Transcript 17th Annual Healthy Carolinians Conference and NCIOM

COORDINATING CARE FOR THE
UNINSURED: RESOURCES FOR
BUILDING COLLABORATIVE NETWORKS
OF CARE IN YOUR COMMUNITY
17th Annual Healthy Carolinians Conference
and NCIOM Prevention Summit
October 8th, 2009
Anne Braswell
Senior Analyst for Research and Development
NC Office of Rural Health and Community
Care
CHANGES IN HEALTH INSURANCE
COVERAGE IN NC: 2000 – 2007

More than 1.5 million nonelderly (18.9%) were
uninsured in NC in 2006-2007


Approximately the population of the Charlotte metro
area
Between 1999-2000 and 2006-07:
 North Carolina experienced DOUBLE the
increase in the percentage who were uninsured
than nationally (NC: 29%, US: 12% increase)
 North Carolinians lost employer-sponsored
insurance at nearly DOUBLE the national
rate (NC: 12.5%, US: 6.8% decrease)*
* Mark Holmes, PhD, Vice President, North Carolina Institute of Medicine
“The NC Uninsured: Who Are They, Why Do We Care, and What Can We Do?” Annual New Hanover County Health Access Summit, Access to Care and Impact
on Our Community, 19 September, 2008.
2
2000: HEALTH RESOURCES AND
SERVICES ADMINISTRATION ANNOUNCED
COMMUNITY ACCESS PROGRAM (CAP)
 New
federal grants program supporting
community indigent care initiatives to increase
access and quality of care for the uninsured and
underserved
 Expanded access for the uninsured by increasing
effectiveness and capacity of the nation’s health
care safety net at the community level
3
COMMUNITIES RECEIVING CAP FUNDS
EXPECTED TO:
 Build
integrated health care delivery systems
offering a seamless continuum of care for the
uninsured and underinsured
 Eliminate unnecessary and duplicative functions
in service delivery and administration, resulting
in savings to reinvest in the system
 Increase access to health care for low-income
uninsured and underinsured persons
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FIRST COMMUNITY ACCESS PROGRAM
IN NORTH CAROLINA
 June
2000: Office of Rural Health and Community
Care applied for CAP funding on behalf of
Community Care Plan of Eastern Carolina for
Pitt, Greene, Edgecombe & Bertie Counties
 September 2000: ORHCC awarded one of only 23
CAP grants in nation -- $897,000 for Pitt et al
5
2000: COMMUNITY CARE PLAN OF EASTERN
CAROLINA AND ORHCC CREATED
HEALTHASSIST
 Built
upon administrative infrastructure of
Community Care of North Carolina (CCNC)
 Established 4 Community Resource Centers
 Co-located services with other community nonprofits (e.g. JOY Soup Kitchen; Pactolus’
Fire/Rescue)
 Provided health care services, care coordination,
wellness and prevention services, adult continuing
education, and job skills training for low-income
and uninsured
6
BEGINNING 2001: HRSA REPLACED CAP
WITH HEALTHY COMMUNITIES ACCESS
PROGRAM (HCAP)
 Additional
indigent care networks were initiated
throughout NC with HCAP funding: Cabarrus,
Guilford, Buncombe, Moore, Beaufort, Durham,
Henderson, Orange/Chatham
 Several communities initiated programs, but were
not awarded federal funding: Mecklenburg, Wake,
Vance/Warren, Wilkes, Wilson, Mitchell/ Yancey,
Watauga, New Hanover, and others
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2005: HCAP NO LONGER FUNDED BY HRSA
 After
2005, former HCAP sites and other
programs in NC struggled to maintain the same
level of programs and services with limited
resources
 Early in 2007, the last HCAP “carryover”
funding ran out
 In the summer of 2007, The Duke Endowment
provided 4 months of emergency funds
8
IMPACT OF HCAP PROGRAM IN NC
