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 130 contracted providers such as hospitals for behavioral health services.

Population size is a major challenge for LA County. With 7 million services offered 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. After years of using paper records, LA County decided to partner with a large healthcare 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.

Strategic integration

While partnering with Netsmart was an easy solution, 80% of LA County providers use their own digital systems––and that’s where things had the potential to get complicated.

“We strategically planned from the beginning that we weren't going to make all our contractors use our EHR, because they have other lines of business,” explained Paul Arns, Chief of Clinical Informatics. “What you see in those cases is they have their own EHR, and they have to do certain forms of duplicate entry into another system. So we did a number of things to integrate.”

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 a middle integration layer for core operations like client searches, real-time integration, 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 describes these “custom web services” as basic interoperability, noting that all contractors are required to use them through ProviderConnect from Netsmart. (This includes fee-for-service hospitals as well as the Department of Health Services.) 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 a partnership 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 to 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 claiming.”

“We have a heavy volume of claims coming in,” Patterikalam said. “So, our solution basically integrates with the contract providers, integrators 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 collaborate on 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.”

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 online electronic e-prescribing (OrderConnect), and direct, secure two-way messaging (CareConnect™ Inbox) between consumers and providers. Patterikalam also points out the importance of the patient portal (myHealthPointe™)l to streamline scheduling, post-visit summaries and timely client reminders. This is something the County has adopted within the last few months, and Arns is clear that client engagement is the goal.

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

 

Shared Innovation Drives Results

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 is often a test case for new solutions, and their unique requirements can inspire Netsmart to produce something new.

“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,” she 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 your 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.”

“When a new solution comes out, we let those early adopters through first before we move in, because when we move over, we're moving over,” said Arns. “With us, we’re talking about a lot of people, a lot of volume, a lot of money. We can’t afford to fail.”

This was the case with the new NX user experience, which Arns said they were really interested in before finally adopting. At the time of this publication, LA County was in the process of migrating over to NX, a considerable change for a network with 7 million services per year. So far, Arns and Patterikalam have praised the new UX for being exactly what their organization needs––flexible and customizable. They can build new forms, develop widgets and put together consoles for their staff and fleet of contractors. It’s resulted in efficiency, improved data quality and integrity, and 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 for 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