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COMMUNITIES in CHARGE in CENTRAL
NEW MEXICO
Albuquerque,
NM
April
2000
§ Background
New Mexico ranks
last in the nation in the percentage of its population between 19-64
that is uninsured. New Mexico has limited resources for new
taxes for public services and an increase in taxes for health care is
not a realistic strategy in the current political environment.
In the central New Mexico area, much of the care for the uninsured is
delivered by the safety net of the University of New Mexico Health
Sciences Center (UNMHSC--a public academic health center) in
coordination with the Albuquerque FQHCs. However a significant among
of indigent care is also provided by the private health care
systems. Total indigent care costs for the region is estimated
at between $100-200 million financed through disproportionate share
funding, county indigent funds, special grant-financed programs, and a
substantial amount of cost-shifting.
The central New
Mexico region has four major vertically-integrated hospitals which
also own or are closely affiliated with one or more managed-care
plans. The region has an extremely high rate of managed care
penetration, estimated at over 60 percent. In 1997, the state
implemented mandatory managed care for approximately 200,000
beneficiaries.
Communities in Charge in Central New Mexico is a collaborative initiative for
a four-county region including and surrounding Albuquerque. The Coalition
represents all the major health care providers and systems in the area, the
state health and human service departments, and a wide range of community
grassroots organizations. The program will design a financing system for care
for approximately 125,000 uninsured adults. (The program concentrates on adults,
as virtually all of New Mexico's low-income children are eligible for Medicaid.)
The program
design recognizes the special circumstances in the state-a political
reality that new taxes for health care are not an option at this time,
a very low-income population with little current access to
employer-provided health care coverage, and significant opportunity to
build a system of coverage for working families. From the
outset, the Coalition has included the key players to make the project
work. This includes the provider community--public and
private--which includes the majority of the health care dollars, and
the state Medicaid agency which controls the other major portion of
the financing system, and the business community whose support is
essential for project success.
The Coalition was formed in the spring of 1999, but
includes many of the same members as the coalition formed in New Mexico for the
Covering Kids project. The Coalition is led by a Steering Committee which
includes representatives from the New Mexico Hospitals and Health Systems
Association, the University of New Mexico Health Sciences Center, the state's
health and human services departments, the New Mexico Health Policy Commission,
the New Mexico Primary Care Association, the New Mexico Advocates for Children
and Families, county government, and the business sector.
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§ Guiding
Principles
The project
plans to utilize a financial strategy that reorients existing health
care dollars so that they are used more efficiently while leveraging
other resources. Various financial options will be reviewed and
approaches developed to improve the health care delivery system to
free up funding to finance care for the uninsured, work with the
business community to explore potential incentive systems for
employer-provided coverage, and work with the state to leverage
federal funds.
The project will
dovetail with tow other major initiatives - the UNM Care Plan and
Kellogg Community Voices project of NNMHSC, a state project that
addresses the uninsured. The first uses a "health
commons" approach to address coverage issues to the
uninsured. The second is directed by a legislative memorial and
sponsored by the New Mexico Health Policy Commission
The
Communities in Charge Coalition will serve as a critical
consensus-building group in developing the financial strategies; the
lead organization for the Coalition is the New Mexico Hospitals and
Health Systems Association.
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§ Initial
Project Objectives
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§
Financing
& Outreach Strategy
Financing
Strategy
Rather than constructing a
single financing solution for the uninsured, a variety of mechanisms will be
pieced together. The project will seek to reallocate existing health care
dollars being spent on behalf of the uninsured and will also explore options for
leveraging additional federal and state resources, including cost-neural
Medicaid waiver options. The project will also investigate potential
business/employer incentives that could be designed to improve
employer-subsidized coverage.
Outreach
Strategy
The membership of the
Coalition includes the state's major health care advocacy groups. These
groups will take the lead in designing strategies to communicate with and
involve the uninsured in the development of outreach strategies. The
Coalition plans particular targeting efforts through church organizations, labor
organizations, and other existing grassroots organizations. New Mexico has
been creative and successful in its outreach strategies for Medicaid and SCHIP.
Delivery
System
The
anticipated network and delivery system design will build off the
experiences of the UNM Care Plan which has developed linkages between
UNMHSC the FQHSs, dental providers, public health services, social
services, and case management services. This project will allow
expansion of this model to the private provider system to create a
more seamless and integrated system between the public and private
sectors.
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§
Challenges
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§
Demographics
Geographic Area: Four counties in central New Mexico including the
Albuquerque area; a mix of urban, suburban, and rural counties
Total Population: About 700,000; over 1/3 of the state's population
Uninsured Population: 125,000 adults
Target Segment: Uninsured adults below 235 percent of the federal poverty
level (Virtually all uninsured children in New Mexico are eligible for Medicaid
or SCHIPS, which covers children in families with incomes up to 235 percent of
the FPL).
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§
Contact
Us
Maureen
Boshier
President
& CEO
New
Mexico Hospitals & Health Systems, Inc.
2121
Osuna Road NE
Albuquerque,
NM 87113
Phone:
(505) 343-0010
Fax:
(505) 343-0012
E-mail:
mboshier@nmhhsa.org
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