Between 2000 and 2005, HCAP helped:
 Induce physicians and hospitals to provide more
free care and services for the uninsured
 Local governments and philanthropic
organizations to provide matching investments of
funds and resources
 Bring about both perceived and measurable
improvements in the health and wellness of
participants
 Reduce inappropriate use of hospital EDs and
other costly services by participants
9
A KEY LESSON LEARNED FROM HCAP:
There must be sustaining funds to
support the infrastructure needed to
effectively operate community indigent
care programs.
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2007: “HEALTHNET” INITIATIVE
In SFY 2007-08, NC General Assembly made
a one-time appropriation to ORHCC of $2.88
million to implement HealthNet to support
North Carolina’s safety net primary care
provider networks and develop communitybased systems of care serving the uninsured.
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NC HEALTHNET:
Links local safety net organizations and indigent
care programs providing free and low-cost health
care services with Community Care of North
Carolina’s networks of physicians and services.
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HEALTHNET NETWORKS INCLUDE:
 Physicians
 Hospitals
 Public
Health
 Free Clinics
 Rural Health Centers
 Community Health
Centers
 Departments of Social
Services
 Behavioral Health
 Other Community-Based
Safety Net Organizations
13
HEALTHNET TARGET POPULATION:
Uninsured adults, 18-64 years old, whose family
income is below 200% of FPL
14
HEALTHNET ENROLLEES:
Provided a Primary Care Medical Home and
access to:
 Specialty Care
 Wellness Education
 Prevention Services
 Prescriptions Medications
 Care Coordination for Chronic Medical
Conditions
 Other Needed Services
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HEALTHNET NETWORKS:
Receive technical assistance and grants from
ORHCC to support the community’s ongoing
efforts to:
 Increase access and quality of care through a
coordinated delivery system
 Share and conserve limited resources through
collaborative partnerships
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2007: HEALTHNET IN YEAR 1
 Funded
16 HealthNet Networks providing
services for the uninsured in 27 counties
 40,000+ individuals were provided a medical
home
 25,000+ individuals had access to needed
prescription medications
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2008: HEALTHNET IN YEAR 2
In SFY 2008-09, ORHCC received $2.8 million in
recurring appropriations to sustain existing
HealthNet Networks and $975,000 in nonrecurring funds to develop new collaborative
networks.
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2008: HEALTHNET IN YEAR 2
 Funding
21 HealthNet Networks that provide
services for the uninsured in 38 counties
 50,000+ individuals have a medical home
 38,000+ individuals have access to needed
prescription medications
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2009: HEALTHNET IN YEAR 3
For SFY 2009-10, ORHCC has received
$4.8 million in recurring appropriations to
sustain the existing HealthNet Networks
and develop new programs as available
funding will permit.
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ORHCC TECHNICAL ASSISTANCE:
Office of Rural Health and
Community Care staff provides:
Community Needs & Gap Analysis
 Strategic & Business Planning
 Network Development
 Medical, Dental, and Psychiatric
Provider Recruitment for
Underserved Areas & Educational
Loan Repayment
 Architectural Design Support for
Capital Projects

