Five models that work cited for indigent care
Indigent Care Models
December 31, 1996
A Florida county managed care program for the poor is the largest of five local health programs singled out last month as "models that work" by the Health Resources and Services Administration’s Bureau of Primary Health Care, the W.K. Kellogg Foundation, Pharmacia & Upjohn and the Robert Wood Johnson Foundation. HRSA and its partners seek to replicate grassroots models for providing better, lower-cost health care to vulnerable populations. The Bureau of Primary Health Care is issuing abstracts and step-by-step replication information on the top 20 programs. To obtain a copy (available in February) call 301-594-4310.
Hillsborough County Health Care Plan, Florida—A public hospital crisis in Hillsborough County in the late 1980s led county officials to set up this public managed care plan. When the county's only public hospital, Tampa General Hospital, faced annual increases of 20%, county officials went to the Florida legislature to get approval for a half-cent sales tax to finance a new approach to funding care for the indigent.
Most indigent care used to be provided in emergency rooms and hospital admissions. Now residents are receiving more primary care services through networks of primary care physicians, specialists and hospitals, both for-profit and non-profit. Mental health, dental and other ancillary services are provided through contracts with public and private community providers. Dental benefits in the county system are better than they are in Florida’s Medicaid program.
Indigents not eligible for Medicaid or other programs and who have incomes up to 100% of the federal poverty level can enroll. (Those up to 150% of the federal poverty level may be allowed to enroll in the future). County residents with chronic diseases who have incomes up to 200% of the federal poverty level pay for services on a sliding fee scale. Many clients served by the plan are single middle-aged adults who have applied for Supplement Security Income for a chronic disabling condition.
The plan has enrolled about 60% of the target population of 39,175 residents. Shelley Blood, manager of monitoring and evaluation for the county’s Department of Health and Social Services, says there are signs the health of the population is improving.
Two years ago, the top three reasons for hospital admissions among plan members were diabetes, asthma and infections, admissions that are preventable with early, ongoing care. Today, the top three reasons mirror those for the general insured population, chronic pulmonary disease, heart conditions, and cancer.
About two-thirds of the plan's fiscal 1996 operating budget of $77.9 million comes from the half-cent local sales tax with the remaining $26.8 million, the amount previously spent by the county, coming from local property taxes. In the county, the plan has been the subject of controversy recently because of questions about surpluses (the sales tax must be used for medical care) and about whether the county is recouping Medicaid payments when it can. Three taxpayers recently filed suit over the Medicaid reimbursement issue. Contact Ms. Blood at 813-272-5040.
Resources for Human Development, Philadelphia—This nurse-run managed care program serves two public housing communities through a combination of primary health care and help with many underlying health and social problems.
Since start-up in 1992, the program has provided primary care to more than 2,400 of 4,200 residents, cut the rate of low birthweight babies from 13.6% to under 2% and cut emergency room usage from excessive, levels to markedly below-average levels. Most of the families it serves are African-American and headed by females; about 75% are covered by Medicaid.
Two health centers provide medical services, as well as group health education, psychological counseling, social services, transportation, and support groups for violence prevention, parenting, and addiction recovery. The program has links with a university school of nursing, a community hospital, managed care organizations, specialty providers, and Physicians for Social Responsibility.
Despite the program’s track record, Donna Torrisi, director of the Abbotsford and Schuylkill Falls Community Health Centers, says the nurse-run program is still battling regulators who will not allow the nurses to sign patient forms even though they deliver their care. It also has met resistance from two of the four HMOs chosen to participate in HealthChoices, Pennsylvania’s new Medicaid managed care program. The HMOs have been unwilling to sign contracts with the nurse-run managed care program, but Ms. Torrisi is optimistic the state will convince the HMOs to work with her organization. Contact Ms. Torrisi at 215-843-9720.
Project Vida, El Paso, TX—This multiple-service social agency stresses a "one-stop shopping" approach to serving some 1,300 families in one of the nation’s poorest urban areas. The program includes primary health care, education, improvement of housing, discouragement of gang activity, and a host of social services ranging from a food co-op to a bi-lingual family therapist. A primary care clinic treats 350 patients a month who had no previous care provider, and the program maintains 97% of registered infants and children on schedule for immunizations. Project Vida estimates savings of more than $150,000 a year through prevention of inappropriate emergency room usage. Contact Bill Schlesinger, co-director, at 915-533-7057.
Camp Health Aide Program, Monroe, MI—Operating in nine states, the program has trained over 300 migrant workers as lay health advocates who, in turn, work with 15,000 farmworkers and community members each year. The aides provide health education, advocacy, outreach, first aid, referrals, and other services in a culturally accessible manner. The program fosters improved relations between migrant populations and federally funded migrant clinics and state and local health providers. Contact June Grube Robinson at 313-243-0711.
The Los Angeles Free Clinic Hollywood Center—The program emphasizes the use of peer educators and counselors to reach its target population of 3,000 homeless and runaway youth. The program offers medical care, dental care, psychiatric services, substance abuse counseling, pregnancy and HIV testing, and job testing and placement. Providers include a hospital, an HMO, the local school district, and members of private industry. Contact Julie Jasko, director of communications, at 213-653-8622.
Five models that work cited for indigent care
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