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DRIS Initiative Update
Lompoc Valley Community Health Care Council Forges Ahead
On March 19th, 1998, Lompoc Valley Community Health Care Council (LVCHCC) became the first site to complete Phase I of the DRIS Initiative by selecting three integrated rural health care functions to pursue through financial feasibility. On March 25th, representatives from the Mission Valley IPA and the Lompoc District Hospital signed a non-binding agreement designed to bring the entities together to work toward the development of a Community Health Organization (CHO). By the end of June, the Council had approved the Bylaws of the CHO corporation, its governance and its organizational structure. Financial feasibility analysis is presently underway aimed at creating a business and implementation plan which will provide the greatest probability for the CHO to be successful.
Data Findings which Led to Functions Selected
The DRIS Initiative’s focus on assuring that decisions be based on good data was readily understood by the LVCHCC members. The Council reviewed in depth the community assessment data prepared by Healthcare Financial Solutions, Lompoc’s Data Consultants, which provided the extensive analysis of the utilization, staffing, governance and finances of the health care system in the Lompoc Valley. The data presented 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. To help the Council set priorities and look at system issues in the selection of functions, the tool of placing the data in a community context by examining it under the separate headings of access, cost and quality was used. The following list provides the primary data points the Council focused on to begin the discussion of functions.
Access
- Significant primary care physician shortage
- Shortage of mental health and substance abuse services
- Under 18 population double national average
- 35% of population below 200% of poverty
- 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, one each for 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 possible functions to begin building a community network to assure maximum access and high quality in a cost efficient manner. A list of functions was assembled and discussed by each committee.
These ideas, after being examined in committees, were reviewed by the Executive Committee of the Council and then further reviewed by the Community Health Council. Out of the process, the Council elected to explore the following three functions as alternatives to develop for interfacing with Managed Care:
- coordination of managed care administrative functions through a Community Health Organization;
- development of community pathways for substance abuse; and
- information systems inventory of all providers and community agencies.
Lompoc Valley Community Health Organization
The new CHO will be designed to be a non-profit corporation whose purpose is the development of an integrated provider network with the capability of arranging for the provision of high quality, cost effective health services that can successfully operate in a managed care marketplace.
Proposed Provider Network Functions:
- Provide coordination and management of patient care services toward enhanced quality, reduction in duplication of resources, increased efficiencies and decreased costs to consumers
- Share substantial financial risk in order to achieve cost containment goals
- Serve as the exclusive bargaining and contracting agent for all managed care contracts
- Develop a community pathway model for dealing with the issue of substance abuse
- Inventory existing information systems in the provider community toward the goal of linking and networking information systems
As a community collaborative, the CHO organizational chart (Fig. 1) demonstrates the relationship between the various participating network provider organizations and the LVCHCC. The committee structure to the CHO (Fig. 2) will include advisory members from the community recruited primarily from the Council.
© CIRHM