Jack Cheng, COO, Chinatown Service Center
Photo: Chinatown Service Center
Chinatown Service Center is a 53-year-old nonprofit agency that began as a social services organization supporting the immigrant community in Chinatown in Los Angeles. Over the decades, it has grown into one of the largest community care organizations in the region and a federally qualified health center.
THE CHALLENGE
Jack Cheng is COO of Chinatown Service Center. He joined the organization right at the start of the COVID-19 pandemic. One of the big challenges he and the team faced was tracking the quality of care provided, along with the improvements patients were seeing over time.
In early 2020, this was especially important because of the revenue loss caused by the pandemic. The providers already were delivering a high level of care, but the results weren't consistently showing up in the reports that matter to health plans.
"Most of the problem was suboptimal coding and documentation," Cheng explained. "Anyone who has ever worked at a provider group can tell you doctors are not coders. Their focus is on caring for patients, not clerical tasks. So even though patients were receiving appropriate preventative care – like diabetes screenings, A1C monitoring, and colorectal cancer screenings – these services weren't consistently recorded in a way that could be recognized for reporting purposes.
"Internal reporting showed we were meeting many of our patient care targets," he continued. "But the reports from the health plans did not match our internal data, meaning our HEDIS performance rankings and pay-for-performance incentives did not reflect the quality care our providers were delivering."
HEDIS stands for Healthcare Effectiveness Data and Information Set, performance standards that track core metrics, such as care effectiveness and access.
"Until that gap was addressed, we were essentially flying blind when it came to demonstrating our performance and improving care outcomes – and there was no way we were going to add additional stress to providers, who were already experiencing rapid day-to-day change during the pandemic," he added.
PROPOSAL
Chinatown Service Center was looking for a claims submission tool that could turn its clinical information – the care it delivered and the impact to patients – into something that would be appropriate for HEDIS measures. The organization wanted to maximize its pay-for-performance reimbursement because it earned it.
"We also wanted to ease the clerical burden doctors were already experiencing," Cheng noted. "We wanted to automate the whole process and eliminate the need to manually code things like screenings, labs and preventive services that are really important for payer metrics.
"We already had a great working relationship with the vendor Med Tech Solutions," he continued. "They're our consultants. They helped us with a new EHR rollout, along with all kinds of tech adoption for the center. So we approached them with this problem to see if they could customize something for our specific needs."
The vendor came back with a HEDIS Quality Measures Template, effectively a checklist to ensure center staff were coding everything correctly and not only meeting every benchmark set for reimbursement but also documenting it.
"The tool was intended to work directly within the EHR," Cheng explained. "As providers completed patient visits and ordered screenings or lab tests, the system would detect those actions and generate the appropriate CPT, LOINC and diagnosis codes. Those codes would then be attached to the claims submitted to health plans, ensuring every service delivered was recognized and counted toward performance measures.
"At the same time, we would now have a template we could follow for quality data metrics, which validated the work we were doing," he continued. "To that end, the tool was designed to integrate with other systems when necessary, acting as a centralized location to record HEDIS measures, all within the EHR."
That way, care teams treating patients with chronic conditions could ensure they're doing everything they're supposed to do – ordering the correct labs, monitoring things like blood pressure and blood sugar regularly, and adjusting medications – whatever it is that patients need, based on protocols, to stay healthy. And in turn, contain costs for the center and the health plans.
MEETING THE CHALLENGE
Providers continue their usual patient care activities as normal, and the Med Tech Solutions HEDIS reporting tool removes the need for them to manually add codes for reporting purposes. The system automatically "reads" clinical inputs and notes and converts them into the required codes.
"To keep everyone on track, providers have access to dashboards and metrics to track their own performance, which helps them feel engaged with the process while they double-check everything for accuracy," Cheng said.
"There was still a need for some training during implementation," he added. "The vendor worked on site with our teams, including providers, to ensure everyone understood how the template functioned and why it mattered."
Early iterations required more hands-on guidance, but over time, the tool became increasingly automated. New providers are onboarded with structured training, and the medical team holds bimonthly review sessions to discuss updates, performance metrics and improvements to ensure the template continues to operate as intended and that providers are happy with it.
"Other than the NextGen EHR, we use population health management software called Relevant," Cheng noted. "It provides us with a visual representation of our data, which allows leadership to monitor performance and identify areas for improvement. It's a companion to the HEDIS template, so to speak.
"The template works seamlessly with our internal billing department," he continued. "Once the codes are generated automatically by the template, they are attached to the claims and submitted, ensuring all services provided are accurately captured for health plan reporting and reimbursement."
RESULTS
In 2023, Chinatown Service Center earned top recognition from L.A. Care Health Plan, one of the largest Medicaid health plans in Los Angeles County, securing the No. 1 spot in chronic care across the plan's network of community health centers and clinics.
"This recognition was credited to the use of the custom HEDIS reporting tool and subsequent claims submissions – both directly and indirectly," Cheng said. "Directly because it helped automate a complicated coding and data collection process in the ways I outlined, but also because it helped our providers understand their own performance metrics so they could provide truly the best care to patients.
"On that note, the center also achieved No. 3 recognition in women's health services within the L.A. Care network," he reported. "The technology was instrumental in this success as well. It automated coding for things like cervical cancer tests, mammograms and other preventive care services – and all of that was now reported, accurately, to L.A. Care."
In 2024, the center again received the No. 1 in chronic care distinction.
"Before adopting the HEDIS tool, all of these services were performed, but the gap between reality and what was documented weighed heavily on us," Cheng concluded. "Now that gap has been closed. With our data, we can demonstrate our results in the area of women's health, and we've been recognized for our ongoing improvements in care delivery."
Follow Bill's health IT coverage on LinkedIn: Bill Siwicki
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