Development and Implementation Grant
                            Phase Two National Press Release

Austin, TX




ICC Vision:  Affordable Access to Effective Health Care

ICC Mission:  The Indigent Care Collaboration (ICC) is an alliance of healthcare safety net providers working together to improve the financing and delivery of health care to all residents of the central Texas region.

ICC Values:  Respect, Trust, Integrity, Consensus, Data-driven decision making.

An ideal system for delivering care will have the following characteristics:

  • Patient-centered quality services

  • Excellent Care Management

  • Holistic

  • Available to all

  • Easy to access

  • Sophisticated information tools with patient privacy protected

  • Equitable burden of financing

  • Accountable

  • Broad community support

  • Choice

  • Financially sustainable

  • Collaborative

  • Consumer financial participation

Positioning Statement

The strength of the ICC is that it is a unique organization established and led by all of the safety net providers in the three-county region.  The ICC addresses collaboratively multiple healthcare issues for the medically indigent and the community at large.

Through the CIC Grant process, the ICC focused on the development of appropriate clinical and administrative integrations to support the notion of an adequately financed and organized system of care.

Project Objectives

  • Establish web-based regional information system

  • Enhance efficiency and cooperation of indigent care providers in Hays, Travis, and Williamson Counties

  • Develop additional financial resources for program implementation and coordination

  • Maximize Medicaid and CHIP enrollment through aggressive outreach

  • Expand MAP and Seton Clinic enrollment each by 2,000 lives

  • Integrate behavioral health into primary services

  • Expand the specialty care provider network

  • Simplify Medicaid enrollment through state pilot project

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        Program Design

The ICC is a unique safety net, provider-focused collaboration that works to improve access to care, availability of care, and financing of safety net care, within the context of cultural and political factors distinctive to the central Texas region.  While much of what the ICC has done is proving to be transportable to communities throughout the nation, through the CIC grant process, the ICC focused on the development of appropriate clinical and administrative integrators to support the creation of an adequately financed and organized regional healthcare delivery system.

It is increasingly apparent that traditional efforts are no longer adequate to assure access to services over the long term and maintain a stable safety net.  Existing programs and funding sources are categorical and fragmented and have not been sufficiently responsive to the changing incentives of the care system.  At the ICC, we have demonstrated that these conditions described an opportune time to pursue system restructuring in Central Texas.

The organizations responsible for providing or supporting the bulk of safety net healthcare services are represented on the ICC and committed to finding new ways to coordinate the use of these funds to promote and expand effective application of available resources.

Since 2001, our overall work plan has been guided by both a board-driven strategic plan and a board-approved business plan.  We have staffed ourselves accordingly to meet our work plan goals, with administrative staff, technical staff, additional long-term legal and technical consultants, and program-specific staff leading a multi-agency collaborative effort outlined in a 15-year strategic plan adopted via Board consensus.  Safety net providers are fully invested in carrying out the plan and collectively have provided hundreds of thousands of dollars in cash and in-kind service to the Collaboration.

Key components of our work plan include the implementation of a Master Patient Index/Clinical Data Repository, Disease Management initiatives, online centralized and uniform Medical Assistance Program Eligibility tools, a volunteer physician initiative modeled on Project Access and innovative pharmacy solutions.  We have expanded public education, research, education/outreach, and needs assessment activities, and have worked closely with a group of community leaders to develop new taxing strategies to support safety net and emergency health and mental health care.

We have laid out as our outcome measures those which measure our success in producing a workable model or models of care for this region, and financing strategies that both support the care models and are supported by the stakeholders involved in the process.


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        Financing & Outreach Strategies

The ICC has developed multiple strategies for outreach to our affected constituencies.  These have led the engagement of all key safety net providers in our work, the support of community and political leaders for our work, and increased awareness of the media and general public of the problems, and potential solutions, involved in delivering safety net health care.  We have added outreach to affected low-income patients as well.  Through our "I-Care" system, we have created an ICC-sponsored means of branding the expanded services that our providers now offer or plan to offer, and a public umbrella for marketing our services.

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        Accomplishments to Date

From its inception as a collaboration of Travis County safety net providers, the ICC has expanded out to relevant organizations in the surrounding counties to broaden its base and regionalize the project.  In 1999, representatives from both Hays and Williamson Counties were added to the ICC Board.  In 2000, Austin Travis County Primary Care was added as a separate representative on the Board, and in 2001, the Travis County Medical Society, which is in the process of launching a Project Access initiative with the ICC, was added to the Board.  In 2004, additional Williamson County providers are joining our collaboration and being represented on our Board.