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ORHCC TECHNICAL ASSISTANCE
(CONTINUED)
 Coordination

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


with:
Community Care of North Carolina
(CCNC) and Medicaid
Critical Access Hospital Program
Farmworker Health Program
Medical Access Program
Medication Assistance Program
Community Health Grants
Program
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ORHCC TECHNICAL ASSISTANCE
(CONTINUED)
 Free
software applications for
access, referral, eligibility,
enrollment, and care
management (CARES and
CMIS) and for the Medication
Access & Review Program
(MARP)
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PARTICIPATING IN HEALTHNET
Health care providers and safety net organizations
that would like to partner with the local HealthNet
Network or want help with planning and organizing
a new HealthNet Network should contact:
 CCNC’s
Community Care Coordinator for the
county
 Office of Rural Health and Community Care

919-733-2040
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HEALTHNET PARTNERING WITH
CARE SHARE HEALTH ALLIANCE
 ORHCC
helps support the Care Share Technical
Assistance Center with HealthNet funds
 ORHCC is also a part of Care Share’s
Funders’ Collaborative where grant decisions are
coordinated to eliminate duplication and identify
gaps
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CARE SHARE HEALTH ALLIANCE
Shelisa Howard-Martinez
Care Share Health Alliance's mission is to improve the health
of low-income, uninsured North Carolinians by supporting
local Collaborative Networks of care.
Care Share Health Alliance
Is an independent, statewide resource that
brings people together to improve the health
of low-income, uninsured persons.
Our basic tenet is to meet communities where
they are and to build on their strengths and
resources.
Successful Collaboration
Includes:
• Broad stakeholder participation – everyone comes together
around an intersecting issue (caring for the uninsured);
• Effective & Passionate Leadership (Sparkplugs);
• Group staying focused on what is best for the health of the
individual/patient;
• Shared vision and goals;
• Creating something new together (shared ownership &
responsibility);
• Celebrating success and having fun together!
Continuum of Collaboration
Partners meet on a
regular basis, planning
to implement a
project/system together
No collaboration,
silos, lack of trust
All safety net providers at
the table, coordinated for
all the uninsured,
prioritized needs, funding
Continuum of Collaboration
Informal, episodic
collaboration,
letters of support
Integrated system –
common systems,
coordination of care
across partners –
i.e. Project Access
Hospital
Dental
Specialty
Care
Medications
Patient
Medical/Primary Care
Home
DSS
Mental
Health
Wellness &
Health
Education
(Prevention)
Public
Health
Chronic
Disease
Management
Care Share Offers New Resources
Convening, Facilitation and Support through:
• On-site technical assistance and phone consultations to support
communities who want to enhance their collaboration and/or
develop Collaborative Networks of care.
• Webinars – “Emergency Department Utilization Reduction” with
the NC Hospital Association and “Central Fill Pharmacy” with
the NC Association of Free Clinics.
• Web-based tools, templates and resources, an interactive
Knowledge Bank of best practices, and a 2010 conference.
Menu of Technical Assistance Services
• Capacity Building: organizational development, financial
management, leadership building, Information Technology
expertise, programs/systems design;
• Identifying new resources for communities;
• Referrals to other agencies to leverage resources;
• Advisory/coaching with leadership;
• Conflict Resolution;
• Community-Wide Planning.
Knowledge Bank
Is an interactive resource for communities who
want to enhance their collaboration.
• Capacity development resources,
• Online Tools and Templates,
• Monthly Webinars and teleconferences,
• Calendar of events.
Sign up at www.CareShareHealth.org.
Community-Wide Planning
•
•
•
•
Goal is to develop a three-year, community-wide plan to care for the
uninsured
Builds on existing community health assessments and plans
Streamlines planning and other efforts
Leverages all resources in the community
Opportunity to develop:
• A new or updated Strategic Plan,
• A Finance plan,
• Evaluation plan,
• Sustainability plan to enhance long-term financial viability.
Technical Assistance Team
West
Rachel Rosner
(828) 232- 2976
Central
Linda Kinney
(919) 800-8967
East
Shelisa Howard-Martinez
(919) 861-8359
How to connect with Care Share
• Call or email a Care Share Team member to
discuss your needs.
• Invite us to your community to learn more
about how we can help you build collaboration
to care for the uninsured.
• Register for the Knowledge Bank
• Check calendar for upcoming Webinars
17th Annual Healthy Carolinians Conference &
NCIOM Prevention Summit
October 8, 2009
Coordinating Care for the Uninsured in Gaston County
Presented by
Veronica Feduniec, Executive Director
Background



Issues
 High non-urgent ED utilization
 Admissions to ED for access to pool specialists
 No physician follow-up after discharge
Partners
 Gaston Memorial Hospital
 Gaston Family Health Services
 Gaston Together (GCHC)
 Community Health Partners
Milestones
 First meeting:
December 2006
 First grant application:
February 2007
 First grant award received:
January 2008
 First patient enrolled in HNG:
January 2008
HNG Target Population
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Uninsured
Gaston County resident, 18 and older
Income <= 100% FPG
Chronic Conditions or High User of the ED
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Diabetes
Asthma
Congestive Heart Failure
HNG Patient Benefits
(Full continuum of care)
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Medical Home/Primary Care
Specialty Services
Hospital Services
Case Management/Health Coaching
Medication Assistance
Health at Home Self-Care Guide
Health at Home Guide

Self-management resource
guide
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Recipients of book receive
face-to-face education on its
use
Move individual toward selfsufficiency
Community-wide initiative for
book distribution to low-income
Survey component included
Printed in English and Spanish
Health at Home Survey


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520 surveys distributed
9% return rate (lower than community rate of 12-18%)
Mobile population - 20% returned “undeliverable”
Health at Home Survey
Prior to
H@H
Had a regular place to go for
health concerns
Go to a Dr./Clinic for regular
health care
Go to the ED for regular health
care
After
H@H
41%
53%
75%
28%
6%
Health at Home Survey

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
61% report that H@H has helped treat a
health problem at home
61% report that H@H has helped to
identify a needed visit to the doctor
57% report H@H has saved an
unnecessary ED visit
Achievements
Current:
 1,700 members
 182 Medication Assistance Program members
 241 active primary care, specialty and hospital providers
Year-to-Date 2009:
 3,413 primary care appointments
 902 specialty care appointments
 33% reduction in ED visits
 11% reduction in charge/visit for all hospital services
Since Inception:
 $8.6 million in charity care donated
 Return on Investment of 11 times
Community-Wide Planning

HNG pilot program for Care Share Health
Alliance
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Addition of strategic community partners
Growth of “full continuum of care”
Expansion of program to all uninsured