Travis County Commissioners Court
December 6, 2005
Item 8
We have a discussion item under health and human services item no. 8. Is this something we can take at this moment.
>> yes.
>> that would be great. If that's all right, court, we will go ahead and call up item no. 8. Receive report from copia consulting, llc regarding Austin networks project.
>> good morning, good morning, Commissioners, sherri flemming executive manager for Travis County health and human services and veterans as much as. I have with me rachel how we -- rachelhowe. You gave approval for the department to transfer about $5,000 in one-time money to the community action network for our part in a feasibility study to look at the potential for sharing data. So copia consulting was the entity who conducted the feasibility study and has a report that is prepare and that they will share with you this morning, rachel?
>> good morning,.
>> good morning.
>> is it on? Can you hear me?
>> where exactly did this come up?
>> it's going to come up on the seen.
>> the television screens, yes. There it is.
>> I知 not sure if I know how to -- okay. What I知 going to do is go through this quickly, I know that less is more for you. I do want to hit the highlights because it's a complicated process in order to understand the technology a little bit. There are certain details that I will have to share with you. If you will bear with me. What we did is this came about or was born from the fact that copia consulting was initiating the mayor's task force, the reentry round table, doing a lot of work with mhmr. Through that process we began to realize that a lot of criteria, goals, things, we set up for ourselves through the community through those initiatives, there was a tremendous amount of crossover, mhmr schedule us if we would look at a lot of the reports in the community and create a matrix and align those with their strategic plan, realizing that there's a tremendous amount of overlap, a lot of discussion about duplication of needs in the community. As we were doing that, we actually realized one big thing that came out when we combined probably about 10 different reports, criteria, goals, that sort of thing. The one big thing that stood out was that over, over, over again probably at least over the last five years, our community has been saying that we need to share information across the social service systems, that it would probably be so much more efficient, we could do a lot better tracking clients, we know that there's a tremendous amount of duplication, if we could just capture these clients. So that's how this idea came about. If you will just -- it will come back up. Okay. What we are talking about are two different things. As we did this due diligence, we originally were looking at 1 the idea of sharing information, is there technology available now that was not available before that would make that affordable. And then the other piece was is there a way to -- to develop eligibility screening so that we could also understand what clients are eligible for when they walk into any door in one of our systems. What we learned was that there were two software tools that are available in our community, those are the two that we researched because they already currently exist and are already being used by a lot of the providers. And one is service point, which is being used by the basic needs coalition. The other is a tool called [indiscernible] combining eligibility for those clients that are uninsured to try to get them insured. As we go through this process, we will be talking about two things, one is eligibility and the other is sharing of information. So medicaider is the common eligibility tool, that is the cool opportunitily being used by the partners with the indigent care clab breaking. What happens is they have over 60 different third party payor services in there that gives them the ability to try to ensure people who come three their indigent care that are uninsured when we come in the door. They are able to end gate amazing amounts of revenue, thngs thingslike medicaid, medicare, chip, not just the big four but a lot of others. Our idea was could we also enter social service programs into this, those that have common criteria that would allow us also to in any door that a client walked into, quickly be able to screen them, not only see if they were eligible for medical insurance, but also rental assistance, utility, other programs that we have in this community and also the big ones like tanf, food stamps, those sorts. Servicepoint is the web based, both of these are web based soft wears. Seventhpoint is the soft air that does the information sharing. It's a -- it's a case management tool. And so it is where we would actually be able to share information across systems. The value of the proposition truly is that the idea would be that the clients, there would be no wrong door, so in any door that the client walks into, we could figure out if they need to be insured or if they are eligible to programs so they don't continue to walk from place to place to place. Much more efficient. We have been trying to do that for years, trying to get our hands around that. The economic benefits are the fact that the matter is medicaid is a revenue generating tool. It actually is able to get people on insurance when they are uninsured. If theycal phi for various things qualify for various things, it has the ability even for some social service entity, like mhmr, jails, people who actually have a line item in their budget where they are spending money to pay for insurance, it -- you know, we have an opportunity here to possibly get these guys insured. Right now we are capturing them at brack or people's, but we would like to capture them in any door that they come in. The community planning benefits are huge in that we would for the first time ever have real-time data. We could actually tell, we would know how many people actually qualified that we didn't have the money to serve. We would know that they actually qualified. We wouldn't be guessing. The findings that we had, the questions were does the technology exist that could do this in an affordable fashion. The fact of the matter is that, yes, technology does exist now so that all of these entities would not have to change their data base systems and all agree to buy one data base, which was the thing in the past that would have to happen. Technology now with the use of xml, some other techniques can travel behind any of these systems and take their lack and convert it into one common language, put it into a common repository, also much more affordable. The project can be accomplished using existing data bases and also with confidentiality they have these systems and companies now adhere closely to hipaa rules and regulations and have a lot of things in place to deal with that. The return on community investment just an example, seton clinics, two years ago, were spending 100 k a month. Then their drug costs now are down to 20 k a month, once they start using medicaider, it is huge. We are talking a significant deal, 80% savings.
