Enhancing Access and Quality of Oral and Mental Health Services

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Enhancing Access and Quality of Oral and Mental
Health Services
HRSA All-Grantees Meeting November 2007
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OCHIN Network
Founded in 2001 (501c 3) Mission To
improve the health of the medically underserved
through the best use of information and
information technology
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OCHIN Network

• Collaborative of 20 organizations
• Washington, Oregon, California
• 150 clinic sites
• County Health Departments, FQHCs look-alikes
  Rural Health Centers, School-based Health Clinics
• 200,000 annual patients
• 1,000,000 annual visits
• 3,500,000 total visits
• 2,500 users - 800 providers

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OCHIN Network Patients Served

• 35 Hispanic
• 65 children women of child bearing age
• 2/3 at or below 100 FPL
• 50 uninsured in past year
• 45 on Medicaid in past year
• 20 rural

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OCHIN Network

• Organized Healthcare Arrangement (OHCA)
• An organized system of health care in which
  otherwise
• separate covered entities as defined in
  HIPAA, hold
• themselves out to the public as participating
  in a joint
• arrangement and participate in joint activities
  pertaining
• to at least one of the following
• Utilization review activities
• Quality assessment and improvement activities
• Payment activities when financial risk is
  shared
• Code of
  Federal Regulations, Public Welfare, Section
  164.501

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OCHIN Network

• Shared Health Record
• OCHIN uses a single master patient index (MPI)
  structure
• Increased patient safety continuity of care
• Most cost effective solution
• Enhanced research potential

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OCHIN Network Current Services
Fully integrated Practice Management suite and
Electronic Medical Record system (Epic Systems)

• Registration
• Scheduling
• Billing
• EMR
• Reporting

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OCHIN Network Current Services

• Consultation services
• Strategic planning
• Readiness assessment
• Change management
• Workflow reengineering
• Project management
• Strategies to improve AR

• Management of clinical content
• Financial planning
• Grant writing
• Training optimization strategies
• Web-based training
• Report design

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OCHIN Network Current Services
Interfaces

• 11 lab orders/results
• 20 payor
• Medicare eligibility
• Dental eligibility
• Dental billing
• Document management

• Radiology transcription
• Pharmacy ADT
• EyePacs image processing
• Meditracks
• Surescripts Rx

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OCHIN Network Current Services

• Centralized billing
• Televox HouseCalls- appointment reminder

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Improving Access Quality to Oral and Mental
Health Services

• Opportunity EMR to EHR
• Eliminate artificial segregation of personal
  health
• Create a comprehensive clinically integrated
  EHR
• Clinical integration Safer more cost
  effective care
• Reduce racial, ethnic and poverty disparities

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Improving Access Quality to Oral and Mental
Health Services

• Opportunity Integrate dental services
• Unhealthy oral bacteria can lead to/worsen
  many other
• health conditions.
• Financial barriers to care cause minority
  elderly to receive
• fewer dental services.
• 1. Stanton, M.W, Rutherford
  ,M.K.. Dental care improving access and quality.
  AHRQ 2003

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Improving Access Quality to Oral and Mental
Health Services

• Opportunity Integrate dental services
• Poor children are 50 less likely to have
  preventative
• dental visits than children in middle-high
  income brackets.
• US children ages 2 9 with untreated tooth
  decay
• Mexican-American 70
• Poor (lt200 FPL) 20

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• African-American 68

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1. Stanton, M.W, Rutherford ,M.K.. Dental care
improving access and quality. AHRQ 2003
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Improving Access Quality to Oral and Mental
Health Services

• Opportunity Integrate mental health services
• 45 of suicides have seen PCP 1 month prior.
• 42 CHC patients have 2x depression than ave
  population.
• PCP averages 50 of their time treating mental
  health
• issues in 70 if their patients.
• 2. Luoma et al.,
  2002 Fact Sheet Resource Guide, 2005 Assoc of
  State Health Officials.

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Improving Access Quality to Oral and Mental
Health Services

• Opportunity Integrate mental health services
• Since 1980, suicide has doubled among young
  black males
• in US.
• American Indians appear to suffer
  disproportionately from
• depression and substance abuse.
• 
  3. Satcher, MD., Ph.D., Mental
  Health A Report of the Surgeon General, 1999.

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Improving Access Quality to Oral and Mental
Health Services

• OCHIN Strategy
• Build on network success, relationships and
  trust.
• Add Incremental mental health portion to PM
  EMR.
• Continue to move towards integrated primary
  care HOME.
• Capitalize on members desire to move to full
  integration.

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Improving Access Quality to Oral and Mental
Health Services

• OCHIN Plan
• Continue working with community to move towards
  PHR.
• Continue to collaborate with states on
  integration initiatives.
• Maintain flexibility/openness to evolving
  integration needs.
• Develop strategic vendor partnerships for
  future needs.
• Use HRSA Innovations grant to help get us
  there.

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Improving Access Quality to Oral and Mental
Health Services

• Challenges
• New model of care delivery
• Potential provider reluctance- integration vs.
  subsuming
• Training for mental dental health providers
  support staff
• Billing- health behavior codes, limited
  reimbursement for same
• day appointments, dental billing
• Reporting needs
• Change is hard, even when its the right thing
  to do!

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Lessons Learned

• Start simple, build on success, dream big.
• HIT isnt magic it amplifies what is.
• Make an investment for the long term Ford
  Explorer.
• Do not underestimate the need for change
  management.
• You can never over communicate.
• Technology is the easy part.
• Be realistic.
• You dont have to do this alone.

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Thank You!
QUESTIONS?
Susan Chauvie [phone] chauvies_at_ochin.org