Community Health Community Health Network of WVNetwork of WV

& & MedLynksMedLynks

A Case StudyA Case Study

Community Health Community Health Network of WVNetwork of WV

& & MedLynksMedLynks

A Case StudyA Case Study

Vivian Kost, CHNWVWorld VistA Meeting

June 16, 2007

Who Are We?Who Are We?

The Network is a tax-exempt, non-profit health The Network is a tax-exempt, non-profit health center- controlled West Virginia corporation.center- controlled West Virginia corporation.

The nineteen Network member health center The nineteen Network member health center organizations collectively provide services to organizations collectively provide services to over 120,000 patients in 32 of West Virginia’s 55 over 120,000 patients in 32 of West Virginia’s 55 counties each year, with 78 delivery sites and counties each year, with 78 delivery sites and nearly 400,000 patient encounters annually.  nearly 400,000 patient encounters annually. 

Our member health centers provided over $40 Our member health centers provided over $40 million in health care services last year, with million in health care services last year, with 70% of this care to Medicare, Medicaid and 70% of this care to Medicare, Medicaid and uninsured uninsured patients. patients. 

The Health of West VirginiansThe Health of West Virginians Of West Virginia adults: Of West Virginia adults:

64% are obese or overweight;64% are obese or overweight;

32.4% have high blood pressure (with another 28% at-risk 32.4% have high blood pressure (with another 28% at-risk due to hypertension);due to hypertension);

37.5% have high cholesterol;37.5% have high cholesterol;

28.2% are current smokers;28.2% are current smokers;

9.8% have been diagnosed with diabetes (and another 3% 9.8% have been diagnosed with diabetes (and another 3% are undiagnosed diabetics);are undiagnosed diabetics);

40% are pre-diabetic; and40% are pre-diabetic; and

85% have one or more risk factors for chronic disease.85% have one or more risk factors for chronic disease.

(Source: West Virginia Department of Health and Human Resources)

Why Focus on Health Improvement?

Why Focus on Health Improvement?

West Virginia Ranks 50West Virginia Ranks 50thth in the percent in the percent

of adults under age 65 limited in any of adults under age 65 limited in any

activities because of physical, mental or activities because of physical, mental or

emotional problems!emotional problems!

(Source: Commonwealth Fund State Scorecard on Health System

Performance, 2007)

Why Focus on Health Improvement?

Why Focus on Health Improvement?

It’s about the economy, stupid!It’s about the economy, stupid!

Our members have joined together in a health Our members have joined together in a health

improvement project… the EHR is improvement project… the EHR is oneone of the tools used of the tools used

to help patients improve their overall health thru the use to help patients improve their overall health thru the use

of Planned Care.of Planned Care.

How Can a System Help?How Can a System Help?

All the right care, All the right care,

at the right time, at the right time,

in the right way, in the right way,

every time!every time!

CHNWV Health Improvement Project

CHNWV Health Improvement Project

The Network and its members have identified a The Network and its members have identified a number of significant health improvement number of significant health improvement opportunities and have targeted:opportunities and have targeted:

diabetes, diabetes,

cardiovascular risk reduction, cardiovascular risk reduction,

depression, depression,

weight management and physical activity, weight management and physical activity,

asthma; andasthma; and

cessation of tobacco usecessation of tobacco use

Why Explore Open Source?Why Explore Open Source?

The use of a predominantly Open Source solution, The use of a predominantly Open Source solution, allowed us to use a larger percentage of our allowed us to use a larger percentage of our available dollars for implementation vs. available dollars for implementation vs.

acquisition.acquisition.

Use of public domain solution reduces software Use of public domain solution reduces software licensing fees (some licensing applies for licensing fees (some licensing applies for

certain applications and certain applications and national codes, i.e., national codes, i.e., CPT, ICD);CPT, ICD);

FlexibilityFlexibility

Support CommunitySupport Community

Access to national templates and tools of IHS and Access to national templates and tools of IHS and VA reduces VA reduces some set-up costs;some set-up costs;

Why a Network?Why a Network?

