CCHN Supports Clinics in Serving Low Income and Uninsured
For close to 30 years, the Council of Community Clinics (CCC) has supported community health centers that serve as the health care safety net for low income and uninsured residents of San Diego and Imperial Counties.
Contact: Stephen O'Kane (619-542-4300)
Media Inquiries: Vince Heald (858-453-9600)
By Richard M. Barrett
Special to the Daily Transcript
These clinics provide vital primary and preventive health care services to more than 400,000 patients each year -- constituting more than one million patient visits -- through a network of 17 community clinic and health center organizations that operate 75 care sites throughout these two counties.
San Diego County has one of the highest uninsured rates in the state, with an estimated 430,000 residents (12% of children and 19% of adults) having no health insurance. And since there are no county-owned and operated clinics or hospitals, community health centers are the main sources of primary care for the growing population of uninsured in the region.
A key factor in CCC's enduring success and its ability to continue to support its member clinics was the creation in 1993 of one of its little known subsidiaries, the Community Clinics Health Network (CCHN).
CCHN's overall mission is to enhance the quality of care, improve population health outcomes, and strengthen business efficiencies. It does so by offering specialized programs, services and technology solutions to more than 30 community clinics and health center corporations, lending its expertise in the areas of contracting, quality management and information technology.
Among the network's more notable innovations, and a fitting example of the organization's support of, and commitment to, quality management, is its Physician Council. It is comprised of medical directors from each clinic who meet monthly to exchange information and share best practices in quality and disease management. Physician Council members set annual healthcare priorities - this year, they are childhood obesity, diabetes and the implementation of electronic health records -- and conduct chart audits to collect and assess health outcomes based on those established priorities.
"The Physician Council provides the clinical leadership of the healthcare network," said Vicky Penland, CEO of the Community Clinics Health Network. "It selects healthcare priorities each year and looks at various ways of improving the quality of care in those areas. Clinic physicians are deeply committed to practicing evidence based medicine, and utilize every opportunity to do so."
One of the network's disease management programs in particular has already produced extremely positive results in terms of patient outcomes. CCHN's Diabetes CARE Project (Coordination, Access, Registry and Effectiveness), is a collaborative effort involving 12 community health centers, hospitals, the County's Health and Human Services Agency and Project Dulce. Funded by the Health Resources and Services Administration, it is designed to increase access to diabetic care for uninsured adult patients and to improve the effectiveness, efficiency and coordination of care.
According to results of chart audit reviews conducted between July 2004 and August 2005, clinics are seeing continued improvements in diabetes care. For example, the numbers of patient eye exams and foot exams have increased. LDL cholesterol levels have decreased, and more patients have a documented self-management goal. Clinical information on patients with diabetes has been collected in disease registries from 12 clinics since April 2004 and as of December 2005, a total of 4,000 patients reflecting more than 16,000 patient encounters are included in these registries. This data provides meaningful historical information on patients, helps establish benchmarks for care and tracks results for the purposes of patient health improvement and population health management.
In support of its disease management efforts, CCHN is now developing a data warehouse to provide a repository for data from disease registries, lab and practice management systems, electronic medical records, pharmacy systems, hospitals, public health systems and specialty providers.
"The data warehouse will provide easier access to critical information needed by our physicians and other providers to track patient health outcomes for the purposes of quality and disease management," said Christy Rosenberg, CCHN's Director of Quality and Population Health. "It will allow physicians to review data and identify areas where improvements can be made in patient health."
With an organizational focus on employing information technology solutions to ensure quality of care and the sustainability of community clinics and health centers, CCHN established a technical services organization (TSO) in 2002.
"The mission of the TSO is to continuously improve health care provided to patient populations through enhanced utilization of information technology," said Susan Leonard, TSO Director. "The TSO helps clinics improve operational efficiencies, capitalize on economies of scale, and improve care and outcomes for clinic patients and the communities where they live."
In pursuit of this mission, clinic medical directors have identified the adoption of an electronic health record (EHR) system as one of their top priorities, emphasizing that the network cannot continue making progress in quality improvement and disease management without it.
"Adopting and implementing an EHR system in our clinics is a multi-phased project that will continue through 2008, when we hope to install the system at pilot clinics," said Leonard. "We are currently developing strategy, securing funding, determining outcome requirements and conducting readiness assessments for our clinics. We'll continue working with medical directors, technical staff and other key clinic representatives to assess EHR systems and identify interface and hardware needs."
CCHN is further solidifying its reputation as a leader in healthcare IT by utilizing videoconferencing technology in an innovative telemedicine project designed to increase access to care for patients who live in rural areas of the county. Funded by the California Telemedicine and eHealth Center (CTEC), the project involves 13 sites, all of which have videoconferencing equipment allowing them to connect to the network's pool of providers.
"The telemedicine program allows patients in one location to electronically "visit" a specialist in another location and access specialty care from the comfort of their primary clinic without the cost of travel, daycare or time away from home or work," Leonard said. "We see a real need for it and so far, patient satisfaction surveys are validating that."
As vital as these programs are in maintaining the strength and integrity of San Diego's healthcare safety net, the reality of the situation is that they require levels of funding that the CCC and CCHN don't have. Community clinics primarily receive funding through federal, state and local government health coverage programs such as Medi-Cal, Healthy Families, and County Medical Services. In addition, they receive revenue from private foundations such as The California Endowment, the Tides Foundation, and Kaiser Permanente.
But according to Penland, additional funding is desperately needed from the private sector, including local businesses and philanthropists, in order to continue offering these programs.
One potential source of new funding for clinics and their programs is the proposed Tobacco Tax Initiative, which will be on the November ballot. This initiative would raise the state's tobacco tax by $2.60 per pack of cigarettes and generate approximately $2.27 billion for health care treatment (53%) in emergency rooms and clinics, prevention programs (43%) such as cancer, heart and asthma prevention and control programs, and research (5%) on tobacco-related disease and cancer. Hospital emergency care services would see the largest revenue amount ($828 million), followed by a statewide children's health initiative ($405 million) that would cover low income uninsured children. Clinics statewide would receive approximately $64 million, which would be distributed based upon the number of uninsured patients served.
"This funding would provide an important boost for clinics that have no source of reimbursement for as many as one-third of the patients they serve," Penland said. "We want the community to vote yes on the Tobacco Tax Initiative in order to direct needed funding to clinics, which in turn provide care to the uninsured."