Health Information Exchange Drives Teamwork, Efficiency and Effectiveness Across Rural Counties
A mother and her children visit the Worthington branch of the Southwestern Mental Health Center, which is a partner in the SPCC network of providers.
Collaborative partnerships, such as the one between Blue Cross and Blue Shield of Minnesota and Southern Prairie Community Care (SPCC) have proven especially forward-thinking.
Through what could be called a “cooperative think tank,” a group of 12 counties in southwestern Minnesota have banded together in order to approach care for their citizens more holistically. SPCC realized the challenge in this approach: Southwestern Minnesota has a relatively low population of 185,000 across the 12 SPCC-member counties, which meant doctors were spread across a long distance and information sharing was challenging. Additionally, 36,000 of the residents were on Medicaid, which is one of the highest rates in the state.
“A Better Way”
Since its establishment in 2012, SPCC has been dedicated to bettering life for its clients by facilitating the integration of health and social service programs.
“Those working closely with the Medicaid population in southwestern Minnesota found that there were certain individuals who would be seen by several different groups and agencies in a community, without coordination or connection between the care and service providers,” said SPCC Medical Director Norris Anderson. “Southern Prairie began an intentional effort to facilitate a discussion among the various sectors engaged to find a better way.”
Blue Cross Partnership Begins
In 2014, SPCC entered into a collaboration with Blue Cross to help further its vision of battling the area’s higher-than-state-average rates of poverty, obesity, physical inactivity, diabetes and other health indicators.
SPCC’s work with Blue Cross is as mutually beneficial as it is innovative. By working with the population in the 12 counties that SPCC represents across southwest Minnesota, Blue Cross is able to identify best practices that could be replicated statewide.
Meetings include those important to an individual client such as a mental health worker, county case worker, health care home coordinator, public health worker, physician, school representative, vocational rehabilitation specialist and an SPCC integration coordinator.
A New Way to Share Communication
Conversely, Blue Cross’ investment has helped SPCC to forward the development and operation of an information system that connects all the public and private health and social services providers within the SPCC region, known as a health information exchange (HIE) program. Each patient who consents to data sharing within the system can allow their providers to access a consolidated health record that includes information from all other providers connected to the HIE. Southern Prairie Community Care is one of only three organizations to have been certified by the State of Minnesota to deliver these services.
“The health information exchange program is critical in that it enables the various parties within the health and human services system to communicate with one another in a way that couldn’t be done previously,” said Frank Fernández, Blue Cross vice president for government market solutions and CEO of BluePlus (the health maintenance organization affiliate of Blue Cross). In Minnesota, patients must affirmatively consent to providers sharing their information on an annual basis, so patients who agree to participate in the information exchange enable the coordinated care system.
“Typically, when physicians see a patient for the first time, they might not know this person has already been seen in three other emergency departments that week or even that day,” Fernandez said. “The health information exchange gives the ability to provide a bigger, broader picture of someone, and helps the providers understand what they really need. It may not be a shot or a pill. It may be housing, and this enables them to help connect the patient with resources.”
“The health information exchange…helps the providers understand what [their patients] really need.”
“SPCC engaged local providers caring for patients in the region to guide the design of the health information exchange,” said Liz Cinqueonce, SPCC senior vice president for community health improvement. “This has been a key factor in helping SPCC to develop a trusted solution that will provide information when and where it is needed for patients and providers to make better informed decisions for their care.”
Bridging the Gaps through Care Coordination
Beyond this, Blue Cross supports staffing and management of care coordination services to enhance SPCC’s “Accountable Community for Health” program, which includes business, policy and clinical expertise offered through the SPCC Center for Community Health Improvement.
They bridged this gap by embedding the staff with SPCC care coordinators, designated staff members in charge of planning team meetings, assuring that teams are communicating amongst themselves and generally connecting the dots. “SPCC staff are striving, along with the broad local/regional health care system, to operate in a more functional manner, especially for those individuals who are not served well by the present medical delivery system,” said Anderson.
“The SPCC integration coordinators provide a community based care coordination combining an assessment of medical, behavioral health, and social factors. This allows an individualized care approach which provides a more complete picture of the factors affecting the individual’s health and connects community resources along with the local health care system to address the specific needs to improve health.”
The collaboration allows Blue Cross and SPCC to evaluate how integrated care initiatives and health information exchanges are working in southwestern Minnesota, so they can continue to improve the health of the community.
Bringing It All Together To Improve Health
The partnership allows for a rare opportunity – to gather data on a small and relatively unique population, to monitor and track health and continue to make improvements.
These learnings are the bedrock both for SPCC to continuously improve upon its goals to achieve the best population health and for future initiatives within the state of Minnesota. “SPCC has made great strides in developing integrated care and building relationships across sectors. We are excited to continue finding ways to bridge gaps, expand our reach, and continue to make a difference in the lives of the people in our communities,” Anderson said.
See all the ways that SPCC is improving the health of people in southwestern Minnesota at southernprairie.org.
See more about Blue Cross’ commitment to SPCC in this video.