Vision: There will e an effective permanent system for low-income,
uninsured adults to receive appropriate timely and affordable healthcare.
Mission: The mission of the Communities in Charge Coalition is to
create and implement an appropriate healthcare delivery system for uninsured adults
who live in Jefferson County; are ages 19-64 and have a household income at or
below 200% of the Federal Poverty Level (FPL).
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Louisville Jefferson County Communities in Charge Coalition is a 115-member
organization representing community healthcare stakeholders including hospitals,
safety-net providers, University of Louisville, physicians, behavioral
health/substance abuse experts, state and local governments, faith institutions,
businesses, and healthcare consumers. In August 2001, the Coalition formed
a not-for-profit corporation to oversee development and operations of its
programs for the uninsured in Jefferson County.
Coalition has seven working committees to channel the skills of
participants: Finance, Information Systems (IS), Public Information and
Outreach (PI & O), Research Care Coordination, Behavioral Health and
Consumer Advisory. The Coalition's diversity of volunteer expertise and
interests are critical to successfully implementing and funding its programs.
estimated that there are approximately 46,000 uninsured adults in Jefferson
County who meet the eligibility standards identified in the mission
statement. The Coalition is committed to developing a members benefit
package available to all individuals eligible for services. However, it is
believe that like most communities there is a small percentage of this
population who because of chronic illness, lack access to specialty care and
poor disease management in utilizing a disproportionate amount of indigent
healthcare resources. This group of medically fragile individuals is
thought to most benefit from coordination of care in medical/social case
management model. The community, therefore has chosen to enroll a small
group of these patients in a demonstration project that is designed to test
availability of services, eliminate duplication of efforts, and to develop
system changes to improve health outcomes and diminish costs of care.
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testing the medical, social and behavioral health/substance abuse treatment
systems, with the pilot population, plans call for expansion of the services to
more eligible members. The coalition is negotiating with safety-net
providers and government leaders to reinvest the achieved savings back into
programs for expansion to the broader population. In addition, a
community-based effort to create a return-on-investment strategy is underway
that would quantify cost benefits for the community at large, i.e., businesses, government,
healthcare consumers and providers. This information will be sues to help
perpetuate the program in the coming years.
Coordinators perform a variety of functions to facilitate community-based
care. The program will employ a diverse team of professionals, including
social service specialists. The team will assist patients in accessing
needed specialty care, behavioral health/substance abuse services,
transportation, home health, and equipment and disease monitoring tools.
They will promote healthy behaviors, conduct patient education, conduct health
risk assessments, client tracking and patient satisfaction evaluations.
Care Coordinators identify clients who likely qualify for SSI benefits and would
with legal aid qualify them and secure coverage. Care Coordination
caseloads are expected to be 25-50 clients. Referral into the Care
Coordination Program will be by healthcare professionals, clients, or family
members. Client Participation in the program will be optional.
services are being provided by existing safety-net providers, including
University Hospital and clinics, the FQHC's and private practice
physicians. All enrollees will have access to comprehensive healthcare
services including a medical home for primary care, specialty care, diagnostic
testing such as lab work and x-rays, pharmacy assistance, care coordination,
inpatient/outpatient hospital services, 24/7 nurse help line for medical advice
and behavioral health/substance abuse services. Efforts are underway to
expand services to include ambulance services, home health, medical equipment
and dental care.
and outpatient hospital services will be provided by University Hospital to the extent
that space and financial resources allow. Physicians who do not have
privileges at University may refer patients to University of Louisville for care
and then resume oversight for follow-up care. Other hospitals will absorb
inpatient care above University capacity or when a physician from another
hospital opts to oversee care during inpatient/outpatient treatment.
hospital services will include those services provided to Jefferson County
residents through the Medicaid Program.
Nurse Help Line
will be issued a telephone number to receive basic health information or advice
on whether symptoms warrant emergency treatment. The telephone line will
be linked to registered nurses who will be available to receive calls 24 hours a
day 7 days a week. The service will be patterned after another successful
program in the community which has proven effective in reducing inappropriate ER
usage among Medicaid patients. The telephone number will be listed on each
enrollee's membership card.
proposal submitted in Health Kentucky Inc., would extend to comprehensive drug
formulary to all Communities in Charge members in Jefferson County. Using
this formulary, prescriptions would be filled at clinic and hospital pharmacies
as well as community-based private pharmacies. Participating drug
companies have agreed to replenish the pharmacy's stock of medications for
eligible clients. Participating pharmacies would wave their usual
dispensing fees. Under the proposed agreement, drug companies would
continue to replenish the pharmacies stock for KPC-issued drugs, but pharmacies
would receive normal dispensing fee for private patients between 100 and 200% of
the federal poverty level. The patient would pay this charge as a
co-payment at the time the prescription is filled.
testing such as lab work and x-rays will be performed primarily by University
Hospital, its clinics and the community health centers. A member who
chooses one of the clinics as his/her medical home, will continue to receive
basic lab and x-ray services that extend beyond the capability to the
community-based facilities. The same services will be provided for
patients being treated by the hospital and its clinics. The University of
Louisville Hospital leadership has pledged to provide these services, like other
hospital services, up to maximum financial and facility resource capacity.
hospitals will perform diagnostic testing beyond University capacity or at the
request of a participating physician. Negotiations will be conducted with
private labs in the community to provide services for the physicians who
customarily refer patients to them. Health Kentucky which sponsors the
Kentucky Physician Care Program, has an informal agreement with Smith Kline
laboratories and may be extended to serve Communities in Charge as well.
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Accomplishments to Date
The Louisville Jefferson
County Communities in Charge Coalition successfully completed Phase One of The
Robert Wood Johnson Communities in Charge grant program during 2000. This
successful completion included the building of a highly effective coalition,
researching the issue of access to healthcare for the low-income uninsured,
raising community awareness, developing a plan for improving access to
low-income uninsured, developing a financing strategy and successfully
completing Phase Two grant to secure implementation funding for this plan.
At the time Jefferson
County, Kentucky submitted the Phase One Robert Wood Johnson Foundation
Communities in Charge grant application, the Louisville Jefferson County
Communities in Charge Coalition was a concept. The concept was to build on
the foundation of collaboration within the medical community that had developed
over an extended period of time. An extensive communications and public
awareness campaign was used to invite participation in the Coalition of the
initiation of Phase Two. Ninety-five individuals have joined the
Coalition, representing a broad array of stakeholders with an interest in
improving access to healthcare for the uninsured in Louisville, Jefferson
Most recently, the Public
Information and Outreach Committee went through the arduous process of searching
for a new name to market the program. The committee chose getCare
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text currently available
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getCare Health Plan
552 E. Market Street, 2nd Floor
Louisville, KY 40202
Phone: (502) 583-4690
Fax: (502) 583-1978
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