In 2001, the ICC completed its initial 15-year Strategic Plan, adopted a Business Plan, and created a draft Communications Plan.

The ICC has developed several specific ventures as it works toward its long-term goal to improve the financing and delivery of services to the unfunded population.  The first step has involved the development of a care management system that builds upon the collaborative efforts that have already been established, such as leveraging the ability of the unified call system to establish and track patients through a medical home.  At the core of this care management system is a Master Patient Index/Clinical Data Repository.  The MPI houses demographic and contact information on all of the individuals who use the safety net healthcare service delivery system.  As of the beginning of 2004, this included over 250,000 individuals.  The CDR holds medical encounter information, including diagnosis and procedure codes, payment source, some pharmacy, some lab, for all people dating back to 2002, wherever the information is available via direct electronic interface with a safety net provider's data system.  As of the beginning of 2004, there were over half a million encounters in the system and an additional 50,000 pharmacy encounters.

Several other elements have been included in our overall system redesign, including expansion of MAP, expansion of the ICC call system, joint pharmacy ventures, joint staff training ventures, and ultimately, the creation of the new healthcare financing district being voted on in 2004.

We have made significant progress in all of these areas.  We have seen the development of new cross-country collaborative venues among our members, one of which has resulted in the opening of a new clinic in Williamson County, and we have secured new funding from a local Foundation to enable us to pilot new mental health services in three primary care clinics.  We have also worked with and through our Insure-A-Kid (SCHIP Outreach) Program to enroll thousands of children in SCHIP, we have expanded the MAP and Seton Clinic enrollment by more than 2,500 lives each, we have developed a formal working agreement with the Travis County Medical Society to launch Project Access a volunteer physician initiative and we have become the state's designated pilot for the development of a regional healthcare delivery system.

We have been working, with success, to overcome hurdles through an aggressive work plan and careful planning.  As of the beginning of 2004, we have achieved the following outcomes in addition to the development of the MPI/CDR.  In partnership with over 80 eligibility workers at over 30 locations, we successfully screened over 45,000 uninsured people for eligibility for medical assistance and charitable programs using our common online eligibility tool.  We increased enrollment in Seton Care Plus and MAP by a combined 7,000 before integrating many of the MAP patients into the Austin Texas County FQHC System, where we now track their ongoing care.  We enrolled over 400 patients in our Diabetes Disease Management pilot and over 350 patients in our mental health/primary care program (and documented improving health status in this population).  We recruited over 600 physicians into our Project Access Program and enrolled our first 200 patients.  We developed multiple pharmacy initiatives, including an expanded, centralized PAP screening program and a 340B network proposal under review by the HRSA Pharmacy Affairs Branch for approval as an Alternative Methods Demonstration Program.

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  • Potential HIPAA compliance issues in developing shared information resources

  • Development of care models that are affordable and complete enough to satisfy stakeholders

  • Political support in three counties with distinct approaches to solutions of community problems

We have addressed HIPAA and state privacy challenges through the information of a permanent legal team with representatives from several of our members, and have implemented solutions to address HIPAA issues in particular.  Most noteworthy among these is a uniform authorization for patients to sign to direct their PHI to be shared electronically among members from within the MPI/CDR.  As of the beginning of 2004, over 30,000 patients had signed this authorization.  The ICC's major initiatives - MPI/CDR, program expansions including MAP and Seton Care Plus, new program initiatives including Project Access, Disease Management including Diabetes and Mental Illness, and pharmacy - have been chosen to meet the specific needs of stakeholders.  Increasing political support for the safety net providers has been evidenced by the successful collaboration of business and community leaders and state legislators that resulted in passage of regional health care district enabling legislation during the 2003 legislative session, and the scheduling of a vote authorizing the creation of a Travis County Health Care District in May of 2004.

What is most special about the ICC is the tremendous commitment from the twelve partners in developing and carrying out initiatives.  The considerable results that we have had to date result from that commitment.

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        Contact Us

Paul Gionfriddo
Executive Director
Indigent Care Collaboration
1213 N. IH-35
Austin, TX  78702
Phone: (512) 927-2677
Fax: (512) 927-1350

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Communities In Charge 2002 is a program of The Robert Wood Johnson Foundation.
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