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Hillsborough County Health Care Plan
Hillsborough County (Tampa), FL
Community Size: Approx. 1 million
Program Started: 1991

Overview & Structure:

Political forces carried the day in Hillsborough County, FL. Faced with state mandates that obligated local taxpayers to cover hospitalization for indigent patients - and costs skyrocketing at 17% per year - county commissioners in Tampa took matters into their own hands. The award-winning program they created in 1991 actually expanded coverage from 15,000 to more than 25,000 residents but has still saved taxpayers $100 million over the last 10 years. In fact, the average monthly cost per enrollee served plummeted from about $600 to $250 over a period when most health care costs were rising.

The Hillsborough County Health Care Plan is a comprehensive managed care plan for indigent residents with incomes up to 100% of the federal poverty level who do not qualify for other coverage. Services are delivered by a network that includes 600 primary care physicians, 12 clinics and 5 hospitals. Mental health, dental and other ancillary services also are provided through contracts with public and private providers. The program, enabled by state statute, was funded with a ½ cent sales tax approved by the County Commission.

The Plan emphasizes primary and preventative services, early intervention, health education, and the coordination of health and social services. Through competitive contracts with providers in four regional networks, enrollees are “mainstreamed” into the system and provided access to the same providers available to other insured residents. The Plan is administered by the Hillsborough County Department of Health & Social Services with oversight from a community advisory board.

Features:

• Comprehensive program offering 5 plans with access to primary care, specialists, inpatient and outpatient hospital services, diagnostic and rehabilitative care and prescriptions. Dispels the notion that there has to be a special place for dispensing “charity care” by delivering services through broad network of mainstream providers.
• Sustainable source of funding via sales tax.
• Channels patients from expensive emergency care settings to primary care medical homes.
• Holistic approach merges medical and social services.

Outcomes:

• Reduced per patient costs 65% from $600 to $250 per month.
• Estimated savings of $100 million over 10 years ($10 million emergency care, $90 million in medical expenses).
• Reduced hospital admission rates for chronic diseases such as diabetes and asthma to those of the general population.
• Improved health and quality of life of more than 25,000 residents.

Low-income individuals with incomes up to 100% of the federal poverty level.

Financing/Costs:

Lessons learned:

• Proved that dramatic cost savings can be achieved by redirecting indigent care funds from hospital emergency rooms, placing the uninsured into a managed care environment, and creating new opportunities to leverage resources.
• Demonstrated that a community plan to care for the uninsured – backed by tax support -- not only was politically viable, it can actually be a powerful political strength.
• Established that managed care contracts through the County could be marketable.

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