>> why the decrease? Was that because of efficiency? What was the reason for the decrease?
>> the reason is because prior to using medicaider which is the software tool that has all of these third party things in there. They were doing it by hand, paper, pencil, a few scberts only trying to qualify them for the big ones like medicaid, it's a cumbersome process and they can't do it as fast as the computer can do it. The computer can do it in about five minutes, because it has all of that information programed in. They can one do it much quicker now and two they stand a lot greater chance of getting a hit of over 60 different sources than two or three. Reimbursements for eye glasses, so many programs they didn't have the time to try to find out whether somebody was qualified for it. This means that they are having to use less of the money in their budget to cover those costs and more of them are being insured and being paid by insurance.
>> okay.
>> does that make sense? Yes, it does. More available resources.
>> yes and the quickness of it and the efficiency, absolutely.
>> correct.
>> I知 going to just flip these these charts real quick. The proven outcomes. The why the is that we have known forever if we were to kind of merge the care of the mental health systems, behavioral health with health care that we would get much better results, not only for the clients but the efficiencies. And the emerge program was a program funded by the hogg foundation tested in 2003-2004. Served in the community clinics as they are being served for medically related things, there was also a behavioral health person there to serve them as well if they had those needs right at the clinic. What we learned was that patient's use of medication decreased by 8% in a random sample that their e.r. Visits were decreased by 78% and that -- I mean, these are the guys that we call another frequent fliers, you know, really being able to get our hands around that. I mean, that -- 8.2% they -- those over utilizers had an average of 8.2 million visits, down to 1.8, that's a significant savings once you start attaching dollars to that. Like I said medicaider has 34 agencies using it, service point 27 agencies, a ton of users, made sense to look at the software companies currently existing in our community, because it's a lot more affordable, because actually they are the best at what they do. The idea is that -- of course we rolled this out with implementation ideas and some suggestions, but I think that I have probably hit the highlights of the fact that we would like the social service agencies to add in the -- that we link up those systems for those folks that are using service point and we begin to start sharing the information that the agencies are comfortable sharing so that we can monitor the clients and stop duplication. One thing that -- that we are talking about with data, one thing that we discovered for instance is that the indigent care collaboration has access to a lot of medical information, sharing going on between those entities that we would be able to for those that -- that needed medically related information like mhmr would have access to some of that and that -- simply by having access to some of that information, for instance the housing community, paul hilgers has a pat of money to -- a pot of money to deal with lead based paint issues in housing, we discovered that the indigent care collaboration can track by zip code and address all of the clients who have been treated for lead based paint poisoning so we simply just take that information and we connect the two, they know exactly where to go so those clients don't have to move out of their houses that just one example of how we can use this information. This is an example of it. These two systems, all of these systems can talk to one another, go behind, extract the information that each system agrees to release. It will not release information that it doesn't agree to release. Dumps it into medicaider or chassis, saves us some experience of recreating something like that. With access the appropriate access, you could access whatever you are allowed to access so it can cut you off based on the decisions of the partner and every partner can create access in the way they want it. For instance, if health and human services only wants access to certain things, and mhmr wants to allow access to other things, then they have the ability to do that with the technology. You know, some time ago, when we -- when some of these things came before the Commissioners court a while back, one of the things that we were interested in was the coup indication of services -- duplication the services, of course to increase the efficient see that those services -- efficiency in those services, also the relationship that they have with the service providers out there, non-profits that provide the services to ensure what we do from hhs point of view is not duplicated by these others. It appears what we have here today does add a lot of these things. I guess I have just a question, maybe can you help me on this. Is that when you have I guess new non-profits or either those that -- that may not be where they should be as far as to ensure that the software is used to enhance, promote this particular program, how -- how are those kind of short comings addressed and also, number two, depending on who you are, the affordability, this is a very expensive software, what kind of -- in other relationship within the network itself, there has to be some positive relationships to abstract the type of information that you need to have. Just the example that you gave I guess as far as some of the decreases as far as cost is concerned. Because you were able to find other resources or funding in those particular sources that offer funding, I think that's very, very, very significant. However, I知 concerned about -- I知 concerned about those things that I just asked as the -- as the software affordability or the -- or the persons that of course how we deal with as far as the service providers that we deal with, Travis County, just for an example, as -- is everybody available to get on board with a lot of these things being brought here today. Especially with the networking capabilities and ensure that we have a common data base, but not only that to make sure that that data base is -- is friendly to -- to the multi-services that are needed in independent no profits, doing and providing different services. Looking at the affordability of the connectivity.
