Community Programs: A State Focus on Underserved Populations

1
Community Programs A State Focus on Under-served
Populations

• Sheryl Garland
• Administrative Director
• Office of Ambulatory Care
• Medical College of Virginia Hospitals and
  Physicians
• Virginia Commonwealth University
• November 22, 1999

2
The Challenge

• One of the largest challenges in the health care
  industry is providing care for the 43 million
  uninsured in the U.S.

3
Across the country initiatives are being
developed to

• Obtain coverage for the uninsured by changing
  institutional policies and programs
• Increase access to services at the local level
• Focus on prevention and public health
• Action Where It Counts Communities Responding
  To The Challenge of Healthcare For The
  Uninsured,
• The Access Project, June, 1999.

4
RWJ Access Project

• A recent survey conducted by the Access
  Project, an initiative of the Robert Wood
  Johnson Foundation, revealed that the majority of
  organizations engaged in healthcare access
  efforts at local levels are participating in
  partnerships or coalitions to meet their goals.

5
Safety Net Hospitals

• Safety Net hospitals and health systems
  across the country are struggling to provide
  quality health care to low income and vulnerable
  populations during an era of shrinking
  reimbursement and limited federal government
  intervention.

6
Community Responsibility

• Safety Net hospitals and health systems have a
  collective mission of providing care to patients
  regardless of their ability to pay. In addition,
  these providers often have responsibilities to
  their communities that go beyond the delivery of
  direct health care services

7
NAPH

• The National Association of Public Hospitals and
  Health Systems (NAPH) is an organization that
  advocates and represents the nations urban
  safety net providers.

8
NAPH members strive to meet the key needs in
their communities, such as

• Providing inpatient and outpatient care to
  Medicaid and Medicare beneficiaries, the
  uninsured, and underinsured
• Playing an essential community role in providing
  specialty and tertiary level services
• Training a large portion of the nations health
  care professionals

9
Initiatives

• Initiatives that have been implemented by NAPH
  members are diverse in scope and service

10
Initiatives include programs that

• Expand ambulatory care
• Focus on disease management
• Are unique to targeted populations
• Represent health outreach initiatives

11
Initiatives include programs that(contd)

• Deal with injury or violence prevention
• Address teen pregnancy
• Focus on process improvement and enhanced quality
  patient services
• Promote healthy communities

12
MCV/U.VA Uncompensated Care

• As you are aware, the University of Virginia
  (UVA) and the Medical College of Virginia
  Hospitals of Virginia Commonwealth University
  (MCVH) receive funding to provide care to the
  uninsured in the Commonwealth of Virginia

13
MCV 90 Million

• In FY 1998, MCVH provided over 90 million in
  indigent care to patients

14
VCUs Academic Health Center is a State-wide
Resource
Number of Patients (unique inpatients)
by county FY98
2,740
to
8,590
to
200
2,740
20
to
200
to
20
1
Inpatients Fiscal Year 1998
15
VCUs Academic Health Center State-wide
Distribution of Indigent Care Costs
MCVH and MCVP Total Costs Indigent Care Projected
FY99 Entire Commonwealth by County
48,300,000
2,000,001
to
10,000,000
700,001
to
2,000,000
151,001
to
700,000
10,001
to
150,000
1
to
10,000
0
Source MCVH Fiscal Services for MCV Hospitals
16
1997 Charity Care as a Percentage of Gross Revenue
18.3
13.30
3.07
2.30
State Overall
Inova
2.77
UVA
2.15
MCV Hospitals Physicians
Carilion
Sentara
Source 1998 Virginia Health Services Cost
Review Council Annual Report 1998 Data for
1997. (MCV Hospitals Physicians
Unreimbursed Charges are FY 97 Data)
VHS Cost Review Councils Definition of Charity
Care Charity Care represents (unreimbursed)
charges to individuals with incomes less than
200 of the federal poverty level and payments to
or from the Virginia Indigent Health Care Trust
Fund.
17
1997 Percentage of Entire Charity Care for the
Commonwealth
31.17
10.83
17.45
Inova
4.54
UVA
5.44
MCV Hospitals Physicians
Carilion
Sentara
Source 1998 Virginia Health Services Cost
Review Council Annual Report 1998 Data for
1997. (MCV Hospitals Physicians
Unreimbursed Charges are FY 97 Data)
VHS Cost Review Councils Definition of Charity
Care Charity Care represents (unreimbursed)
charges to individuals with incomes less than
200 of the federal poverty level and payments to
or from the Virginia Indigent Health Care Trust
Fund.
18
Community Initiatives

• In addition to the health care services provided
  by hospitals and health systems across the state,
  a host of community initiatives have been
  developed to support the needs of the uninsured
  population throughout the Commonwealth.

19
VHCF

• Several noteworthy projects have been identified
  and funded though the Virginia Health Care
  Foundation (VHCF).

20
These projects include

• Free Clinics (medical and dental)
• Mental Health initiatives
• Case management for targeted populations
• Outreach activities
• Programs to assist patients in obtaining
  prescription medication

21
MCV Priority

• Despite the increasing demands, MCV Hospitals
  and Physicians continue to maintain as a priority
  provision of quality health care services to the
  uninsured of the Commonwealth.