Centralized hosting reduces hardware cost;Centralized hosting reduces hardware cost;

Centralized support and staffing, reducing ongoing Centralized support and staffing, reducing ongoing support costs and clinical application support; support costs and clinical application support;

Training ResourcesTraining Resources

Sharing CommunitySharing Community

Common Challenges and NeedsCommon Challenges and Needs

What do Vendors Need to Know?What do Vendors Need to Know?

In 2004, 914 federally qualified health centers (FQHCs) provided In 2004, 914 federally qualified health centers (FQHCs) provided medical and dental primary care services to 13.1 million patients. medical and dental primary care services to 13.1 million patients. Almost 10,000 full-time-equivalent (FTE) physicians, nurse practitioners, Almost 10,000 full-time-equivalent (FTE) physicians, nurse practitioners, physician assistants, and certified nurse midwives provided care. physician assistants, and certified nurse midwives provided care. Study found that EHR-related benefits for most CHCs did not pay for Study found that EHR-related benefits for most CHCs did not pay for ongoing EHR costs, yet quality improvement (QI) was substantial.ongoing EHR costs, yet quality improvement (QI) was substantial.

Making some rough assumptions, CHCs will need $550 million–$1.1 billion, or $55–$110 million per year spread over ten years, to pay for EHRs, including technical and organizational assistance.

Assumptions include a ten-year EHR implementation period in the CHC sector, $35,000–$50,000 per FTE provider in initial costs, and an average $5,000–$15,000 per provider net annual cost in the first four years post-implementation.

Source: Source: The Value Of Electronic Health Records In Community Health Centers: Policy

Implications Health AffairsHealth Affairs, 26, no. 1 (2007): 206-214

What do Vendors Need to Know?What do Vendors Need to Know?

Initial EHR costs per FTE billing provider averaged almost $54,000.

30% hardware ($17,022)

28% software ($15,697)

22% installation/training ($11,999)

12% lost productivity ($6,763)

8% other/connectivity (4,164)

Ongoing costs per FTE provider per year averaged $20,610.

Initial costs averaged $16.20 per medical encounter and ongoing costs averaged $6.21 per medical encounter

CHCs had higher EHR costs and lower financial benefits, and they made much greater QI efforts.

Source: Source: The Value Of Electronic Health Records In Community Health Centers: Policy

Implications Health AffairsHealth Affairs, 26, no. 1 (2007): 206-214

How does the cost differ?How does the cost differ?

Average cost is $4,000 per FTE (compared to Average cost is $4,000 per FTE (compared to $26,000 in the Health Affairs study) for set-up $26,000 in the Health Affairs study) for set-up and and training, less under ASP training, less under ASP standard standard configuration configuration deployment; deployment;

On-going cost is $200 to $400 per FTE per month On-going cost is $200 to $400 per FTE per month (compared to $1,400 in Health Affairs study).(compared to $1,400 in Health Affairs study).

What Have We Learned So Far?What Have We Learned So Far?

It’s not a product….It’s not a product….

……it’s a PROCESS!it’s a PROCESS!

What Have We Learned So Far?What Have We Learned So Far?

How much you “get” is How much you “get” is

determined by how much you’re determined by how much you’re

willing to “give.”willing to “give.”

ChallengesChallenges

Hardware & Connectivity in largely rural constituency.Hardware & Connectivity in largely rural constituency.

Provider AcceptanceProvider Acceptance

Complexity of RPMSComplexity of RPMS

Understanding what you REALLY need from a vendorUnderstanding what you REALLY need from a vendor

Finding qualified support staffFinding qualified support staff

Site PreparationSite Preparation

Streamlining change management Streamlining change management processprocess

It’s a process not a product!!!It’s a process not a product!!!