Building a Countywide Healthcare Safety Net

1
Building a Countywide Healthcare Safety Net

• Orange County, California

2
Agenda

• Orange County
• The Health Funders Partnership
• The Safety Net Project
• Children's Health Initiative
• AccessOC
• Revenue Enhancement
• Advocacy
• Q A

3
Orange County, California

• 800 square miles
• Population 3 million
• 32 Latino
• 15 Asian/P.I.
• 49 Caucasian
• Income disparity
• 16th out of 100 metropolitan areas very high
  income
• 30th out of 100 metropolitan areas very low
  income
• Santa Ana 1 on Urban Misery Index
• Significant health issues

4
The Health Funders Partnership of Orange County

• A virtual organization consisting of entities
  that fund health and health related activities in
  Orange County, California
• Organized in 1999
• Members include
• Private Foundations
• Corporate Foundations
• Hospital organizations
• United Way
• County Health Care Agency
• Health Plans
• Children Families Commission

5
HFPOC Mission

• To improve local health by enhancing the impact
  and efficiency of
• health philanthropy in Orange County through
  collaboration.
• The Partnership attains this through
• The gathering, sharing and dissemination of
  information, thereby creating a learning
  community for health philanthropists.
• The identification of strategic issues for action
  and collaborative funding consistent with the
  mission and the management of these projects.
• Various creative funding approaches

6
HFPOC Activities

• Diabetes Initiative, Phase I 2001 2004
• Patient-centric
• Diabetes Initiative, Phase II 2004 2007
• Community Advocacy
• Diabetes Initiative, Phase III In development
• Healthy Smiles for Kids
• Developed, incubated, spun off
• Community Cares Health Centers
• Financial workout subsequently acquired
• Coalition of Orange County Community Clinics
• Strategy effort

7
The Safety Net Project

• Began September, 2004
• Convening of organizations the Mob
• Group process true collaboration
• Identified four areas created committees
• Specialty care
• Childrens health
• Revenue enhancement
• Advocacy

8
Safety Net Activities

• Committees meet regularly
• Executive committee meets monthly
• Mob meets quarterly
• Focused on solutions
• Early results promising

9
Childrens Health Initiative

• Mary Jo Hooper, Executive Director

10
The Perception of Orange County
11
The Reality of Orange County
12
Low Income Childrens Enrollment Orange
CountyPublic/Private September, 2007

• Orange County 0-18 Population 849,414
  2
• County-Wide Enrollment
• Government Sponsored Programs
• Healthy Families 76,727
• Medi-Cal Emergency Medi-Cal
  178,189
• Sub-Total 254,916
• Privately Funded Programs
• California Kids
  4,660
• Kaiser PermanenteChild Health Plan
  6,546
• Healthy Kids as of September 1
  311
• Sub-Total 11,517
• Current Low-income Children Enrolled
  266,433
• of Population Enrolled In Low Income
  Programs 31
• Remaining Uninsured Estimate 2005 1
  62,000

13
How this Impacts the Community

• Uninsured children
• one and a half times higher death rate 1
• Nine times more likely to be hospitalized for
  preventable condition 1
• Parents who cant afford health insurance
• five times more likely to use ER as regular
  source of care for children
• Average rate of 450 per ER visit 1
• Every dollar spent on immunizations saves 10-14
• 100 million annual loss to schools in Orange
  County due to absenteeism
• O.C. loses 20-25 million each year from state
  and federal sources because children eligible for
  Medi-Cal and Healthy Families are not enrolled
• 80 of uninsured children have employed parents
• Businesses lose productivity because parents stay
  home to care for sick children
• Children from low-income families with
  government-sponsored health insurance are
  healthier, enjoy a better quality of life, and
  scored eight points higher in a quality-of-life
  survey. 2

1 California HealthCare Foundation Study
Snapshot Uninsured Children, 2003
2 The impact of realized access to care on
health-related quality of life A two-year
prospective cohort study of children in the
California State Children Health Insurance
Program, 2/2006
14
The Childrens Health Initiative of Orange County

• Belief A childs good health is the foundation
  for a lifetime of opportunity and success
• Vision All children in Orange County will have
  access to basic comprehensive healthcare
• Mission To enroll all children into healthcare
  coverage and empower families with knowledge
  about preventive care

