group, CCHCA has been providing the people of San Francisco with quality service and culturally competent health care through our network of highly skilled physicians. We have conveniently located physicians available in a full range of medical and surgical specialties. Services are offered in a variety of Asian languages, such as Cantonese, Mandarin, etc.”
Further, CCHCA’s leaders note, “In addition to providing accessible health care to the citizens of San Francisco, CCHCA is also involved in the community. In partnership with the Asian American Medical Group (AAMG), CCHCA provides its patients with access to in-person health education and online resources found at Asian American Medical Group (AAMG) Health Education Resources, promoting healthy living in the Asian community and beyond.”
The Chinese-American immigrant community that the CCHCA serves is diverse, but includes many disadvantaged patients, notes Don Brandeburg, the IPA's director of health information technology. "We have both many elderly, and a significant Medicare managed care population, as well as many MediCal (as Medicaid is known in California) patients." Indeed, three-quarters of CCHCA's patients on MediCal beneficiaries, with most of the remainder Medicare beneficiaries (and a plurality being dual-eligibles).
Further, more than 80 percent of the IPA's providers are located in the Chinatown area, while, by IPA rule, the patients must be in or near the area.
Among the particular data management and care management challenges has to do with precise patient identification. In that context, Brandeburg and his colleagues have been partnering with the Monrovia, Calif.-based NextGate, to optimize patient identification, and also for analytics around care coordination.
Brandeburg spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland about the organization's current initiatives; below are excerpts from that interview.
What are some of the key data management and care coordination issues you face, as your organization's IT director?
One is diversity of systems. Each of our providers decides which EHR [electronic health record] system they want to use. They have no contractual obligation to use a particular vendor. And we have many elderly Chinese-American doctors. As you can imagine, that's not an easy demographic to get updated. That said, the bedrock principle is that we want the doctors to know how they're doing at all times.
The doctors actually review patients' med lists with them at every appointment, but they often fail to code that task. And the only good way to ensure that that coding takes place and is done accurately is through the use of this program, in order to effectively marry the different types of data involved. In fact, we've found that it's very easy to mix up different data from historical and new claims, in this context.
What have been some of your key learnings from what you've obtained so far in this work?
There are so many variables in deciding what technologies to implement, what strategies to take. We want to run the way a startup does, by leveraging all the latest technologies for our community, so we sometimes take [tech investment] risks. But fundamentally, if you can't identify whether or not services have been performed for your patients, across your network, you've got a problem.
As we know, the future of healthcare is going to be pushed forward by payers in a top-down fashion. And if you can't have a health plan ask you a question, and then be able to answer that question very quickly, you're. Shins the eight-ball. So you need to be able to run reports on your health plans' members to find out what's going on with them.
The classic thing that I tell my group is that you can't manage what you can't measure. So we need to be able to measure what's going on. Our community physicians are incredibly well-trained, and they have an entrepreneurial spirit, and a lot of what's in their charts and records is incredible; and if you're not capturing that for them, you're doing them a disservice.
What are the technological keys to success in this?
Some are around the challenge of selecting--and affording--an EHR. There are some less expensive systems out there. Vendors like Elation EHR want to get into the market, so you can negotiate some great deals. You obviously need an EHR as your clinical IS backbone. I don't know that we were in a particularly unique situation when we chose Elation. We had a legacy EHR, and also had a lot of hardware and a lot of databases; we had also implemented an EMPI [enterprise-wide master-patient index], in partnership with our previous EHR vendor.
Meanwhile, the cloud is getting cheaper and cheaper again. If I were to start all over again right now, I would have the entire foundation hosted in the cloud. There are a lot of solutions out there; but your doctors have also got to want them. And that means getting the proper committees put in place, with buy-in from your physicians and other stakeholders.
What will happen in your organization in the next couple of years?
We're building our own portal for providers in our network that takes all the EHR, claims, and pharmacy data, everything we can possible collect on patients, and hosts it in a secure portal. We're tired of having vendors do everything for us. We still have some work to do on the portal; it's not yet user-friendly enough. But we're getting there. We're using Tableau, which has been pretty good for us, in terms of data visualization. But none of this would be possible with EMPI as a backbone.