>> the six partners that originally pulled the -- pooled the money are looking at a five-year budget. That would be inclusive of enough licenses to kind of really infiltrate the community in a big way, understanding I think one of the things that they are really looking at is understanding that some of the smaller non-profits don't have the budgets necessarily to afford those, they are looking at building those in in the beginning as they look for the money so we have the ability to kind of expand some within the community. The other piece is that they are looking at the ability to do that. The other piece is that of course the more you purchase, the better price break you get. So the -- in the beginning if they look at a chunk of those, then they will get a much better price per license from the software companies and get a much better deal. The other piece is that if they already have a case management tool other than, say, service point, which many of them do, they don't have to buy service point. You can still interface with them because it is this web based mechanism. It has the ability just like mhmr has five different systems, they are not going to switch over necessarily to service point. It will still extract their information as well. So if those people need a case management tool we are suggesting that they look at service point as one. If they don't, then we have the ability to interface with what they currently have.
>> so in other words it's friendly.
>> yes. It does --
>> friendly service, non-profit friendly the way -- the direction as far as what you are recommending, I didn't want no strum welcoming block to -- stumbling block to create problems with our service providers that we have under contract with Travis County to ensure those services ever continued at a pace where the person that need the services will be able to get it, we won't create a stumbling block.
>> the way technology works today, no one has to change their system, that is accurate.
>> thank you.
>> on your sheet that says data elements to share, if I could suggest two questions that it seems like we ask all of the time that I think are relevant in terms of trying to match people. Is this person a veteran and is the head of household or anybody in the family a current member of the armed services. Because we are also Travis County health and human services and veterans services, and simply because of the current situation we have a lot more folks now that are -- have household members that are away, fighting on our behalf, perhaps that's a question that we need to make sure because there are also other things related through veterans services that people are eligible for and they are earned benefits, they are not so is the pepper a veteran, is anybody a current member of the armed services.
>> that's a great suggestion. One of the biggest need expressed over and over in this community, boy is it a big need now based on katrina. If this had been in place, we would have been able to track those clients, been in our system, we would know exactly who and where they are. The second thing is that the idea that we have needed a housing data base for low income housing and also for shelters. There is right now service point has what's called shelter point. It has a tool that the part, the software that if we add our -- if we just -- all we have to do is input or information, we could have real-time information about all of the shelter beds that are available at any given moment in our community. They also have a tool called housing point which is the same thing. We would enter our low income housing into it. We would know at any given time where our real estate is and who it's available to. So for instance it is only available to a single mom, three kids that has a disability, it will give her only the property that are available for that type of need. So these are amazing tools, one of the top criteria that came out of that was the need for -- for that kind of real-time housing inventory in this community.
>> we are posted to receive the report. Which we have done. What's the next step?
>> this report will be also -- a resource council on Friday of this week. There are still many, many questions, governorrance is one. I think some of the partners and myself have met to work on this issue, who owns the data, who -- we seem to have reached consensus that this would be the type of project that really at least initially would require the community action network to be the entity that oversees it. Just simply because of their position in the community. But there are still very specific pieces that require more study. So I believe that the hope is that once the -- once the can body have been presented with this information, that there will be a commitment from the resource council, one way or the other, as to whether or not we think this is a viable project for the community and then what is the level of commit of the partners to move it into the next implementation, in phases. One of the things that I have requested was that we develop an implementation plan that each phase is all inclusive. Therefore, if we had a certain pot of money, we knew that we could get this much further down the road, but if we didn't do anything else, here's the advantage of just doing this one thing. Because it from my perspective, you know, funding ebbs and flows, so we want to make progress, but we also want to be assured that we don't lose progress if for whatever reason the funding falls off we have to slow down our implementation process. We want to gain something at each stage of the implementation.
>> so you will ask us to put it back on at the appropriate time.
>> I will definitely do that.
>> being on. You are -- are you going to can on Friday?
>> I think so.
>> any other questions or comments? Thank you very much. Appreciate it.
>> thank you all.
>> thank you.
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Last Modified:
Wednesday, December 7, 2005 7:31 AM