HEALTH CARE MODELS FOR THE UNINSURED
Sheryl L. GarlandVice PresidentAmbulatory Care ServicesMedical College of Virginia Hospitals and PhysiciansVirginia Commonwealth University Health SystemNovember 26, 2001
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One of the largest challenges in the health care industry is providing care for the 44 million uninsured in the U.S.
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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.
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A survey conducted by the Robert Wood JohnsonFoundation’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.
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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
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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 anera of shrinking reimbursement and limited federal government intervention
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The National Association of Public Hospitals and Health Systems (NAPH) is an organization that advocates and represents the nation’s urban safety net providers
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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
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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
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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
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As you are aware, the University of VirginiaHealth System (UVA) and the MedicalCollege of Virginia Hospitals and Physicians(Virginia Commonwealth University Health System - VCUHS) receive funding to provide care to the uninsured in theCommonwealth of Virginia
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In FY 2001, theVCU Health System provided over
$100 million in indigent care to patients
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In addition to the services provided by theVCU Health System for the uninsuredin the Richmond Metropolitan area,
there are various initiatives underway that provideservices
for uninsured or underinsured populations
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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
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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
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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
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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
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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
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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
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“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
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Managed Care Models That Have Been Implemented Wishard Program in Indianapolis,
Indiana University of New Mexico Boston Medical Center and
Cambridge Health Alliance
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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
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Virginia Coordinated Care Service Area
C a r o l in e
H a n o v e r
H e n r ic oR ic h m o n d C ity
C o lo n ia l H e ig h tsH o p e w e llP e t e r s b u r g
C h e s te r f ie ld
G o o c h l a n d
P o w h a ta n
A m e lia
D in w id d ieP r in c e G e o r g e
C h a r l e s C it y
N e w K e n t
K in g W i l l ia m
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Virginia Uninsured Rate
8
12.6 13.4 14.0116.25
19
96
(C
en
su
s)
19
97
(C
en
su
s)
19
98
(C
en
su
s)
19
99
(U
CL
A)
20
00
(U
CL
A)
0
5
10
15
20
Richmond-Petersburg MSA: Projected Number of Uninsured
79.806
131.753144.322
155.419173.678
0
50
100
150
200
Thousands
Percent of Uninsured Virginians
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Number of Uninsured Patients Receiving Services through the VCU Health System
Number of Uninsured Patients
FY 2000
38.781
19.619 14.814 10.0562.576 0.977 0.885 0.321 4.805
Tot
al
Ful
l Ind
igen
t-C
ateg
ory
1
VC
C E
ligib
le
Ric
hmon
d
Hen
rico
Che
ster
field
Tri-
City
Are
a
Han
over
Oth
er A
reas
01020304050
Thousands
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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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Figure 1. VCC Patient Demographics (Age)
Under 2010%
20 - 3430%
35 - 4425%
45 - 6432%
65 Plus3%
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Figure 3. VCC Patient Demographics (Race)
Black69%
Other6%
White25%
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Figure 4. Overall Utilization -- Encounters by TypePreliminary Estimates
0
10,000
20,000
30,000
40,000
50,000
60,000
Month
Nu
mb
er o
f E
nco
un
ters
FY00 (10 months) 2,322 45,528 9,245
FY01 (10 months) 2,082 44,493 8,140
Inpatient Discharges Outpatient Visits Emergency Room Visits
Overall Number of Encounters FY00 (10 months) = 57,095Overall Number of Encounters FY01 (10 months) = 54,715
4.2% decrease from FY00
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F ig u re 5 . O v e ra l l U ti l i za tio n --
E stima te d T o ta l C o sts
F Y 0 0 F ig u re s A d ju ste d fo r
C o mp a riso n w i th F Y 0 1
F ig u re s In c lu d e B o th F a c i l i ty
$ 0
$ 5 0 ,0 0 0 ,0 0 0
M o n th
F Y 0 0 (1 0
mo n th s)
$ 1 8 ,8 8
5 ,3 1 5
$ 1 3 ,0 4
8 ,0 3 6
$ 2 ,4 0 3 ,
5 8 6
Figure 5. Overall Utilization -- Estimated Total CostsFY00 Figures Adjusted for Comparison with FY01Figures Include Both Facility and Physician Costs
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
Month
Est
imat
ed T
ota
l Co
sts
FY00 (10 months) $18,885,315 $13,048,036 $2,403,586
FY01 (10 months) $19,146,254 $11,787,338 $1,986,595
Inpatient Discharges Outpatient Visits Emergency Room Visits
Overall Total Costs FY00 (10 months) = $34,336,937Overall Total Costs FY01 (10 months) = $32,920,187
4.1% decrease from FY00
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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
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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
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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
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CAP Grant
Grant is one of 63 awarded this funding cycle across the country
Provides an opportunity to develop infrastructure for community coalitions
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