Development and Implementation Grant
                            Phase Two National Press Release

Communities In Charge Jacksonville
”Jax Care"

Jacksonville, FL 



§        Objectives

JaxCare Inc., is a public/private partnership whose mission is to increase access to healthcare for low-income, working uninsured residents of Duval County for the purpose of improving overall community health, obtaining healthcare and enhancing the economic foundation and social well being of our community.

JaxCare Inc., is designed as a new public/private partnership committed to enabling businesses to provide their low-wage, uninsured workforce with access to healthcare.  JaxCare is a resource management corporation that provides a framework for coordinated, efficient, knowledge-based healthcare that reduces uncompensated healthcare costs for medical facilities and other providers while increasing access and improving health outcomes.  JaxCare is designed for the low-wage workforce who earn too little to afford commercial health insurance, but too much to be eligible for Medicaid and other government programs.

JaxCare is the community-based strategy being developed by the Communities in Charge - Jacksonville Coalition.  Conceptualized and developed the "Communities in Charge" grant initiative of The Robert Wood Johnson Foundation, a two-year pilot test of JaxCare, is being financed by local and national, private and governmental resources.  JaxCare has the unanimous support of the Jacksonville Mayor and City Council, the Jacksonville Regional Chamber of Commerce, the Jacksonville Economic Development Commission, all 5 major hospitals, physicians, other providers and insurers.  A key component of the program involves electronically linking health and social service providers in Northeast Florida into a shared database to facilitate eligibility, screening, enrollment, referrals, and case management.  This puts current resources to maximum use before spending additional dollars.

The governments of Duval County and the City of Jacksonville are consolidated to include the entire 840 square miles of the jurisdiction.  The total population is approximately 80,000 with an estimated 15 percent of the population uninsured.  Survey data and population projections indicate that there are approximately 100,000 to 130,000 uninsured individuals on any given day - 70% of which work.

JaxCare will concurrently pursue Four Business Objectives:

  • Implement and evaluate the two-year pilot programDesigned to demonstrate the viability and benefits of deploying a fully integrated, community-based, managed care program for delivering healthcare to the uninsured using a multi-hospital, community-service integration model.  The target population for the pilot is 1,500 working, uninsured, low-income (defined as 150-200% of the Federal Poverty Level).

  • Strengthen Jacksonville's capacity to contain costs by optimizing the appropriate use of existing healthcare resources through integration and coordination of health and social services using cutting edge information technology.  CIC-Jax (not JaxCare Inc.) and the United Way of Northeast Florida's First Call -211 Program have built an internet-based information-sharing network for safety net providers.  We are in the process of connecting all Duval County safety net services and JaxCare providers into that system.  Communities in Charge Jacksonville has obtained nearly $1.7 million to date in federal grant funds from the U.S. health Resources and Services Administration to expand the United Way of Northeast Florida's Northeast Florida Information Network (NEFIN) to include healthcare providers, services, clients and health status indicators as well as to enable access and data entry retrieval from any service site in the system.

  • Develop long-term program and revenue models that are cost effective and financial self-sustaining.  During 2003 and 2004, JaxCare staff and volunteer leadership will develop models to fund the program on a sustained basis.  They will explore long-term revenue sources and financing strategies to expand access to healthcare strategies that involve self-pay revolving fund models, pursuing legislative action, attracting additional federal funding, and altering our local approach to caring for the indigent and uninsured.  In addition, they will collaborate with similar coalitions in other Florida communities to discuss policy issues that affect multiple locales and identify opportunities for collaborative action to facilitate policy changes that will increase access to healthcare.  This will be facilitated through a series of policy meetings planned and executed in partnership with the Winter Park Health Foundation and other Florida Foundations.

