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Lessons from Community-Based Initiatives to Expand Coverage and Improve Care Delivery Citizens’ Health Care Working Group May 12, 2005.

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Presentation on theme: "Lessons from Community-Based Initiatives to Expand Coverage and Improve Care Delivery Citizens’ Health Care Working Group May 12, 2005."— Presentation transcript:

1 Lessons from Community-Based Initiatives to Expand Coverage and Improve Care Delivery Citizens’ Health Care Working Group May 12, 2005

2 Outline  Context for national funders’ investment  Communities in Charge  Findings  Important Considerations  Replicable Strategies & Strategies to Avoid

3 Federal/State Surpluses No Federal/State Solutions Communities Motivated -Issue of uninsured more tangible -Experiencing real financial pressures Context Environment in which Programs were Conceived

4 Examples Hillsborough County, FL Milwaukee County, WI Marian County, IN Wayne County, MI

5 W.K. Kellogg Foundation Community Voices Robert Wood Johnson Foundation Communities in Charge Federal HRSA Community Access Program Could communities create and finance new coverage and delivery systems? Raising the Question

6 Objective Communities 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

7 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 coverage  Restructuring of care delivery

8 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

9 Funded Sites San Mateo Co. Spokane Portland Alameda Co. El Paso Austin Albuquerque Jacksonville Portland Buffalo Brooklyn D.C. Birmingham Jackson Macon Baltimore Columbia Wichita St. Louis Louisville

10 3 Program Approaches Public/Private Coverage (4)  Financing  Target populations Public/Private Voluntary (4) Other Public/Private (4)

11 Findings Location matters…because states differ  Medicaid eligibility thresholds  Medicaid disproportionate share distributions  Local responsibility for indigent medical care  “Riches”…and distribution of revenue

12 Findings Not 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

13 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

14 Findings Communities can’t solve the coverage problem on 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

15 Findings Communities 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

16 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

17 Replicable Strategies  Health Policy Forums  Common eligibility screening tool  Shared clinical record  State/Federal partnership coverage programs  Coordinated gap-filling

18 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

19 For More Information Terry Stoller Program Director Communities in Charge Principal Medimetrix 1100 Republic Building 25 Prospect Avenue Cleveland, Ohio x 3039


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