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Lessons from Community-Based Initiatives to Expand Coverage and Improve Care DeliveryCitizens’ Health Care Working Group
May 12, 2005
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Outline
Context for national funders’ investment Communities in Charge Findings Important Considerations Replicable Strategies & Strategies to Avoid
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Federal/StateSurpluses
No Federal/StateSolutions
Communities
• Motivated- Issue of uninsured
more tangible- Experiencing real
financial pressures
ContextEnvironment in which Programs were Conceived
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Examples
Hillsborough County, FLMilwaukee County, WIMarian County, INWayne County, MI
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W.K. Kellogg FoundationCommunity Voices
Robert Wood JohnsonFoundation
Communities in ChargeFederal HRSA
Community Access Program
Could communities create and finance new coverage and delivery systems?
Raising the Question
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ObjectiveCommunities in Charge was a four year, $16.8M
project of The Robert Wood Johnson Foundation to help communities design and implement new, or significantly expand existing, community-based systems for financing and delivering a full spectrum of care to the uninsured and under-insured
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Expectations
Community-wide initiative Result in systemic change Serve a large number of uninsured individuals Roughly modeled on Hillsborough HealthCare
Financing change to support new coverageRestructuring of care delivery
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Important Attributes
Large communities Initial focus on coverage (versus access) Emphasis on systematic process for design
and implementation Active coalitions (public-private partnerships) Champions & Invested leaders Plenty of providers
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Funded Sites
San Mateo Co.
Spokane
Portland
Alameda Co.
El Paso
Austin
Albuquerque
Jacksonville
Portland
Buffalo
BrooklynD.C.
Birmingham
JacksonMacon
Baltimore
ColumbiaWichita
St. LouisLouisville
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3 Program Approaches
Public/Private Coverage (4) Financing Target populations
Public/Private Voluntary (4) Other Public/Private (4)
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Findings
Location matters…because states differ
Medicaid eligibility thresholds Medicaid disproportionate share distributions Local responsibility for indigent medical care “Riches”…and distribution of revenue
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FindingsNot every community has the “right stuff”
Key champions and invested senior leadership
Strong coalition with right people at the table Keen knowledge of the fiscal and political
commitments of critical partners Awareness of local and state environment Understanding of the community’s strengths
and limitations REAL resources
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Findings
Health care system is not a “system” for the uninsured
There are many gaps There are many silos Existing financing structures are a barrier to
system change
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FindingsCommunities can’t solve the coverage
problemon their own
Without SIGNIFICANT state and/or federal financial assistance, community-based coverage programs cannot achieve the scale necessary to address need and ensure long-term sustainability
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FindingsCommunities with the “right stuff” can
impact how care for the uninsured is financed &
delivered
Leveraging funds Brokering public/private partnerships Institutionalizing coalitions Bridging gaps along the care continuum Building and sustaining new safety net
infrastructure Facilitating outreach and enrollment in existing
public programs
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Important Considerations
Rethinking health care delivery and financing takes time, is hard work, requires $$$$, and is not for every community.
Big “P” and little “p” of politics as usual at local and state level can sink success of community efforts
Leadership is critical
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Replicable Strategies Health Policy Forums Common eligibility screening tool Shared clinical record State/Federal partnership coverage programs Coordinated gap-filling
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Strategies to Avoid ER “diversion” programs
Without significant incentives and outreach, will not change care seeking patterns
Real access to primary care and specialty services is required
Small business strategies Well-documented challenges to overcoming
the small business owner “cost” barrier Examples
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For More Information
www.communitiesincharge.org
http://www.statecoverage.net/pdf/issuebrief405.pdf
Terry StollerProgram Director
Communities in Charge
PrincipalMedimetrix
1100 Republic Building25 Prospect Avenue
Cleveland, Ohio 44115216-523-1300 x 3039