  • Educate and advocate for public policies and financing strategies to sustain expanded access to healthcare for the target group.  JaxCare was designed and structured for execution through the Jacksonville Community Forums on Health Care and the Uninsured.  communities in Charge partnered with the Jessie Ball DuPont Fund during 2002 to convene these forums allowing local policymakers, stakeholders and professional challenges to meet with national and regional experts for discussions about the local challenge of financing and delivering healthcare to the uninsured.  The forums offered policymakers an opportunity to engage in informed discussions and issue analysis in a neutral setting.  This resulted in the definition of strategies appropriate for Jacksonville and the development of this business plan.

A grassroots community education and communication initiative will be executed in Duval County during 2003 and 2004 in conjunction with our coalition partners.

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§       Program Design

JaxCare will implement a two-year pilot program to test the design, infrastructure and delivery strategy of a countywide managed care program for the low-income, working uninsured.  Careful evaluation will track results and measure impact, allowing fine-tuning approaches and thorough value and cost analysis prior to any program expansion.

This two-year pilot period will allow time for development of a detailed financial strategy to sustain and expand the program.  We have examined funding strategies, from revolving loan funds to tax-supported funding most of which require time, planning and consensus building before implementation.  Further, a number of issues that might ultimately affect financing options require the attention of the Florida Legislature.

Consequently this two-year window is crucial to our ability to strategically address these topics, develop a framework that accurately determines full program parameters, and solidify a comprehensive long-term financing mechanism.  Assuming positive evaluation and successful financial planning, program expansion will begin in Year Three.

Timeline - The JaxCare Program is anticipated to begin in the Spring with construction of the administrative, operational and program infrastructure.  Member enrollment begins Summer 2003.  This relatively short ramp-up schedule is possible because of the administrative groundwork already laid by Communities in Charge - Jacksonville.  This pilot plan will be active through Summer 2005, with final evaluation activities requiring an additional three to six months.

Eligibility Criteria:

JaxCare requires initial eligibility through Duval County Businesses.  Each participating business must meet the below listed Employer Eligibility Criteria.  Once it is determined that a business meets the eligibility criteria, employees (individuals) of such businesses, who meet the Individual Eligibility Criteria may be enrolled in JaxCare.

Employer Eligibility Criteria:

  • Duval County businesses with three or more employees who either;

  • Do not provide health insurance benefits to employees, and have not provided these benefits for the preceding 12 months and or,

  • Have a non-benefit eligible workforce (excluding employees during their healthcare probationary period).

Individual Eligibility Criteria:

  • Residency:  Duval County

  • Age:  18-64

  • Income:  150-200% of the Federal Poverty Level (FPL)

  • Employed through participating JaxCare businesses

  • Not eligible for any health insurance program

Recruitment Strategy

Public notice of the employer-based, two-year, time-limited JaxCare pilot program will be given, and eligible businesses will be contracted on a first-come first-serve basis.  In addition, JaxCare staff will work with the Chamber of Commerce, United Way and other similar organizations to recruit businesses for the pilot program.  Member enrollment will be ramped up progressively over the course of twelve months and managed in such a way that the program infrastructure can effectively and cost-efficiently serve the membership.


JaxCare members will have access to a full continuum of healthcare services available through a network of private practitioners and public providers, specifically:

  • Primary and specialty doctors

  • Laboratory and diagnostic services

  • Generic pharmaceuticals

  • Hospital Care (inpatient and outpatient)

  • Proactive care management including; risk screening of all enrollees; health education and promotion; case management for those at risk for chronic or serious illness; disease mangement for patients with chronic or serious illness.


All services for which JaxCare does not have contracted providers for are excluded.  Any serices not expressly included are excluded.  Only medically necessary services are included.  In addition, certain services are specifically excluded from the JaxCare Program such as:

  • Abortions

  • Acupuncture

  • Artificial insemination in-vitro federalization and other procedures, pharmaceuticals and treatment modalities intended to induce pregnancy

  • Biofeedback

  • Chiropractic Therapy

  • Dental care or Orthodontic services

  • Electrolysis

  • Experimental or investigational care

  • Eye glasses, contact lenses, or orthopotics

  • Lasik eye surgery

  • Hearing tests (routine) and hearing aids

  • Massage therapy

  • Non-formulary medications

  • Non-skilled custodial care

  • Obstetrics

  • Private duty nursing

  • Respite care and retirement home care

  • Services that are not authorized by the PCP and/or JaxCare, except in the event of a life or health threatening emergency

  • Sex change procedures

  • Transplants

  • Work related injuries or illnesses

A number of services will be limited.  Full information about covered services and exclusions will be provided to employers and employees prior to program enrollment.


