17 th annual healthy carolinians conference and nciom prevention summit october 8 th , 2009
DESCRIPTION
COORDINATING CARE FOR THE UNINSURED: RESOURCES FOR BUILDING COLLABORATIVE NETWORKS OF CARE IN YOUR COMMUNITY. 17 th Annual Healthy Carolinians Conference and NCIOM Prevention Summit October 8 th , 2009 Anne Braswell Senior Analyst for Research and Development - PowerPoint PPT PresentationTRANSCRIPT
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 BraswellSenior Analyst for Research and
DevelopmentNC 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
4
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
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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 non-
profits (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
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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 community-based systems of care serving the uninsured.
11
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 non-recurring funds to develop new
collaborativenetworks.
18
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
19
2009: HEALTHNET IN YEAR 3
For SFY 2009-10, ORHCC has received$4.8 million in recurring appropriations tosustain the existing HealthNet Networksand develop new programs as available
funding will permit.
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ORHCC TECHNICAL ASSISTANCE:
Office of Rural Health andCommunity 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 21
ORHCC TECHNICAL ASSISTANCE (CONTINUED)
Coordination with: Community Care of North
Carolina (CCNC) and MedicaidCritical Access Hospital ProgramFarmworker Health ProgramMedical Access Program Medication Assistance ProgramCommunity 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 organizationsthat would like to partner with the local HealthNetNetwork 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 ALLIANCEShelisa 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
Informal, episodic collaboration, letters of support
No collaboration, silos, lack of
trust
Integrated system – common systems, coordination of care across partners – i.e. Project Access
Continuum
of
Collaboration
Partners meet on a regular basis, planning
to implement a project/system
together
All safety net providers at the table, coordinated for
all the uninsured, prioritized needs, funding
PatientMedical/Primary Care
Home
Dental
Chronic Disease
Management
Specialty Care
Wellness & Health
Education(Prevention)
Public Health
Medications
Hospital
DSS
Mental Health
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.
Care Share Offers New Resources
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 & 17th Annual Healthy Carolinians Conference & NCIOM Prevention SummitNCIOM Prevention Summit
October 8, 2009October 8, 2009
Coordinating Care for the Uninsured in Gaston CountyCoordinating Care for the Uninsured in Gaston County
Presented byPresented byVeronica Feduniec, Executive DirectorVeronica Feduniec, Executive Director
BackgroundBackground IssuesIssues
High non-urgent ED utilizationHigh non-urgent ED utilization Admissions to ED for access to pool specialistsAdmissions to ED for access to pool specialists No physician follow-up after dischargeNo physician follow-up after discharge
PartnersPartners Gaston Memorial HospitalGaston Memorial Hospital Gaston Family Health ServicesGaston Family Health Services Gaston Together (GCHC)Gaston Together (GCHC) Community Health PartnersCommunity Health Partners
MilestonesMilestones First meeting: First meeting: December 2006December 2006 First grant application: First grant application: February 2007February 2007 First grant award received: First grant award received: January 2008January 2008 First patient enrolled in HNG: First patient enrolled in HNG: January 2008January 2008
HNG Target PopulationHNG Target Population
UninsuredUninsured Gaston County resident, 18 and olderGaston County resident, 18 and older Income <= 100% FPGIncome <= 100% FPG Chronic Conditions or High User of the Chronic Conditions or High User of the
EDED DiabetesDiabetes AsthmaAsthma Congestive Heart FailureCongestive Heart Failure
HNG Patient BenefitsHNG Patient Benefits(Full continuum of care)(Full continuum of care)
Medical Home/Primary CareMedical Home/Primary Care Specialty ServicesSpecialty Services Hospital Services Hospital Services Case Management/Health CoachingCase Management/Health Coaching Medication AssistanceMedication Assistance Health at Home Self-Care GuideHealth at Home Self-Care Guide
Health at Home GuideHealth at Home Guide
Self-management Self-management resource guideresource guide Recipients of book receive Recipients of book receive
face-to-face education on face-to-face education on its useits use
Move individual toward self-Move individual toward self-sufficiencysufficiency
Community-wide initiative Community-wide initiative for book distribution to low-for book distribution to low-incomeincome
Survey component includedSurvey component included Printed in English and Printed in English and
SpanishSpanish
Health at Home SurveyHealth at Home Survey
520 surveys distributed520 surveys distributed 9% return rate 9% return rate (lower than community rate of 12-18%)(lower than community rate of 12-18%)
Mobile population - Mobile population - 20% returned “undeliverable”20% returned “undeliverable”
Health at Home SurveyHealth at Home Survey
Prior Prior to to
H@HH@H
After After H@HH@H
Had a regular place to go for Had a regular place to go for health concernshealth concerns 41%41%
Go to a Dr./Clinic for regular Go to a Dr./Clinic for regular health carehealth care 53%53% 75%75%
Go to the ED for regular Go to the ED for regular health carehealth care 28%28% 6%6%
Health at Home SurveyHealth at Home Survey
61%61% report that H@H has helped report that H@H has helped treat a health problem at hometreat a health problem at home
61%61% report that H@H has helped to report that H@H has helped to identify a needed visit to the doctor identify a needed visit to the doctor
57%57% report H@H has saved an report H@H has saved an unnecessary ED visitunnecessary ED visit
AchievementsAchievementsCurrent:Current: 1,7001,700 members members 182182 Medication Assistance Program members Medication Assistance Program members 241241 active primary care, specialty and hospital active primary care, specialty and hospital
providersprovidersYear-to-Date 2009:Year-to-Date 2009: 3,4133,413 primary care appointments primary care appointments 902902 specialty care appointments specialty care appointments 33%33% reduction in ED visits reduction in ED visits 11%11% reduction in charge/visit for all hospital services reduction in charge/visit for all hospital servicesSince Inception:Since Inception: $8.6$8.6 million in charity care donated million in charity care donated Return on Investment of Return on Investment of 1111 times times
Community-Wide PlanningCommunity-Wide Planning
HNG pilot program for Care Share HNG pilot program for Care Share Health AllianceHealth Alliance Addition of strategic community Addition of strategic community
partnerspartners Growth of “full continuum of care”Growth of “full continuum of care” Expansion of program to all uninsuredExpansion of program to all uninsured