15
100 School Campaign Celebration
16
Care Management Modela proven way of caring

• Outreach
• Enroll
• Establish Medical and Dental Home
• Stay connected to encourage preventive care
• Re-enroll
• Real success in pilot retention program, able to
  realize retention rate increases from 30 to 70

17
Our Mission
18
AccessOC

• Beth Trombley, Chair

19
AccessOC

• Mission
• to strengthen the safety net of specialty care
• The statewide system for delivering specialty
  care for the uninsured is overburdened and
  inadequate.
• 85 of Clinics Report Patients Often or Almost
  Always have problems obtaining specialty care.
• AccessOC efforts are to turn ad hoc access into
  a formal system of care.

20
AccessOC

• Collaborative Committee
• Multiple sectors participating
• Physicians
• Hospitals
• County health care systems
• Local health department
• Community health centers
• Funders
• Planning, developing and implementing programs
  collectively
• Evidence Based and Proven Models

21
AccessOC

• Executive Director and staff of 2
• Case Manager bilingual, clinical background
• Program Director bilingual
• Governing Board
• Program Goals
• Improve access to specialty care
• Lower the demand for specialty care
• Improve the delivery system for specialty care

22
AccessOC

• Same day surgery program
• Low risk, ambulatory surgeries volunteer
  providers
• Replication of Operation Access (based in San
  Francisco
• First surgeries, May, November 17 patients
  served
• Non-surgical specialty care
• Feasibility studies on multiple approaches
• Health Information Technology
• Volunteer Networks and Referral Programs
• Emergency Department On-Call Panels
• Protocols/procedures/sustainability

23
Revenue Enhancement

• Dave Riley, Chair

24
Coverage Initiative (CI)

• Main activity has been Federally-funded,
  State-administered Coverage Initiative.
• Only 10 funded and Orange County allocated 51
  million Federal funds over 3 years to improve
  medical care for over 17,000 uninsured, indigent
  adults.
• Health Funders Partnership supporting
  implementation.

25
MSI at Community Clinics

• Medical Services Initiative (MSI) patients are
  linked to medical home (community clinic or
  primary care physician).
• 13 community clinics and 130 Community physicians
• Reimbursement levels for community clinics
  increased and pay-for-performance system for
  community physicians in development.
• Clinics given assistance in proper billing of the
  new services in the expanded MSI program.
• Net effect is 1.9 million increase in community
  clinic revenues

26
Community Clinics - FQHC

• Encouraged and supported FQHC or FQHC Look Alike
  status for Orange Countys community clinics.
• Asian Health Center application approved.
• Currently providing consulting services
• FQHC compliant billing system
• Established interim Medi-Cal Billing
• Rescue Mission clinic application submitted, not
  approved.
• Application will be re-submitted.
• Application for Camino Health Center is in
  development.
• Plan to submit in December 2007.

27
Increased Hospital Revenue

• Last year County funds matched to obtain
  additional 150,000 for two Disproportionate
  Share Hospitals Western Medical Center Santa
  Ana CHOC at Mission.
• This year, pending Board of Supervisors funding
  approval, could bring in additional 300,000 for
  the same hospitals.

28
Grant Activity

• Worked with Specialty Care Committee (AccessOC)
  to apply for Kaiser Specialty Care Initiative
  (potential of 1 million over four years).

29
Health Care Reform

• Participating in Health Care Reform legislative
  activities to assure that Orange Countys Safety
  Net improved, not damaged, by Californias
  proposed expansions of coverage.

30
Advocacy Committee

• Richard Chambers, Co-Chair

31
Advocacy Committee

• Advocacy
• Broadly safety net
• Specifically individual projects/activities
• Developing targeted communications plan
• Communications
• Target opinion leaders, officials, etc.
• Develop simple, common message

32
Questions?

• Ed Kacic, Chair Safety Net Mob
• President, Irvine Health Foundation
• Mary Jo Hooper, Executive Director
• Childrens Health Initiative of Orange County
• Beth Trombley, Chair - Access OC
• Associate Director, Public Affairs for Orange
  County
• Kaiser Permanente
• Dave Riley, Chair Revenue Enhancement Committee
• Assistant Director, Orange County Health Care
  Agency
• Richard Chambers, Co-Chair Advocacy Committee
• CEO, CalOptima