The plan will use proven medical management principles and base program requirements for care and service on nationally recognized standards, performance goals and benchmarks.  Shands Jacksonville will support costs of medical management for the two-year pilot.  Case management will be conducted through JaxCare.

Through the process of outcome monitoring and evaluation, program adjustments will be made to ensure improvements in:

  • Health status of the population served;

  • Use of most cost effective and efficient services;

  • Coordination of care management services across agencies;

  • Inappropriate use of services, including misuse, overuse and abuse;

  • Jacksonville's ability to make healthcare available and accessible to the low-income uninsured.

All providers and practitioners will be required to participate in JaxCare Improvement and Utilization Management activities.

Delivery System

Services will be delivered through a series of networks; Hospital Based Provider Networks, Provider networks will be established around each participating hospital.  Hence, there will be:

  • JaxCare - Baptist

  • JaxCare - Memorial

  • JaxCare - St. Luke's

  • JaxCare - St. Vincent's

Brooks Rehabilitation hospital will provide rehabilitation services for all networks under arrangements defined prior to the program onset.  Hospital services include inpatient and outpatient care and services such as lab and diagnostic services and outpatient surgery.  Since the Hospitals will donate their costs, the networks are designed to assure equitable distribution of care burden among hospitals.  JaxCare will establish this patient distribution formula in consultation with Hospital CEO's.  Each hospital is expected to assist in building their physician network and in recruiting potential JaxCare members through patient outreach.

Primary Care Physician Network:  This network will include both private practitioners and public agencies such as the Duval County Health Department and Federally Qualified Health Centers.  The JaxCare primary care network will be geographically compatible to member access needs.

Specialty Physician Network:  This network will be recruited according to existing hospital affiliations.  Specialists will be assigned by hospitals and use only that designated hospital for their JaxCare patients.  Use of patient and outpatient hospital services by JaxCare patients will be carefully monitored to ensure that no hospital receives more than its pre-determined allotment of JaxCare patients.

Prevention & Outreach Focused Approach:  The medical management of JaxCare members with chronic illness, acute illness and those relatively healthy but-at-risk for serious health conditions.  This will improve their health status in the short term and prevent, delay or reduce the severity of long-term complications and costs.  This is accomplished through JaxCare's aggressively managed and coordinated system of interventions, which include disease management, case management and health education prevention programs.

Care Management:  There are four levels of care management interventions that JaxCare will contract with the University of Florida Jacksonville Health Science Center to facilitate improved outcomes to patient care:

  • Risk Management - All JaxCare members receive risk and need assessments to provide staff with the information needed to stratify patients into appropriate risk categories for targeted care.

  • Health Promotion - Activities that focus on health maintenance, health education and self-management.

  • Case Management - Personal one-on-one interaction between patient and case managers to facilitate patient responsibility for care planning, accessing appropriate care services, ongoing monitoring of health status.  Evaluation and follow-up are ongoing.

  • Disease Management - A coordinated and evidence-based approach that emphasizes prevention of exacerbations and complications using patient empowerment strategies.  The process also includes ongoing evaluation of clinical, humanistic and economic outcomes with the goal of improving overall health.

Generic Pharmaceuticals:  These will be available under a strict generic only formulary.  Discounted pricing will be available through the Duval County Health Department Pharmacy.  Negotiated discounts will be pursued with retail pharmacies.  In addition "compassionate use" pharmaceuticals (drugs donated by pharmaceutical companies to needy patients) will be pursued for eligible patients.  Finally, federal discount prices will be pursued for qualifying patients through the assistance of a pharmacy consultant provided through the Community Access Program (CAP) grant.

