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Section V. Data Findings which Led to Functions Selected
The data from the extensive analysis of the utilization, staffing, governance and finances of the health care system in the Lompoc Valley were revealing in many areas and one of the interesting parts of the process was trying to sort through and develop priorities. The data represented such a broad array of issues that there were many requests to focus on a narrow problem area rather than focus on the system and its response to managed care. One of the tools used was to try to place the data in a community context by examining it framed under the headings of access, cost and quality. The following list provides the primary data points which the Council focused on to begin the discussion of functions.
ACCESS
- Significant primary care physician shortage
- Shortage of mental health and substance abuse services
- Population < 18 double national average
- Population below 200% of poverty 35%
- 25% of population over 65 below 200% of poverty
- Large non English speaking population
COST
- Duplication of many administrative services
- Large uninsured population
- Systems organized by payer not by community need
- Three of five major providers managed by out of community interests
QUALITY
- Insufficient translation services
- No system to assure coordination of care
- No system for referrals out of the area and for return
- Each individual provider has unique quality measures
- No system to measure outcomes of an episode of care
Staying focused on the two essential goals of the DRIS project:
- To increase community understanding and involvement in building and operating rural integrated systems.
- To facilitate the development of integrated rural delivery systems in which a single entity takes responsibility for managing access, quality and cost.
The Council created three work groups--access, cost and quality. Each work group discussed at length possible functions which might facilitate a community response to the data based problems encountered. The task of each group was to understand the value of an integrated system of care and analyze what functions might begin building a community network which would assure maximum access and high quality in a cost efficient manner. The following three lists were created and discussed by the three committees.
Access Committee
POTENTIAL FUNCTIONS FOR CONSIDERATION BY COUNCIL
- Development of a unified medical record in the community
- Provision of a multilingual nurse information telephone line that is linked to doctors, hospital, mental health and public health.
- Development of agreements with primary care and specialty providers to provide sliding fee services to uninsured patients
- Development and implementation of a common information release form to be utilized by all community providers to allow for timely release of information between providers
- Development of a system to continuously assess community need and coordination of resources to match those needs
Cost Containment Committee
POTENTIAL FUNCTIONS
- Reduction of service duplication in the areas of Lab and or X-ray
- Creation of a management service organization to provide administrative functions to all providers in the community
- Communication and case management system that links all providers in the case management of high risk obstetric patients
- Provision of prenatal care and deliveries with certified nurse midwives
- Establish a process to review how cost savings will be reinvested in the community
- Development of a community health plan
Quality Committee
POTENTIAL FUNCTIONS
- Development of common clinical pathways among all providers for dealing with substance abuse
- Development of a community health information system
- Analyze external referrals from the community and develop criteria and system for external referrals to return to the local community system
- Development of common referral procedures with the community
- Recruitment of a Network Quality Improvement Specialist to design and implement community wide case coordination efforts
These functions after being discussed in committees were discussed by the Executive Committee of the Council and then after further discussion by the Community Health Council, three functions were elected to develop full plans for implementation. Those three functions are:
- Development of a Community Health Organization
- Development of Community Pathways for Substance Abuse
- Information Systems Inventory of all Providers and Community Agencies
Work Plans for Phase II agreed to by the Council
LOMPOC VALLEY HEALTHCARE COUNCIL
DRAFT WORK PLAN
PHASE 2 DRIS PROJECT
COMMUNITY PATHWAYS COMMITTEE
GOAL:
By April 1, 1999, the Lompoc Valley Healthcare Council will have developed Community Pathways for Substance Abuse patients to assure greater coordination and higher quality of care in the community.
| Strategy | Action Steps | Comp Date |
| Educate all those who need to know about the goal of the committee | Hold meetings with all provider groups, social services and other community agencies interested in issue | May 98 |
| Assure adequate understanding of the media | Meet with media representatives to provide detailed information of the goal | April 98 |
| Assure that all those who need representation are on the working group | Establish potential membership of working group and individually canvas all those for interest and willingness to participate and form group | June 98 |
| Do not reinvent the wheel | Gather pathways in use in other rural communities, and other states around the country | June 98 |
| Determine what types of pathways (if any) are already currently in use in Lompoc Valley | Survey all providers to ascertain what types of clinical pathways may currently be in use or have been tried in the past | August 98 |
| Analyze community based protocols used in other communities and make recommendations for Lompoc Valley | Create sub-committees to share analytic load and make preliminary recommendations to work group | Sept 98 |
| Develop educational tools for sharing analysis | Create detailed explanations, fact sheets and other appropriate materials for distribution | Oct 98 |
| Educate community providers and community leaders about information obtained in community pathways review | Hold series of educational meetings geared to different provider groups and community leaders and social service groups detailing the issues found regarding community based protocols in use in other communities | Nov 98 |
| Create draft community pathways | Create sub committee to create first working document | Dec 98 |
| Seek verbal and written feed back on initial draft | Wide distribution of first draft with methodology established to assure feedback from all interested parties | Jan 99 |
| Develop final draft of community pathways | Subcommittee utilizing all feedback creates final draft of community based pathways | March 99 |
| Develop incremental implementation plan which assures for adequate evaluation | Work Group creates implementation strategies for review by Community Health Council | March 99 |
LOMPOC VALLEY HEALTHCARE COUNCIL
DRAFT WORK PLAN
PHASE 2 DRIS PROJECT
COMMUNITY HEALTH INFORMATION SYSTEMS INVENTORY
GOAL:
By March 1999, the Lompoc Valley Community Heath Council will have completed a comprehensive inventory of information systems of all local providers of care.
| Strategy | Action Steps | Comp Date |
| Educate community providers about the goals of the health information systems inventory | Provide multiple educational sessions to providers regarding the inventory of information systems | June 98 |
| Create appropriate inventory tool for use in data collection | Create tool which can be answered in multiple formats, test tool; use test results to make necessary modifications in collection instrument | Sept 98 |
| Complete data collection | Develop collection strategy which assures 85% return | Jan 99 |
| Develop strategic plan for integration of health information systems in the community | Work Group using data compiled in the survey will develop a strategic plan for review by the Community Health Council | April 99 |
LOMPOC VALLEY HEALTHCARE COUNCIL
DRAFT WORK PLAN
PHASE 2 DRIS PROJECT
COMMUNITY HEALTH NETWORK
GOAL:
By March 1999, the Lompoc Valley Community Heath Council will have agreed on the activities of the network, created a legal structure for the network and developed a business plan for network development.
| Strategy | Action Steps | Comp Date |
| Assure that all sectors of the community are represented | Individual conferences with key leaders and key providers, facilitate open discussion in Community Health Council | May 98 |
| Develop memorandum of agreement | Circulate memorandum amongst all parties and discuss at Community Health Council | April 98 |
| Develop By laws for Community Health Organization | Open discussion with key informants and through Community Council, vote on By Laws of group | June 98 |
| Select specific tasks which CHO could perform for study | Dialogue amongst committees, providers and community to reach consensus on tasks | July 98 |
| Authorize business plan development based on selected tasks | Council approves business plan feasibility study for new CHO | August 98 |
| Facilitate creation of draft business plan | Key informant interviews to assess key elements of the plan | Sept 98 |
| Assess feasibility of CHO | Review Feasibility study | Oct 98 |
| Develop Final Business Plan | Continuous review by Council | Nov 98 |
| Assure final business plan meets needs of the community | Review business plan at each step of development | June - Dec 98 |
| Approve business plan for CHO | Discussion and review by all committees and Council | Feb 98 |
| Assure implementation of business plan | Develop implementation strategies | Mar 98 |
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