Lessons from Community-Based Initiatives to Expand Coverage and Improve Care DeliveryCitizens’ Health Care Working GroupMay 12, 2005

Outline

Context for national funders’ investment Communities in Charge Findings Important Considerations Replicable Strategies & Strategies to Avoid

Federal/StateSurpluses

No Federal/StateSolutions

Communities

• Motivated- Issue of uninsured

more tangible- Experiencing real

financial pressures

ContextEnvironment in which Programs were Conceived

Examples

Hillsborough County, FLMilwaukee County, WIMarian County, INWayne County, MI

W.K. Kellogg FoundationCommunity Voices

Robert Wood JohnsonFoundation

Communities in ChargeFederal HRSA

Community Access Program

Could communities create and finance new coverage and delivery systems?

Raising the Question

ObjectiveCommunities in Charge was a four year, $16.8M

project of The Robert Wood Johnson Foundation to help communities design and implement new, or significantly expand existing, community-based systems for financing and delivering a full spectrum of care to the uninsured and under-insured

Expectations Community-wide initiative Result in systemic change Serve a large number of uninsured individuals Roughly modeled on Hillsborough HealthCare

Financing change to support new coverageRestructuring of care delivery

Important Attributes Large communities Initial focus on coverage (versus access) Emphasis on systematic process for design

and implementation Active coalitions (public-private partnerships) Champions & Invested leaders Plenty of providers

Funded Sites

San Mateo Co.

Spokane

Portland

Alameda Co.

El Paso

Austin

Albuquerque

Jacksonville

Portland

Buffalo

BrooklynD.C.

BirminghamJackson Macon

Baltimore

ColumbiaWichita

St. LouisLouisville

3 Program Approaches

Public/Private Coverage (4) Financing Target populations

Public/Private Voluntary (4) Other Public/Private (4)

FindingsLocation matters…because states

differ

Medicaid eligibility thresholds Medicaid disproportionate share distributions Local responsibility for indigent medical care “Riches”…and distribution of revenue

FindingsNot every community has the “right stuff” Key champions and invested senior

leadership Strong coalition with right people at the table Keen knowledge of the fiscal and political

commitments of critical partners Awareness of local and state environment Understanding of the community’s strengths

and limitations REAL resources

FindingsHealth care system is not a “system”

for the uninsured

There are many gaps There are many silos Existing financing structures are a barrier to

system change

FindingsCommunities can’t solve the coverage

problemon their own

Without SIGNIFICANT state and/or federal financial assistance, community-based coverage programs cannot achieve the scale necessary to address need and ensure long-term sustainability

FindingsCommunities with the “right stuff” can

impact how care for the uninsured is financed &

delivered Leveraging funds Brokering public/private partnerships Institutionalizing coalitions Bridging gaps along the care continuum Building and sustaining new safety net

infrastructure Facilitating outreach and enrollment in existing

public programs

Important Considerations

Rethinking health care delivery and financing takes time, is hard work, requires $$$$, and is not for every community.

Big “P” and little “p” of politics as usual at local and state level can sink success of community efforts

Leadership is critical

Replicable Strategies Health Policy Forums Common eligibility screening tool Shared clinical record State/Federal partnership coverage programs Coordinated gap-filling

Strategies to Avoid ER “diversion” programs

Without significant incentives and outreach, will not change care seeking patterns

Real access to primary care and specialty services is required

Small business strategies Well-documented challenges to overcoming

the small business owner “cost” barrier Examples

For More Information

www.communitiesincharge.org

http://www.statecoverage.net/pdf/issuebrief405.pdf

Terry StollerProgram Director

Communities in Charge

PrincipalMedimetrix

1100 Republic Building25 Prospect Avenue

Cleveland, Ohio 44115216-523-1300 x 3039

tstoller@mx.com