Outpatient Laboratory and Diagnostic Services:  These services will be provided by hospitals and by contract with local providers.

Governance:  The program shall be organized through JaxCare, a new 501 (c) (3) not-for-profit corporation.  JaxCare will employ a public/private partnership model.  The Board of Directors will consist of representatives from the public/private partnership, to consumers and industry experts.  This representative governance assures that the program will be responsive to the needs and interest of both the public and private sectors and keep their sometimes disparate interests in balance.  It also will provide an internal set of checks and balances as each member carefully evaluates the advantages and disadvantages of the program and strive for mutually beneficial solutions.

The JaxCare Board will seek to include leadership from:

  • City of Jacksonville Mayor's Office

  • City of Jacksonville City Council

  • Duval County Medical Society

  • Duval County Health Department

  • Faith Community

  • Hospital Systems

  • Insurance Industry

  • Philanthropy

  • Small Business and Corporate Sectors

A committee structure including committees such as Budget & Finance, Medical Management, Government Affairs, Marketing and Communications, Pilot Committees, Member Relations, and Management Information Systems shall be developed and delegated by the board to oversee various program activities.

Management:  The program will be administered and managed on a day-to-day basis by the corporation-JaxCare, building on the work and resources provided by Communities in Charge - Jacksonville.  This strategy will maximize the use of existing resources and provide work already completed, and make available Communities in Charge grant funs for the start-up phase of JaxCare.  These grant funds, totaling $1.5 million in 2002 and $1.2 million in 2003, are targeted specifically for the development of the JaxCare program; including staff salaries and the development of organizational, administrative and electronic infrastructure.

Further, the structure will maximize certain program financial efficient and allow for the further uninterrupted planning, development and integration of ongoing related projects.  JaxCare will outsource administrative services where it is cost-effective.  During the first six months of the pilot, request for proposals will be let, and based on responses.  JaxCare will determine the best approach for providing:

  • Accounting and finance

  • Third party administration (provider billing and reimbursement)

  • Utilization management

  • Care management 

  • Enrollment and eligibility

  • Provider credentialing and network development

  • Public relations/marketing

Implementation of these decisions were completed by May 2003, along with initial member enrollment and system testing.  The pilot program "go live" date is projected for Summer 2003.

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§        Financing & Outreach Strategies

Financing Approach

The program will be financed on a "pay -as-you-go" basis wherein all costs are immediately shared on a percentage basis by a variety of funding sources both private and public.  These include contributions from employee cost sharing, employer contributions, hospitals (Baptist, Brooks Memorial, Shands, University of Florida Health Sciences Center Jacksonville, St. Luke's/Mayo St. Vincent's), physician groups, the Jessie Ball DuPont Fund, Blue Cross and Blue Shield of Florida and various other foundations and corporation and the City of Jacksonville (general fund).  In addition, the Communities in Charge grants for The Robert Wood Johnson Foundation and the U.S. Department of Health and Human Services will be transferred to fund the JaxCare Program.

Projected medical costs for the program have been calculated by Reden & Anders, Inc., Consultants & Actuaries.  These costs have been determined by the characteristics and size of the covered population and type of benefits to be offered.  To estimate the costs for this pilot program Reden & Anders completed an actuarial analysis using its commercial costs.  TANF cost models and the following provider reimbursement assumptions:

  • Hospital reimbursement at 80 percent of Medicare.  (While these will be donated, all parties desired a uniform measure to track costs across hospitals).

