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Coordinated
Health System of Jefferson County
Birmingham,
AL
This
grant is now inactive. The community requested withdrawal from the
program.
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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
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Implement the initial
Network Service Area
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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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