MilwaukeeCares HPS by sammyc2007


									         How does Milwaukee compare?

• Residents below federal poverty level (2000 Census):
  • Milwaukee - 21.3%
  • Wisconsin - 5.6%
  • USA - 12.4%

• 18% of Milwaukee residents were uninsured for all or
  part of the year (2002)

• Unemployment rate (2003)
  • Milwaukee - 7.9%
  • Wisconsin - 5.2%
  • USA - 5.7%
       Project Access results elsewhere:

• Total hospital charity care reduced by 23%
• Half of the patients become insured, often
  through an employer
• Absenteeism from work is down
• Productivity is up
• 80 percent of patients served report improved
  health status
• Unnecessary ER utilization reduced by up to 80%
• Per capita monthly charity costs reduced by 45%
• Missed appointment rate less than 6%
                        Health Care Network, Inc.
                           Racine, Wisconsin

     Delivering Specialty Care To The
   Uninsured Using Volunteer Clinicians

Barb Tylenda
      Executive Director, Health Care Network, Inc.
Kevin McCabe, M.D.
      Director, Corporate Medical Services, SC Johnson
Health Care Network, Inc.
Barb Tylenda

   Definition of a free clinic:

      - A non-profit, community based organization
      - Provides medical, dental pharmaceutical and/or
        mental health services
      - Little or no cost
      - Volunteer health professionals
      - Traditionally funded locally

        “When you’ve seen one free clinic,
          you’ve seen one free clinic”
Health Care Network, Inc.


 * HCN grew out of a Racine 2000 Summit on Community
   Problems held in the early 1980s.

 * As a result of this summit, a task force was formed to
   address access to health care.
Health Care Network, Inc.

  * How does HCN deliver health care – what are the
    advantages of a referral network?
     - Provides non-stigmatizing care
     - Encourages participation from a wider range and
        larger number of professionals
     - Lowers overhead
     - Offers an opportunity for health care professionals to
        give back to the community
Health Care Network, Inc.


 * Health Care Network, Inc. opened in November 1987
    - Church basement, free space
    - Part time staff person
    - $25,000 budget
    - 40 volunteer physicians
    - 2 hospitals offering basic lab and x-ray work every
       other month
Health Care Network, Inc.

 * Today HCN includes:
    - 232 community physicians representing 27 specialties
    - 10 physicians on site
    - 13 dentists on site
    - 40 community dentists
    - 17 ancillary providers; optometrists, podiatrists,
       chiropractors, hygienists
    - 16 nurses on site
    - 15 community nurse practitioners
    - 8 diagnostic sites (3 hospitals, 4 clinics, health
    - 16 pharmacies offering discounts on medication
Health Care Network, Inc.

 * Who does HCN serve – who is eligible?
    - Residents of Racine County
    - Totally uninsured and ineligible for government
      assisted programs
    - Income at or below 150% of the poverty level
Health Care Network, Inc.

 * Changing demographics
    - 55% female
    - 12% children
    - 50% Hispanic
    - 74% below the poverty level
Health Care Network, Inc.

 * How are new physicians recruited?
    - By one page introductory letter to all community
      physicians with the following information:
         ∙ How diagnostics are ordered
         ∙ Who the patients are
         ∙ Limited commitment requirement
    - Support letter signed by president of the Racine
      County Medical Society.
    - Name of a supporting physician to answer further
    - Physician record form for new physician to sign up.
Health Care Network, Inc.

* What commitment is required?
   - Commit to specific number of patients per month (i.e.,
     2 patients per month).

* What is the turnover rate of providers?
   - Only 6 physicians left program in 17 years for reasons
     other than moving from the area.
   - We never send provider more patients than they
     committed to seeing in a month.
   - We accommodate provider in anyway possible.
   - We keep paperwork to a minimum.
Health Care Network, Inc.

 * How does a patient use our program?
    - Referral by word of mouth, HSD, HD, social service
    - Screened for eligibility.
    - Eligible patients complete application with HCN staff
    - Patient signs contract.
    - HCN assess the type of health care needed.
    - HCN makes the patient’s appointment.
    - HCN makes sure patient has appropriate paperwork.
      for their appointment.
    - Provider completes one page form.
Health Care Network, Inc.

  * How does HCN track patients?
     - Every patient has a chart that contains a record of all
       appointments provided by HCN.
     - Patient appointment form.
     - Physician/dental record form.
     - HCN can access data base for statistics.
Health Care Network, Inc.

 * How has HCN grown?
    - Increased number of providers.
    - Increased number of people served.
    - Opened on site medical clinic in 1992 which is staffed
      by mostly retired physicians.
    - Opened on site dental clinic in April 2005 with 13
      practicing dentists.
    - HCN staff has grown to 11 employees.
Health Care Network, Inc.

 * Fundraising
    - Budget now $550,000
    - 24% from service groups, businesses, foundations
    - 19% United Way donations
    - 20% private contributions and special events
    - 19% endowments
    - 18% Racine County
Health Care Network, Inc.
Dr. Kevin McCabe
 * My colleagues and I were interested in the concept of this
   program but had questions as I know you do.

 * After 18 years of experience in the program, I can assure
   you it is workable.

 * It does not have to be an additional burden to you.

 * It can be a source of personal satisfaction and community
Health Care Network, Inc.