  • Physician fee schedule at 80 percent of Medicare for Jacksonville with certain specialists at 100 percent of Medicaid or higher

  • Pharmacy contracts with 35 percent discount on average wholesale price (AWP) for generic drugs; $5.00 dispensing fee

Financial Risk Control Mechanisms - JaxCare will have in place the necessary controls to assure that program costs do not exceed budget.  There are required to protect the program for the risk of exceeding its budget.  Multiple options are available including:

  • Capping Enrollment;

  • Capping provider payments at some level;

  • prioritizing provider payment in case funds run short;

  • Reinsurance

Member Cost Sharing - Cost sharing is integral to the program design.  Member cost sharing will provide more than $633,000 to the program.  This will be contributed through co-payments for care as follows:

  • $100 per hospital admission co-pay

  • $100 per emergency room visit co-pay

  • $100 per outpatient surgery visit co-pay

  • $100 per ambulance transport

  • $25 per MRI, PET, or CAT scan

  • $10 per physician office visit 

  • $5 per routine laboratory visit

  • $5 per script for generic pharmacy

Employer Contributions - Employer contributions will provide more than $1.26 million of total program cost medical costs.  This will be collected through a charitable contribution to JaxCare through a $50 per member per month employer charge.

Hospital Contributions - Hospitals collectively will contribute all care and services received on an inpatient and outpatient basis by JaxCare patients for the duration of the pilot program at no charge.  The value of these hospital costs over the two-year pilot is $2,131,301 calculated on a reimbursement rate of 80 percent of the Medicare fee schedule.

Local Corporate and Foundation - Will contribute $400,000 or more

City of Jacksonville - The City will subsidize $2.5 million of the direct healthcare costs.

Federal Contributions - Will exceed $1 million during 2003-2004 for JaxCare administration and staff support as well as for other administrative and technological infrastructure, which is not reflected in the financials.

The Robert Wood Johnson Foundation - Will contribute over $340,000 for community education, administration and staff support.

Cost Estimates - Costs of the program have been calculated by Reden & Anders, Inc., Consultants & Actuaries.  These costs have been determined by the characteristics and size of the covered population and type of benefits offered.  To estimate the costs for this pilot program, Reden & Anders completed an actuarial analysis using its commercial costs, TANF cost models and provider reimbursement assumptions.

In calculating these annualized costs for this program Reden & Anders considered several factors that impact unit cost:

  • Hospital reimbursement at 20 percent of charges

  • Physician fee schedule at 100 percent of Medicare for Jacksonville

  • Pharmacy contract with 35 percent discount on generic drugs; $3.00 dispensing fee

  • Risk selection and demographic mix

Table 1 displays all the program funding sources associated with JaxCare Inc., meeting all of its two (2) year objectives including financing for the JaxCare Pilot Program, the continued development of the shared network infrastructure, ongoing long-term sustainability plans for the program and educating and advocating for policies and financing options to increase access to care.  The JaxCare pilot is for a population of 1,500 adults with income at 150%-200% of the Federal Poverty Level, representing a cross-section of risks (neither positive nor adverse selection).

Click Here to View Table 1

Total program costs are based on per member per month (PMPM) costs of $107.06.  Table 2 illustrates the distribution of PMPM costs.

Click Here to View Table 2

Within the categories defined in Table 2 above:

  • "Outpatient Hospital" includes lab and diagnostic services

  • "Administration" includes medical management (quality improvement, care management), billing and enrollment, claims adjudication, member services, marketing, finance and accounting;

  • "Other" includes home health, durable medical equipment and ambulance.


Recruitment Strategy - Targeted enrollment efforts are through large and small employers of Duval County.  In addition, outreach strategy will be based on use of existing programs and linkages.  Linkages to social service, faith-based and other community agencies will be a key component of the outreach and marketing strategy.  The health and social service community will identify appropriate access points for entry into the system of care.  Functional interrelationships among the helping professionals and an understanding of the system, its services and benefits and eligibility process will be a most effective marketing strategy.

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§        Accomplishments to Date

See Above

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§       Challenges

See Program Design

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§        Contact Us

Rhonda Davis Poirier, Ph.D., P.H
Executive Director
West 8th Street
Tower II, 10th Floor
Jacksonville, FL  32209
Ph:  904-244-9271
Fax:  904-244-9275




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