Organization and Planning Grant Requirements

Phase One National Press Release

BALTIMORE CITY HEALTH DEPARTMENT
Baltimore, MD

April 2000

               Background

BCHD chose the Sandtown-Winchester, East Baltimore and Park Heights communities for this initiative since they already-established community level service delivery networks and BCHD had existing relationships with all three communities.  It is a founding member of the Vision for Health Consortium (VFH) since 1994, and BCHD Deputy Commissioner of Operations, Hakim Farrakhan chairs VFH's Board of Directors.  Further, BCHD helped to create PHCHA in 1997.  Elias Dorsey, BCHD Deputy Commissioner for Grants, Research, and Policy was an active HEBCAC Board member.

The Robert Wood Johnson Communities in Charge Initiative provided the impetus to form a coalition of the three existing efforts already underway in the three-targeted areas.

BCHD is working with three innovative consortia within each of the pilot communities:  The table below depicts participants from each community.

Community

Consortium

Health System/Institution

Middle East

Historic East Baltimore Community Action Coalition (HEBCAC)

Johns Hopkins Health System

Park Heights

Park Heights Community Health Alliance (PHCHA)

LifeBridge Health -Sinai Hospital of Baltimore

Sandtown-Winchester

Vision for Health Consortium (VFHC)

Total Health Care, Bons Secours Baltimore Health System, University of Maryland Medical System and University of Maryland School of Nursing

In addition to these three organizations, BCHD has received formal commitments of support from the following health systems and institutions:

  • The Historic East Baltimore Action Coalition (HEBCAC) - John Hopkins Health System

  • The Park Heights Community Health Alliance (PHCHA) - Sinai Hospital of Baltimore

  • Vision for Health Consortium (VHC) - Bon Secours Baltimore Health System, Total Health Care, University of Maryland School of Nursing and University of Maryland Medical System.

Primary care is currently available to the uninsured and residents through Baltimore's Federally Qualified Health Centers on a sliding fee scale, emergency rooms, health department clinical sites, and Maryland Primary Care provider sites.  Although, these safety net providers currently have provisions to provide care to the uninsured, there is not an incentive to design a dedicated, or systematic effort in place to use these primary care sites as a vehicle for cost shifting from the acute care setting.  There are minimal if any effort made in outreach to assure that the services are made available.

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         Guiding Principles

Baltimore City Health Department (BCHD), as the lead agency, is working with three consortia, Vision for Health Consortium in Sandtown-Winchester (VFH), the Historic East Baltimore Action Coalition (HEBCAC), and the Park Heights Community Health Alliance (PHCHS), to develop systems that can serve as models for improving access and quality care for uninsured residents in all Baltimore City neighborhoods.  BCHD is leading a citywide effort to create a coordinated system of healthcare delivery, finance, and information management.

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       Initial Project Objectives

BCHD has identified two objectives to achieve planning goals:

  • Develop a model for providing quality, cost-effective preventive and primary healthcare and supporting services to uninsured residents in the Sandtown-Winchester, East Baltimore, and Park Heights neighborhoods.

  • Develop a business plan for financing and managing services delivery to uninsured residents in three target neighborhoods.

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        Financing & Outreach Strategy

Financing Strategy

Currently, hospital and other Baltimore healthcare providers are absorbing a large portion of the cost of serving the city's uninsured residents.  Today, much of the care for the underserved is being paid for through uncompensated care resources.  Because of high cost, the underserved generally delay seeking care until it reaches expensive, emergency level proportions.  Under Maryland's All-Payer System, acute care for those that do not have insurance is partially offset through a state funding mechanism established by the Health Service Cost Review Commission (HSCRC).  As levels of uncompensated care rise the overall rates increase for the hospital services.  This is a negative incentive for hospital systems that are struggling to the price competition in today's managed care environment.

Potential sources of ongoing support for serving low-income uninsured residents in the three target neighborhoods include the BCHD, the Maryland Health Services Cost Review Commission (this rate-setting commission controls a pool of money to help hospitals reduce uncompensated care), the Maryland DHMH, private foundations, businesses, and increased sales taxes such as the tobacco tax.  In conjunction with the BCHD, the three consortia will develop a business plan that will project the ongoing cost of delivering care to uninsured residents in these three neighborhoods, identify sources of funding, and develop strategies for securing those funds on a continuing basis.  This plan will also require conducting a cost-benefit analysis to determine whether and how adopting a different, more community-based approach to serving uninsured residents will save much money.

