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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
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Primary
Care Services: Family Health Centers, Park Duvalle Community Health
Center, University of Louisville Primary Care Center
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Physician
Specialty Services: University of Louisville Clinics
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Hospital
Services: University of Louisville Hospital, Kosair Children's
Hospital
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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:
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County Health Tax
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City and County DSH
funds returned from last year
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District state funding
for primary care services
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Tobacco Settlement
Funds
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Indigent Care
Fund: Funded by savings from Medicaid managed care as proposed in the
1115 waiver
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Foundation Support
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Faith Communities
Mission Funds
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Community Ministries
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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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