1. 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

2. 2 One of the largest challenges in the health care industry is providing care for the 44 million uninsured in the U.S.

3. 3 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.

4. 4 A survey conducted by the Robert Wood Johnson Foundation’s 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.

5. 5 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

6. 6 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

7. 7 The National Association of Public Hospitals and Health Systems (NAPH) is an organization that advocates and represents the nation’s urban safety net providers

8. 8 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 nation’s health care professionals

9. 9 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

10. 10 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

11. 11 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

12. 12 In FY 2001, the VCU Health System provided over $100 million in indigent care to patients

13. 13 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

14. 14 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

15. 15 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, Women’s Health and Pediatric services Financial and Medicaid/CMSIP eligibility screening at the Center

16. 16 Hayes E. Willis Health Center of South Richmond (cont’d) 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 Department’s budget by $1 million and is one of the lowest cost providers in the VCU Health System

17. 17 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

18. 18 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

19. 19 RCDPH/MCVH Clinical Services Agreement (cont’d) Women’s, Children’s 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

20. 20 “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

21. 21 Managed Care Models That Have Been Implemented Wishard Program in Indianapolis, Indiana University of New Mexico Boston Medical Center and Cambridge Health Alliance

22. 22 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

23. 23 Virginia Coordinated Care Service Area Caroline Hanover Henrico Richmond City Colonial Heights Hopewell Petersburg Chesterfield Goochland Powhatan Amelia Dinwiddie Prince George Charles City New Kent King William

24. 24 Percent of Uninsured Virginians

25. 25 Number of Uninsured Patients Receiving Services through the VCU Health System Number of Uninsured Patients FY 2000 38.781 19.619 14.814 10.056 2.576 0.977 0.885 0.321 4.805 Total Full Indigent-Category 1 VCC Eligible Richmond Henrico Chesterfield Tri-City Area Hanover Other Areas 0 10 20 30 40 50 Thousands

26. 26 Enrollment and Physicians Approximately 13,000 enrollees from November, 2000 to September, 2001 Year to Date Monthly Average - 7370 27 Community PCP’s representing 20 practices Five community-based safety net providers Three specialty areas - Neurology, Ophthalmology, Rheumatology

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31. 31 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

32. 32 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

33. 33 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

34. 34 CAP Grant Grant is one of 63 awarded this funding cycle across the country Provides an opportunity to develop infrastructure for community coalitions