Outreach Strategy

Currently, many uninsured residents do not seek low-cost or free healthcare before their conditions become critical because they do not know such services exist, and are reluctant to interact within the "system" or are too overwhelmed by the psycho-social problems that typically accompany poverty to access care.  Currently, the BCHD is drafting an outreach training curriculum that can serve as a model and help standardize the meaning of "outreach" across programs and services, to include those who are uninsured but eligible for various state or federal healthcare programs.

Delivery System

Although still evolving, each of the three consortia already has a network in place through which healthcare services are being-or-can-be provided to uninsured residents.  This project aims to create a "network of networks" in all three communities that can serve as a model for healthcare delivery citywide.  This aim is not to offer the exact same services in the neighborhood.  

Recognizing that medical problems facing the poor cannot be treated in isolation from educational, housing and employment issues, each consortium includes not only healthcare providers but also representatives from a wide range of social safety net, educational, family support services, church, youth services and housing organizations.

The project's central administrative task will be to create what is called a "shadow managed-care organization."  A shadow MCO is a mock insurance program that can serve both as an instrument for collecting and analyzing data about the uninsured and as a mechanism for proactively managing their healthcare.  In such a system, uninsured residents are assigned an identification number, which healthcare providers and others use to gather basic data, such a number of visits types of diagnostic categories, services rendered, and cost.  This data can be analyzed to gain insight into when, why and how the uninsured seek (or fail to seek) healthcare and the cost effectiveness of current service models.  Armed with such data, healthcare providers, activists, and city officials can identify gaps in services, improve existing services, and design new services in the three target neighborhoods and throughout Baltimore City that ensure better utilization, cost-effectiveness, and health status for uninsured residents.

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       Challenges

  • New leadership at state and local level, Baltimore City is in transition with a new mayor, and the state appointed a new Secretary of Health and Mental Hygiene.  The proposed plan for financing and managing services delivery to the uninsured needs their endorsement.

  • Maryland is the only state in the country where hospital rates are set by a state regulatory commission, Maryland Health Services Cost Review Commission.  As a result, hospitals are not directly eligible for federal funds hospitals in other states can obtain to cover at least some of the costs of serving uninsured patients.  Support will be needed to set rates.

  • Lack of sound data on the uninsured and the financial impact of providing healthcare access to the uninsured.

  • Mobilization and education of health industry leaders, legislators, business community and grassroots organizations to advocate for increase healthcare access for the uninsured.

  • Residents and health providers are not interacting in ways that adequately meet uninsured residents' healthcare needs.

  • Existing health programs and providers of indigent care is not well advertised or understood.

  • The underserved and uninsured residents of Baltimore do not have a voice in how healthcare is delivered.

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       Demographics

The initial twelve-month project will target the uninsured residents of Baltimore City's Middle East, Park Heights and Sandtown-Winchester communities.

Coalition
Catchment

Population

%
Unemployed

%
Poverty

% African
American

Medium
Household
Income-95

Special Designation

Baltimore

660,000

8.7%

22%

62%

$24,000

Empowerment
Zone

Sandtown-Winchester

10,300

17.8%

41.5%

99%

$11,407

--

HEBCAC

43,999

30%

60%

98%

$11,800

Empowerment

Park Heights

33,000

22%

35%

95%

$27,000

Hotspot

  • Baltimore uninsured rate: 24.5% (data source: Behavioral Risk Factor Surveillance System).

  • Targeted area uninsured-while precise figures do not exist as to the number of Baltimore residents who are uninsured in our target areas, the major city hospitals report that between 20 and 30 percent of their patients do not have health insurance.

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        Contact Us

Nkossi Dambita
Baltimore City Health Department
210 Guilford Avenue
Baltimore, MD 21202
Phone: (410) 396-1420
Fax: (410) 396-1617
E-mail:  ndambita@baltimorecity.gov

 

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