Development and Implementation Grant
Requirements
Phase Two National Press Release

 

Coordinated Health System of Jefferson County  
Birmingham, AL

This grant is now inactive.  The community requested withdrawal from the program.

Objectives

Program Design

Financing and Outreach Strategy

Accomplishments to Date

Community "Gift"

Challenges

Press Releases

Contact Us

               Objectives

Several goals have changed from the set forth in Phase One.  First the concept of developing a Healthcare Authority was abandoned in lieu of incorporation to the Coordinated Health System of Jefferson County.  The Healthcare Authority was found to be too limiting and politically driven.  The Coordinated Health System allows for a broader spectrum of representation from the various providers and community organizations.

Second, enrollment of members in the HealthPlus+ plan through their interaction with the current delivery system in participating hospital emergency rooms has not produced the desired results.  Subsequently, the Coordinated Health System (CHS) will refine the process to include a mixture of both the current method of encountering potential members at local health fairs, musical events, etc., and has revisited the front line staff in the hospital ER's to refocus attention of the HealthPlus+ Program.  If these efforts do not quickly produce the desired results, CHS will likely add the step of identifying potential members using hospital charitable care and bad debt records.

Finally, the focus has switched from the funding of the model through the Charitable Trust Fund to the successful development of a working model.  The reluctance of the County Health Department to open he use of their database on the scheduling and tracking of patients has caused CHS to reconsider how to track and refer patients.  While the development was a setback it provided an opportunity to simplify the system.  This reduction of attention lightened the fact that the development of a successful, working ER referral model is a valuable public relations tool for the participant coalition hospitals.  Continued enrollment efforts and the development of a successful specialty referral network will likely lead to sustained funding strategies.

During the first year of Communities in Charge, Phase Two in Jefferson County, CHS listed the following as its goals:

  • Finalize the details of the Emergency Department Transferal Program

  • Complete the development of a Specialty Physician Referral Program

  • Implement the initial Network Service Area

  • Implement a unified enrollment and eligibility system

  • Initiate evolution of program efforts and effectiveness

  • Install and evaluate the electronic patient tracking, scheduling and medical report system throughout each Network Service Area

The lessons learned from the successful initiation of these goals have been illuminating.  First, and foremost, the implementation of subsequent referral programs in other Network Service Areas.  From the pilot Western Network Service Area, Coordinated Health Systems was able to develop an outline of individuals to contact and process a flow that allows the agency to follow a step-by-step method.  The greatest benefit of this outline is that it helps eliminate uncertainty and eases the tasks of managing change, which is inherent to a project of this magnitude.  CHS is continually refining the Emergency Department Referral Program to coincide with lessons learned from the implementation of the initial NSA.  In addition, CHS is evaluating information gathered from the financial analysis of the Western NSA Emergency Referral Program and applying this information to the refinement of the program.  From this financial evaluation and data gathered from the Western NSA, it is apparent that a marketing campaign is necessary to announce the program and educate the target population t the benefits of primary care.  Most problematic have been the goals of developing a specialty physician referral program and installing an electronic patient tracking, scheduling and medical records system.

Efforts to initiate the specialty referral program in the Western NSA has moved forward slowly, but considerable progress has been made in the past few months.  A specialty referral network has been identified.  Going forward, CHS plans to complete a referral database to assist in the tracking and coordination of the specialty referrals in this area.  This database will replace the manual process that is in place now.  This is an exciting prospect in that many valuable lessons will be learned from this undertaking, which can be applied in the ensuing development of other Network Service Areas.

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       Program Design

Communities in Charge in Jefferson County concluded the first year of Phase Two with the implementation of the pilot Western Network Service Area (NSA) and the continued development of additional NSA's.  Last year saw the successful incorporation of the Council for a Coordinated Health Care System of Jefferson County.  The Coordinated Health System was awarded 501 (c) (3) status and continued to add new members in the coalition.  Going forward, CHS will focus on the final development and implementation of a coordinated healthcare delivery system built composed of primary care and referral network.  Components of this delivery system include Emergency Department Transferal and Specialty Physician Referral Program. 

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         Financing & Outreach Strategies

Financing Strategy

Jefferson County is the only county in Alabama that levies tax specifically to meet the healthcare needs of "those who afford none or only part of the cost of their healthcare."  The sales tax generates approximately $84 million a year; approximately $37 million is for the Indigent Care Fund and $14 million in direct subsidy to the Jefferson County Department of Health.  The Jefferson County Commission oversees the Indigent Care Fund as part of the Cooper Green Hospital budget.  The Indigent Care Fund provides half of the operating budget for Cooper Greenland, provides specific services at the Jefferson County Department of Health, Children's Hospital and UAB.  Monies from the ICF are not used to offset uncompensated care costs in the private sector.  The need for a reimbursement system for the opening and subsequent closing of the Bessemer Northside Community Clinic.  The primary care practice opened as a partnership between Bessemer Northside Medical Center (BCMC) and Jefferson Health System as direct outgrowth of the Council's activities.  In this partnership agreement, JHS supported half of the family physician's compensation package so that half of the practice as comprised of uninsured persons.  BCMC and its medical staff agreed to provide specialty referral care, diagnostic services, emergency care and hospitalization of their community charitable contributions.  With no limits placed on the risk for the private providers costs soon began to amount and eventually the private specialty physicians walked away from the clinic facing financial crisis in their practices.  From this experience, the importance of structuring a specialty physician referral program that proactively limits the risk to the providers was learned.