 * The success of a program like this is greatly dependent on
   the partnership forged between the providers and the
   administrators of the program.

 * When trust and confidence is built between the partners, it
   can be an effective approach to serving the low income

Today I want to answer the following questions

 *   How much time will I be expected to give to the program?
 *   Will the patients show up for appointments?
 *   What about diagnostics?
 *   How much paperwork will there be?
 *   How will my patients obtain medication?
 *   Will patients be calling us after hours?
 *   What about hospitalization?
 *   Why should we join?
How much time will I be expected to give to
the program?

* The time commitment asked of physicians was a point of
  discussion when we were originally setting up the

* We found you can easily fit a patient into your daily
  appointment schedule right in your own office making
  scheduling these appointments more convenient than
  giving up a half day or evening on a weekly basis.

* We fill out a form that allows us to choose how many
  appointments we would see per month and HCN does not
  pressure us to see more than that number.
Will the patients show up for appointments?

 * Barb has already discussed the contract and the
   expectation placed on the patients to keep appointments
   and the penalty for not attending.

 * We have a 4% no show rate and this is far better than the
   general population but still aggravating when it happens.

 * At the same time knowing the program will reinforce the
   rules we feel satisfied that our contributions are not taken
   for granted.
What about diagnostics?

  * This is an important area that needs to be worked out
    early in the implementation of the program.

  * While we can be effective with some patients without
    diagnostics, we found that the majority of our patients
    are those with chronic conditions who need a variety of
    lab and radiology tests and I suspect that will be the
    same for your patients.

  * Barb has already described some of our efforts in this
What about diagnostics?

  * As physicians, you have some leverage in this area by
    collectively approaching hospitals or independent
    diagnostic sites and asking them to support your efforts
    for the community good.

  * While administrators of HCN did a good job of growing
    our network of providers, there were many physicians
    who were active as well in securing ancillary providers.
How much paperwork will there be?

 * Since we are beholden to no third party, we can practice
   medicine with nothing else in mind but the care of the
   patient – that’s a breath of fresh air.

 * HCN asks us to complete only one sheet of paper which is
   primarily a check list and they included a return envelope
   for our convenience.
How will my patients obtain medication?

* This remains the most difficult challenge of our program.

* We began with several pharmacies giving discounts to
  patients and we gave out samples as much as possible.

* Several years into the program, HCN staff surveyed
  participating providers and found that developing more
  pharmaceutical assistance was the providers’ main
  concern so this became a goal in the agency’s strategic
  planning process.
How will my patients obtain medication?

* The result was that we now have 6 methods of providing
  pharmaceuticals to our patients:
   - 16 pharmacies offering discounts to our patients
   - Samples are given when available
   - Pharmaceutical Assistance Programs (PAPS) are
      accessed for brand named drugs
   - Rx Outreach Program that offers 40 generic
      medications at a cost of $48 per year
   - Bulk purchase of medications that are dispensed in
      one month quantities
   - Direct payment through vouchers to offset the cost of
      individual prescriptions at $105,000 per year.
Will patients be calling
us after hours?

  * Does not happen often in relation to the number of
    patients seen in the office.

  * Patients do a good job of respecting the parameters of
    the program once the benefits and limitations are
    explained to them.
What about hospitalization?

  * Initially the program had no expectation for providers to
    be involved in this area.

  * If hospitalization was required, patients would be
    admitted through the ER and the process for any
    unattended would go into effect.

  * As we became more experienced with the program, we
    began to admit these patients just like any insured
    patient and this continues to be the practice today.
Why should you join?

* Here are a few sentiments of my Racine colleagues:
   - Program or no program these patients are still here.
      We will have to deal with them in one way or another.
      At least with an organized system there is some
      chance of being proactive and breaking people from
      the cycle of ER care which is much more expensive
      for all of us and most often goes uncompensated.

    - Treating patients in this fashion saves expenses
      associated with billing and involving collection
Why should you join?

    - As physicians, we make a good living and this is our
      opportunity to give back to the community.

    - It is satisfying to be part of something that brings
      community pride. Racine’s program is one of former
      President Bush’s 1,000 Points of Light and has
      brought positive press to our community. We have
      been honored by the American Dental Association,
      the Wisconsin State Legislature and numerous local
      bodies. While none of us joined the program with
      thoughts of recognition, it has enhanced our profile in
      the community and it is always heartening to be
      appreciated for your efforts.
Questions or Further
    Potential Community Partners
•   Hospitals
•   Insurance companies
•   Government
•   Pharmacies/pharmaceutical manufacturers
•   Indigent care clinics
•   Faith communities
•   Foundations
•   Chambers of commerce
•   Health education centers
•   Social service agencies (United Way)
              Questions to be answered
•   How many patients per physician?
•   Will I get credit for uninsured patients I already see?
•   How long will I be following these patients?
•   Will specialists be participating?
•   Where will I see the patients?
•   How are patients assigned to providers?
•   How are pharmaceuticals provided?
•   Will undocumented patients be included?
•   What are the eligibility criteria?
Liability issues
• Volunteer health care professionals working in free
  clinics are covered
  • Free Clinics Federal Tort Claims Act (FTCA) Medical
    Malpractice Program - October 2004.
  • Health Insurance Portability and Accountability Act of
• MilwaukeeCares patients seen in physician offices
  are covered by the physicians regular liability

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