HEALTH CARE MODELS FOR THE UNINSURED

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HEALTH CARE MODELS FOR THE UNINSURED

• Sheryl L. Garland
• Vice President
• Ambulatory Care Services
• Medical College of Virginia Hospitals and
  Physicians
• Virginia Commonwealth University Health System
• November 26, 2001

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One of the largest challenges in the health care
industry is providing care for the 44 million
uninsured in the U.S.
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Across the country initiatives are being
developed to

• Obtain coverage for the uninsured by changing
  institutional policies and programs
• Increase access to services at the local level
• Focus on prevention and public health
  

Action Where It Counts Communities Responding
To The Challenge of Healthcare for the
Uninsured The Access Project, June, 1999.
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A survey conducted by the Robert Wood
Johnson Foundations Access Project in 1999
revealed that the majority of organizations
engaged in health care access efforts at local
levels were participating in partnerships or
coalitions to meet their goals.
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Safety Net Facilities

• Collective mission of providing care to patients
  regardless of their ability to pay
• Assume responsibilities to their communities that
  go beyond the delivery of direct health care
  services

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Safety Net Initiatives
Safety Net hospitals and health systems across
the country are struggling to provide quality
health care to low income and vulnerable
populations during an era of shrinking
reimbursement and limited federal government
intervention
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The National Association of Public Hospitals and
Health Systems (NAPH) is an organization that
advocates and represents the nations urban
safety net providers
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NAPH members strive to meet the key needs in
their communities, such as

• Providing inpatient and outpatient care to
  Medicaid and Medicare beneficiaries, the
  uninsured and underinsured
• Playing an essential community role in providing
  specialty and tertiary level services
• Training a large portion of the nations health
  care professionals

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Safety Net Initiatives include programs that

• Expand ambulatory care
• Focus on Disease Management
• Are unique to targeted populations
• Represent health outreach initiatives
• Focus on process improvement and enhanced quality
  patient services
• Promote initiatives to improve the health of
  communities

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The 2001 NAPH Ambulatory Care Survey revealed

• NAPH facilities serve as specialty referral
  points for patients seen in Community Health
  Centers
• NAPH members have developed programs such in
  schools, homeless shelters and housing
  developments
• NAPH members participating in survey receive over
  18 million in federal grants to operate
  community health centers

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As you are aware, the University of
Virginia Health System (UVA) and the
Medical College of Virginia Hospitals and
Physicians (Virginia Commonwealth University
Health System - VCUHS) receive funding to
provide care to the uninsured in
the Commonwealth of Virginia
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In FY 2001, the VCU Health System provided
over 100 million in indigent care to patients
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In addition to the services provided by the VCU
Health System for the uninsured in the Richmond
Metropolitan area, there are various initiatives
underway that provide services for uninsured or
underinsured populations
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These endeavors include

• Free clinics (medical and dental)
• Mental Health initiatives
• Case management for targeted populations
• Outreach activities
• Programs to assist patients in obtaining
  prescription medications

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Hayes E. Willis Health Center of South Richmond

• Partnership with the Richmond City Department of
  Public Health (RCDPH) to integrate public health
  clinical services into a primary care center
  started in 1992
• Community-based health center that offers Family
  Medicine, Womens Health and Pediatric services
• Financial and Medicaid/CMSIP eligibility
  screening at the Center

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Hayes E. Willis Health Center of South Richmond
(contd)

• Volume has increased from 8,000 patient visits in
  its first year of operation to approximately
  15,000 visits in the current fiscal year
• Community Advisory Board provides assistance in
  establishing the goals for the Center
• Program reduced the City Health Departments
  budget by 1 million and is one of the lowest
  cost providers in the VCU Health System

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RCDPH/MCVH Clinical Services Agreement

• In July 1998, the RCDPH contracted with MCVH to
  provide public health clinical services for
  Richmond City residents
• Communicable Disease Services (STD, TB, etc),
  General Relief, Immigration and Refugee Services
  are provided in one location

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Goals of the RCDPH/MCVH Clinical Services
Agreement

• To provide quality health care in the most
  appropriate site of services
• Reduce redundancy of services
• Reduce the overall cost of providing health care
  to residents in the City of Richmond

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RCDPH/MCVH Clinical Services Agreement (contd)

• Womens, Childrens and Family Planning Services
  have been integrated into primary care locations
  in the VCUHS and community
• A population of approximately 5,000 patients was
  identified and the City Care program was
  established

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City Care Agreement

• Allowed the City of Richmond to reduce its health
  care expenses by approximately 1.5 million
• Richmond City Department of Public Health focuses
  on Case Management, immunizations and responses
  to public health problems

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Managed Care Models That Have Been Implemented

• Wishard Program in Indianapolis, Indiana
• University of New Mexico
• Boston Medical Center and Cambridge Health
  Alliance

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VCUHS Initiative is the Virginia Coordinated
Care for the Uninsured (VCC) Program

• Implemented November, 2000
• Utilizes Managed Care principles
• Focuses on the establishment of relationships
  with Primary Care Physicians
• Goal is to reduce the overall cost per unit of
  service
• Strong emphasis on education of patients
  regarding appropriate access to health care
  services
• Utilizes care management strategies
• Strives to improve the health status and health
  outcomes for a defined population

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Virginia Coordinated Care Service Area
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Percent of Uninsured Virginians
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Number of Uninsured Patients Receiving Services
through the VCU Health System
Number of
Uninsured Patients
FY 2000
Thousands
50
38.781
40
30
19.619
14.814
20
10.056
4.805
2.576
0.977
0.885
10
0.321
0
Total
Henrico
Hanover
Richmond
Chesterfield
Tri-City Area
Other Areas
VCC Eligible
Full Indigent-Category 1
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Enrollment and Physicians

• Approximately 13,000 enrollees from November,
  2000 to September, 2001
• Year to Date Monthly Average - 7370
• 27 Community PCPs representing 20 practices
• Five community-based safety net providers
• Three specialty areas - Neurology, Ophthalmology,
  Rheumatology

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VCC Outcomes

• Will continue to monitor utilization and costs to
  provide services
• Program is supported by the Jenkins Care
  Coordination Program to modify inappropriate
  utilization of services
• Will benchmark with similar programs to assess
  effectiveness of project

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Richmond Coalition of Safety Net Providers (RCSNP)

• Several Safety Net Providers in the greater
  Richmond Metro area have formed a coalition to
  identify and address access issues for uninsured
  and underinsured populations in this region
• Participants are Fan Free Clinic, Daily Planet,
  Vernon J. Harris Health Clinic, Irvin Gammon
  Craig Health Center, Homeward, CrossOver Health
  Center, Richmond City Dept. of Public Health, VCU
  Health System and minority community physicians

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Community Access Program (CAP)

• The RCSNP recently received a 1.1 million
  Community Access Program grant from HRSA
• The program will develop a web-based program to
  input financial and demographic information for
  uninsured and underinsured populations in this
  region

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CAP Grant

• Grant is one of 63 awarded this funding cycle
  across the country
• Provides an opportunity to develop infrastructure
  for community coalitions