LA County builds network of contracted service providers and 10 million people with strategic efficiency and interoperability

The Los Angeles County Department of Mental Health is both a direct service provider and the local mental health plan for the County of Los Angeles. LA County is the largest county in the United States, with a population of about 10 million people in more than 88 cities. In addition, the County Department of Mental Health partners with over 150 contracted providers to provide outpatient, residential and acute inpatient behavioral health services.

Population size is by far the biggest challenge for the LA County. With approximately 7 million services delivered each year, efficiency is a must––as well as quality of care, data and reporting for payors, and interoperability among providers. But building out an integrated system for such a vast and disparate network was far from easy. So, after years of using paper records, LA County decided to team up with a large IT company with the resources to serve their needs: Netsmart. They also chose to adopt the myAvatar electronic health record (EHR) from Netsmart in 2014.

This might seem like an easy transition, but not only is LA County the largest in the nation, its providers are 80% contractors with their own digital systems.

“In cases where a contracted provider is required to use a county's electronic health record, they often wind up having to duplicate data entry in their own system. We felt that a better model would be to facilitate direct integration between those contractors' systems and ours,” explained Paul Arns, Chief of Clinical Informatics.

In other words, although this system was agreed upon as the best solution for LA County, it required some technical innovation to implement. Netsmart built out a custom web services client, with new client and episode entry, and financial eligibility data.

With a network as large as we have, integration has been critical.

- Paul Arns, Ph.D., Chief of Clinical Informatics

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Arns cites these “custom web services” as creating a direct real-time integration between LA County’s EHRs and those of their contractors. In addition, the County has implemented ProviderConnect from Netsmart, a provider portal that syncs data with the EHR. This is used for services such as client lookup and creation by those facilities (including fee-for service hospitals) who do not leverage the web service integration, or more generally for such tasks as requesting member level authorizations. In this way, LA County has achieved interoperability on a large scale, while still allowing their hundreds of contractors to maintain their own systems¬¬––thanks to the collaboration with Netsmart that allows products like ProviderConnect to be customized and scaled.

“They have their own system, then they log into myAvatar. We try to automate things as well as integrate things, and it’s basically seamless for them, right?” said Girivasan Patterikalam, Chief of Enterprise Application Divisions, who was the project director for the adoption of myAvatar. “We leave the flexibility with each organization that is integrated with us so they can have their own workflows. They can do their operations, and they don't need to go back and do any manual data entry. And that's the same thing with the claims.”

“We have a heavy volume of claims coming in,” Patterikalam said. “So our solution basically integrates with the contract providers and revenue management. That's one of the main advantages we were looking for––to have the clinical and the revenue side together.”

Both Arns and Patterikalam are grateful that Netsmart was able to support a custom project of this size.

“I think our volume is unlike anything Netsmart has ever dealt with,” Arns speculated. And although the size of LA County poses regular challenges, it also offers unique benefits. For one thing, the amount of data generated by their records has proven invaluable in both data analytics and sharing. In addition to a public health information exchange (HIE), LA County also uses Netsmart Carequality. Arns observed that it “makes a ton of other information available” that they “wouldn’t otherwise have access to.”

“I think it makes a ton of other information available that we wouldn’t otherwise have access to. It’s a big impact in terms of care coordination, that’s certain.

- Paul Arns, Ph.D., Chief of Clinical Informatics

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Other Netsmart solutions used by LA County include OrderConnect for online prescribing, and CareConnect Inbox for secure, two-way messaging between consumers and providers. Patterikalam also points out the importance of the myHealthPointe™, a solution whose latest version LA County has upgraded to within the last year. Arns is clear that client engagement is the goal.

“I think it has the potential to make a big difference,” he said.

Partnering so closely with Netsmart has allowed an organization the size of LA County to meet their technology needs. Arns and Patterikalam see Netsmart as part of the organization’s strategic plan, meeting with a consultant weekly to discuss their road map and learn about new technology resources. Arns says there’s a lot of “collaborative problem solving” if anything goes wrong.

Patterikalam noted that the size of LA County––Netsmart’s largest public sector client––creates an advantage that goes both ways. LA County often provides input for new solutions, and their unique requirements inspire Netsmart to continue innovating.

“Netsmart is working with us to develop the product, and we often have the vision to do things differently. That pretty much benefits all other users, right? So it's a win-win situation both ways,” he said.

Products customized specifically for LA County have actually ended up in general release, after Netsmart saw the value LA County derived from the solution. “There are things we’re doing to meet our specific business needs,” said Arns, “that sometimes become incorporated into the broader Netsmart solution for the broader community of clients,” Arns said.

Despite the nature of this relationship, LA County doesn’t want to be known as an early adopter, but rather a “shared innovator.”

For example, Arns said they were really interested in the new NX experience before finally deciding to adopt the solution. The move to NX is a considerable lift for a network with 7 million services per year. So far, Arns and Patterikalam have praised NX for being exactly what their organization needs––flexible and customizable. They will be able to build new forms, develop widgets, increase efficiency, improve data quality and integrity, and work within an interface that isn’t dependent on Java––all of which the team is very excited about.

As LA County continues in its mission to serve the largest area of consumers in California, Netsmart will remain a partner in their success. Their size and complexity present a challenge, but County executives say they depend on Netsmart to adequately grasp and meet their needs. In fact, LA County depends on solutions like interoperability, customization, efficiency and integration––all of which are at the heart of Netsmart technology. No matter how big or small, Netsmart can find the answers you need.