Organization and Planning Grant Requirements

Phase One National Press Release

getCare Health Plan
Louisville, KY

April 2000

               Background

Even before the prospect of this funding emerged, representatives of local governments, managed care plan, university health hospitals, a medical school, providers of medical care, the county health department, and community hospitals met to confront the problems of the uninsured and underinsured in Jefferson County.  The implementation of Medicaid managed care, the shrinking state and local funds and an increasing number of uninsured patients have combined to create a community-wide challenge.  While the overall economy and unemployment are the best in many years, the transition from manufacturing jobs to service industry jobs led to an increase in the uninsured population.  Despite good-faith attempts by traditional providers to increase integration services, care for the uninsured is often fragmented and duplicated, leading to excess costs and less than optimal outcomes and growing deficits.  The existing delivery system focuses a majority of public resources on inpatient services, with a reliance on emergency rooms for routine primary care.  Economic incentives are not aligned properly to encourage prevention and primary care, so the system is largely devoted to sick care, rather than prevention and wellness.

The main providers of charity care are:

  • Preventive Health:  Jefferson County Health Department

  • Primary Care Services:  Family Health Centers, Park Duvalle Community Health Center, University of Louisville Primary Care Center

  • Physician Specialty Services:  University of Louisville Clinics

  • Hospital Services:  University of Louisville Hospital, Kosair Children's Hospital

  • Healthcare for the Homeless:  Family Health Center, Inc., Jefferson County Medical Society Outreach Program

         Guiding Principles

In order to achieve the goals of Phase I, the Louisville Jefferson County Communities in Charge Coalition will be formed.   Through this coalition of those who pay, those who provide and those who receive services, we intend to design a system of care that does more than simply replicate the current payment and delivery system of the uninsured.  The plan will include a complete description of the population to be served, a plan for the mechanics of payments and referrals, a description of the services to be provided and the arrangement of current financing resources.

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         Initial Project Objectives

The goals of Louisville/Jefferson County initiative for the uninsured is to provide access to basic health services, subject to the availability of funds with an emphasis on prevention and primary care.  The package of benefits would not be as comprehensive as Medicaid of the CHIP Program.  The package of covered services would include; preventive health services such as family planning and prenatal care, cancer screening and immunizations, primary care and specialty physician services, diagnostic, inpatient and outpatient hospital services and pharmacy services.  Additional services such as behavioral health, dental, vision and home health services, would only be covered if additional funding becomes available or with adequate number premium contributions.  Ultimately the exact mix of services will reflect the goals of the program and the financial realities in the community.

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        Financing & Outreach Strategy

Financing Strategy

Federal, state, local and private source funds are currently used to support health services to the uninsured in Louisville and Jefferson County.  Funding for a new system of care for the uninsured will require utilizing both existing funds and new sources of funding.  Potential sources of new funds for the uninsred are:

  • County Health Tax

  • City and County DSH funds returned from last year

  • District state funding for primary care services

  • Tobacco Settlement Funds

  • Indigent Care Fund:  Funded by savings from Medicaid managed care as proposed in the 1115 waiver

  • Foundation Support

  • Faith Communities Mission Funds

  • Community Ministries

  • Pharmaceutical Manufacturers

Phase I goals for financing are to determine the best mix of additional funding sources and to establish the means of bringing those funds into the system we create.

Outreach Strategy

Current outreach efforts will be inventoried and analyzed.  Applicable outreach efforts can be expanded to include the target population so new efforts can be created.

Delivery System

Louisville and Jefferson County have the basic components and the framework for an integrated delivery system for uninsured adults.  Passport Health could provide the organizational structure and provider network for an integrated system of care.  The current Passport Provider Network includes more than 3,000 physicians, 19 hospitals, 200 pharmacies, and other providers in the 16-county region that covers 95,000 members.  Passport provides coverage for AFDC, SOBRA, SSI AND SSI/Medicare eligible members for full range of Medicaid services (excluding long-term care and behavioral health services).  Passport has also submitted a proposal to become the CHIP provider for Western Kentucky.

A possible alternative for necessary administrative services would be to utilize the infrastructure of Passport Health Plan.  Passport Health Plan is a provider sponsored partnership under Kentucky's Sec 1115 waiver.  Passport Health Plan is a licensed HMO, owned and governed by Jefferson County's traditional providers of indigent care.  In fact, one of the initial goals of Passport was to ensure the viability of the safety net providers and expand coverage to the uninsured.  Passport Health Plan, with its administrative structure provides and ideal mechanism for delivering the necessary administrative services for an insurance program for the uninsured.

By providing services under the administrative umbrella of Passport Health Plan, administrative services costs should be minimized and duplication reduced.  It will also provide a unique opportunity to manage the members' healthcare over time, whether the individual is uninsured or covered by Medicaid Passport.  Since members move in and out of eligibility, an integrated medical management approach could provide seamless service, however the individual is covered.

The Jefferson County Health Department has a long history of collaboration with a wide range of agencies and organizations in the county.  The projects together involve millions of dollars in public resources and have served hundred of thousands of individuals to date.  The Health Department staff is will versed in the nuances of managing processes that involve disparate individuals and organizations, and in some cases have produced model programs that highlight interagency and grassroots input and collaboration.

A successful example integrating social, behavioral, and healthcare services into single multi-service sites is the Neighborhood Place Plan.  This program integrates the delivery of public health, county social services, Medicaid and TANF eligibility determination, school counseling, mental health, substance abuse, and job training services at seven locations in Jefferson County.  The program's goals are to reduce duplication and fragmentation and foster greater integration and coordination of services.  This program could serve as the platform for integrating services for the uninsured.

Both the program model and financing strategy capitalize in Jefferson County's culture of collaboration, and public-private partnerships that have characterized the community's recent and past attempts to address its problem.  Many of the major partners in the consortium have produced model programs nationwide.  A number of these partners have involved research community assessment, planning and policy development in this healthcare arena.

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         Challenges

The most significant hurdle will be the transition of providers negatively affected by changes in the delivery system.  It is anticipated that an integrated system of care will strain certain organizations.  The coalition will seek creative ways to assist organizations that feel affected since these organizations must continue to support.

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       Demographics

The target community, Jefferson County (which includes Louisville) has an estimated population of 670, 607 per the 1997 census. Of these individuals, 116,015 or over 17% are between 100% and 200% of poverty. An estimated 88,738 of these individuals are currently uninsured and represent the target population.

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        Contact Us

Wendy Ward
Executive Director
getCare Health Plan
552 E. Market Street, 2nd Floor
Louisville, KY  40202
Phone:  502-583-4690
Fax:  502-583-1978
E-mail:  getcare@bellsouth.net 

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