Outreach Strategy

A focus on enrollment will be an essential feature of the system development in Phase Two.  To that end, CHS has developed a three-pronged approach to marketing the benefits of the Communities in Charge Program.  As mentioned earlier, CHS identified a marketing firm to assist in the development of an outreach program.  The marketing efforts will begin with a series of focus groups designed to identify the target market and understand what approaches will best bring the education message to this group.  Further efforts will build on this foundation and will include a mass media campaign.  In addition, CHS plans to purchase a van to convert a mobile enrollment unit that will encounter potential members at health fairs, celebrations, and other community gatherings.  Finally, the outreach strategy will employ use of the United Health Plus+ Program to corporations and community advocacy groups in Birmingham.  In collaboration with the Jefferson County Health Department, Jefferson Health Systems, and the private providers, the importance of primary and preventive care through a marketing strategy and outreach education efforts.  Emphasizing the use of a medical home and its ability to provide diagnostic and specialty referrals, the System will attract the uninsured population. 

Delivery System

The model for the delivery system remains the same.  Jefferson County will be divided into five Network Service Areas reflecting current utilization patterns.  Each Network Service Area will consist of primary care physicians, specialists, support services and hospitals.  The uninsured will be actively enrolled in the system branded "HealthPlus+", select a primary care providers, and become part of a Network Service Area.  The public sector, i.e., Cooper Green Hospital and the Jefferson County Department of Health, will be responsible for developing the primary care infrastructure along with an appropriate mix of specialty and diagnostic services.  Medical management of persons enrolled in the system will be consistent with managed care principles, i.e., primary care orientation, health promotion and pre-approval for referrals.  The NSA system will be the key focus in the initial establishment of networks and strategy for care delivery by the Coordinated Health System.  In addition, the Disease Management Network will target conditions that are high cost, require an extensive specialty management, an/or have the potential for significantly improving health outcomes for the illnesses.  HIV/AIDS, asthma, diabetes and sickle cell disease are areas of focus that are already in development and would be enhanced through the Disease Management Network concept.  The Disease Management Networks will build on the referral and patient tracking relationships.  The Emergency Department Transferal Program will capture uninsured individuals as they interact with the conventional healthcare delivery system.  Emergency Department staff will identify a patient as eligible for HealthPlus+, select a primary care clinic, and schedule a follow-up appointment.

The Specialty Physician Referral Program will be composed of specialty physicians who treat a limited number of patients referred from the HealthPlus+ Program.  Physicians will be approached jointly from the Coordinated Health System of Jefferson County and Jefferson County Medical Society.  Each Good Samaritan program physician signs a referral voucher indicating the number of patient referrals that they will commit to see during the next twelve months.  Once a physician's indicated number of referrals have been reached, no other patients will be referred for the remainder of the year.  Referrals will be made on a rotating basis within designated specialists.  So ideally, referrals given to a specialist from the HealthPlus+ Program will be spread through the year rather than concentrated in a short span of time.

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   Accomplishments to Date

      See Program Design

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        Challenges

Among the complex issues of developing the Coordinated health System, include; financing of services, especially specialty care; maintaining working relationships with various providers; satisfying political demands; and recruiting specialty physicians.  All of these issues are significant hurdles that the program is working toward solving through constant collaboration with its member operations.   The envisioned use of the Jefferson County Health Department's common database as a patient tracking, scheduling and medical record system met with some resistance.  In response, the Coordinated Health System adjusted to this development and is seeking alternative solutions to this area.  Since a common data repository is a stated goal of many of the members of the CHS Coalition, this is the likely solution to this problem.  However, funding this endeavor will require creative thinking.  Funding for reimbursement of the specialty referral network is considered to be a necessary step for a continued existence of the referral network.  While initially specialists may agree to see patients on a charitable basis, eventually a reimbursement system will need to be cultivated.  Since many specialists become a primary care physician for patients with chronic illnesses, it is also envisioned that some mechanism for returning the chronically ill patient to the public sector for primary care will need to be developed.

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        Contact Us

Michael Griffin
Project Director
Coordinated Health System of Jefferson County
2121 8th Avenue North, Suite 200
Birmingham, AL 35203
Phone: (205) 327-8254
Fax: (205) 327-8255

E-mail:  lyncht@jccal.org

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