2005 Model Practice Application (Public)

B-E Healthy – A community access to care program

Barry-Eaton District Health Department

The Barry-Eaton District Health Department has led a community-based process to establish a system of care that provides and arranges health care services for the low income, uninsured residents of Barry and Eaton counties. This endeavor has resulted in:

• The incorporation of the Barry Eaton Health Plan, a not-for-profit organization
  
  
• The establishment of two health coverage programs
  
  
• The formation of a primary care clinic at the local health department
  
  
• Receiving a State of Michigan grant in the amount of $250,000 to further develop a model for the provision of health care services to the target population.

The B-E Healthy health coverage program and the associated Health Connections Clinic have been instituted to:

• Increase access to health care
  
  
• Reduce inappropriate use of health care resources
  
  
• Lower uncompensated care costs
  
  
• Improve the health status of individual members

The target for the initial year of operation of the coverage programs was to enroll 1,200 low-income, uninsured out of the estimated 6,000-qualifying residents of Barry and Eaton counties. 1,231 individuals have been enrolled as of 12-31-04, an impressive number given the eligibility for the largest portion of the program was not opened until 8-24-04. The delay in opening this second plan of coverage resulted from the challenges of developing an adequate provider network. This challenge led to the founding of the Health Connections Clinic at the Barry-Eaton District Health Department.

Replication of this undertaking is based to a large extent upon accessing the funding mechanism that supports the provision of health coverage benefits to the target population. The development of a shared vision with the community and the medical providers is paramount to success. Engaging a diverse stakeholder constituency promotes access to needed resources including financial and expertise needed to explore new horizons.

The creation of the B-E Healthy health coverage program and the Health Connections Clinic is an outstanding illustration of a community identifying and responding to important issues. The provision of a health coverage program for the low-income uninsured population was not however, without its challenges. The most significant of which was the development of a provider network that would accept this clientele at Medicaid like reimbursement rates. Unfortunately, a portion of our primary care providers balked at this concept, leaving us with an insufficient network to achieve our initial goal of enrolling 1,000 clients into the B-E Healthy Plan B program.

The phoenix that has arisen from this initial setback is today’s Health Connections Clinic. At the behest of the Health Plan Board, the Barry-Eaton District Health Department established a primary care clinic to serve as the provider for the community health coverage program.

The undertaking to develop a primary care clinic and the collaboration between the provider community, including three area hospitals, primary care practices, pharmacies and Health Department has been a joy to observe. Advisory committees were formed, visioning sessions held, community businesses donated money for start-up equipment, even a hospital in an adjoining community donated significant supplies, just an overwhelming show of support for the concept and our efforts to fulfill the vision. The result? The B-E Healthy Plan B program has enrolled 837 clients in the first five months of operation!

Our clients are seen in the Health Department facilities by mid-level practitioners who employ the latest in equipment and technology. Our decision to employ an electronic medical record has won acclaim by our provider community who is observing our experience pending their own decision to enter the EMR realm. Additionally, our electronic ordering of lab and radiology tests and electronically receiving the results has strengthened the commitment of the three area hospitals to continue their level of donation of such tests. To date, $48,000 in donated lab and radiological tests has been provided by our hospital partners.

The commitment to address the access to care concern in the community, the collaboration throughout the community, and the step by step construction of a system of care captured the attention of our state legislators. The FY ’05 state budget awarded our community $250,000 to continue its efforts to build a system of care for the low-income, uninsured and Medicaid population. This award is just now reaching us and will be employed to demonstrate the effectiveness of providing a medical home to the subject population, encouraging appropriate utilization of services, chronic disease self management techniques and to develop a volunteer physician model to wrap around the newly created clinic.

2.6 million is realized through the identified funding mechanism and the $250,000 grant support:

• A volunteer Health Plan Board
  
  
• Health Plan support staff (.3 FTE secretary, .2 FTE bookkeeper, 1.0 FTE Coordinator)
  
  
• Clinic staff (1.2 FTE nurse practitioner, 1.0 medical assistant, 1.0 FTE clerical, 1.5 FTE case management, .3 FTE outreach)
  
  
• Indirect services including MIS, financial analyst, agency direction and .3 Health Educator and .5 FTE Health Planner
  
  
• Reserves of approximately $1,200,000 are intended for expansion, sustainability and leveraging of other resources

The establishment of a community Health Plan organization and the subsequent creation of a low-income, uninsured health coverage plan and community based primary care clinic was a two year long undertaking. Beginning in 2002, the Barry-Eaton District Health Department endeavored to help establish the Health Plan, the health coverage programs and finally the Health Connections Clinic. Action steps included:

• A private, non-profit 501(c)(3) organization established to provide the organizational structure for the health plan.
  
  
• The Health Department identification of the local dollars allocated to services for the low-income uninsured (which is identified as approximately $650,000 FY ’05) that are currently appropriated to the Health Department from the counties.
  
  
• Contractual agreements between the newly created non-profit organization, the hospital, and the Health Department established to ensure appropriate use of the dollars. The process begins when the local dollars from the county are passed through the state to pull down the federal match, which is returned through the hospital to the new organization. The organization contracts with the Health Department for the existing services and uses the remaining dollars to provide healthcare to other low-income residents in Barry and Eaton Counties.
  
  
• Provider network developed to enroll the Plan A members. Area primary care practices and clinics supported the concept and reimbursement for the chronically low-income, uninsured. Previously, programs to provide care to this population were cumbersome, less than Medicaid rate reimbursed, and left it to the client to find a provider willing to accept them on an episodic basis.
  
  
• An advisory committee, consisting of both the active and retired provider communities, was formed to assist the Health Department in the development of the primary care clinic. This committee continues today as a resource for the newly received $250,000 grant to expand the clinic operation and to model a volunteer physician operation.
  
  
• An aggressive timeline of 7 months was established to launch the primary care clinic including the installation of a sophisticated electronic medical record system. It was only through the assistance of the Health Plan Board, the advisory committee and the staff of the Health Department that the Health Connections Clinic was opened in August of 2004.
  
  
• Evaluation tool was designed in conjunction with a nationally recognized consulting firm and will begin the evaluation process in early ’05.

Sustainability of the health coverage programs and in particular the clinic relies upon continuation of the funding mechanism wherein local funds generate a federal match. Efforts to diversify funding are underway including pursuing FQHC look-alike status, engaging the local hospitals for further subsidization of the Health Plan based in part upon diverting inappropriate emergency room utilization to the clinic setting and to continue to enable other local funding sources e.g. United Way, Community Foundations, to participate in the process. Assuring effective case management will impact costs as will maximizing efficiencies in the clinic operation.