22
The Headlines
Richmond Times Dispatch April 11, 1999
23
Hayes E. Willis Health Center of South Richmond

• Partnership with the Richmond City Department of
  Public Health (RCDPH) to integrate public health
  clinical services into a primary care center
• Community-based health center that offers Family
  Medicine, Womens Health and Pediatric services
• on-site Pharmacy that received funding support
  from the Jenkins Foundation
• Financial and Medicaid/ CMSIP eligibility
  screening at the Center

24
Hayes E. Willis Health Center of South Richmond
(contd)

• Laboratory on-site, with computer linkages to the
  MCVH Reference Lab to obtain test results in a
  timely fashion
• The Center has grown from 8,000 patient visits,
  in it first year of operation, to a projected
  volume of over 15,000 visits in the current
  fiscal year
• Community Advisory Board provides assistance in
  establishing the goals for the Center

25
RCDPH/MCVH Clinical Services Agreement

• In July, 1998, the RCDPH contracted with MCVH to
  provide public health clinical services for
  Richmond City residents
• Communicable Disease Services (STD, TB, etc)
  General Relief, Immigration and Refugee Services
  are provided in one location

26
RCDPH/MCVH Clinical Services Agreement (contd)

• Womens, Childrens and Family Planning Services
  have been integrated into primary care locations
• A population of approximately 5,000 patients was
  identified and the City Care program was
  established

27
RCDPH/MCVH Clinical Services Agreement (contd)

• Community physicians participate in this program
  to offer patients the option of being cared for
  in a location close to their home

28
Goals of the RCDPH/MCVH Clinical Services
Agreement

• To provide quality health care in the most
  appropriate site of service
• Reduce redundancy of services
• Reduce the overall cost of providing healthcare
  to residents in the City of Richmond

29
The Jenkins Foundation Care Coordination Program

• In January, 1999, MCVH and the RCDPH collectively
  received funding to support a partnership to
  coordinate services for uninsured City of
  Richmond residents
• A collaborative team of Nurse Case Managers, Care
  Coordinators, and Outreach Workers has been
  developed to catch patients who fall through the
  health care system

30
The Jenkins Foundation Care Coordination Program
(contd)

• Populations that have been targeted are adults
  and children who are City Care patients or those
  who are diagnosed with the following
• Pregnancy-related disorders
• Asthma
• Diabetes
• Upper Respiratory Infection
• Otitis Media

31
The Jenkins Foundation Care Coordination Program
(contd)

• Teams of health care providers are developing
  non-traditional interventions to support these
  populations

32
Management Strategy of the Jenkins Foundation
Care Coordination Program

• To link the patient to appropriate medical
  resources, which include but are not limited to,
  applying for health care benefits, selecting a
  primary care provider, getting the patient to the
  provider, encouraging appropriate use of the
  medical services at the appropriate time, and
  providing health education in order to help the
  patient obtain the greatest health care benefit

33
Management Strategies (contd)

• Directing the patient to a financial counselor
  for screening
• Identifying the Primary Care Provider
• Arranging transportation
• Directing the patient to use the appropriate
  level of care for the episode of illness

34
Management Strategies (contd)

• Helping patients understand their illness
• Reinforcing teaching
• Answering questions
• Clearly reinforcing treatment plan

35
Objectives for the Program

• Work with identified patient populations
• Care Coordination will provide a service
• Utilizing the Richmond City Department of Public
  Health Nurse Case Manager and Outreach Workers,
  along with community resources
• Manage the underinsured and uninsured Richmond
  City population

36
Program Goals

• Increase appropriate utilization of health care
  services
• Increase health knowledge of health care issues
• Build internal and external alliances to support
  the patient population

37
Alternative Care Program

• Established by the Division of Quality
  Improvement to assist patients who encounter
  barriers at the time of discharge from the
  hospital
• The program allocates funds to support DME needs
  that patients cannot obtain due to financial
  constraints (i.e., hospital beds, infusion pumps,
  etc)

38
MCV Care at Home

• This Home Care agency was developed to support
  the post-discharge needs of the MCV Hospitals
  patients

39
Goals of the MCV Care at Home program include

• reduction in the inpatient length of stay
• reduction in overall costs to the healthcare
  system
• provision of alternative health care options for
  uninsured and underinsured patients

40
A Health System?

• VCU/MCV Hospitals and Physicians are in the
  process of seeking approval to establish the VCU
  Health System

41
Goals of the VCU Health System

• Identification of mechanisms to reduce costs
• Development of enhanced contracting opportunities
• Management restructuring to reduce organizational
  redundancies

42
Managed Care?

• VCU/MCV Hospitals and Physicians are exploring
  the feasibility of developing a managed care
  program for uninsured patients

43
Survival?

• Like many academic medical centers, VCU/MCV
  Hospitals and Physicians are working to develop
  the ventures to ensure the survival of the
  organization