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Emanuel County, GA
Community Size: Approx. 21,000
Program Started: March 2000

Overview & Structure:

In 1996, just after the federal government gave up on ambitious plans to provide health care insurance to all Americans, a small group of physicians in rural Emanuel County set out to create a program where no one fell through the cracks in a disjointed health care delivery system. Four years and many meetings later, a task force led by Dr. Timothy Palmer created a plan called Access Emanuel, to ensure that all county residents have access to quality health care. Rather than depending on traditional insurance, providers accept payment from patients on a sliding scale based on income. The collaborative project provides access to primary care, limited specialty care, and prescriptions -- along with case management for chronically ill patients, which already has resulted in significant per-patient Medicaid savings. A key focus is making access and enrollment as easy as possible, utilizing streamlined applications available at numerous sites. The program is administered by a non-profit board composed of public and private partners, including providers and social service agencies. In 2001, the program was expanded to neighboring Jenkins County.

Features:

• Streamlined application and referral process allows universal screening for all available health care and social services programs, increasing enrollment among eligible adults and children.
• All 16 primary and 6 specialist physicians in Emanuel County are participating in the program, seeing patients based on an equitable distribution of patient visits.
• Five area pharmacies provide $7 prescriptions based on a formulary developed and adopted by pharmacists who also waive their dispensing fee.
• Utilizing a database that tracks patient information and prescription history, a staff person coordinates patient applications for prescription assistance programs through pharmaceutical companies.
• Chronically ill patients referred by providers are enrolled in an intensive disease state monitoring program that includes regular contact with RN case managers, regular clinical screenings, health education and counseling.
• Van transportation to and from appointments is provided to patients in need.

Outcomes (March 2000-June 2001):

• 45% of targeted uninsured population (approx. 1650 of 4,000 total) now has access to primary care and a “health care home.”
• Reduced hospital indigent care costs 75% in one year by identifying and case-managing high-risk patients utilizing the emergency room.
• Nearly $2 million in care donated to date by primary care doctors, the county medical center and pharmacies.
• Intensive case management for 22 chronically ill Medicaid patients produced $311,892 in savings, by reducing emergency room visits and the need for inpatient/outpatient services (FY99 vs. FY 2000 data).
• Facilitated 415 applications for other health care coverage programs through a streamlined application and referral process and new partnerships.
• Increased PeachCare (CHIP) enrollments from 217 to 602 by assisting applicants and screening Access Emanuel applications for uninsured children.

Low-income individuals with incomes up to 200% of the federal poverty level are eligible. More than 1650 of the estimated 4,000 uninsured county residents have been served.

Lessons learned:

• Resources already exist within your community to begin caring for the uninsured more effectively – without major grant funding. The positive results from the sharing of resources tends to have a “snowball effect” when partners begin to feel the accomplishment of helping more people, more effectively.
• Keep communications lines open and strong will encourage an open exchange of ideas and resource-sharing, providing an enormous opportunity for system improvement.
• Streamline procedures and applications to increase access and expedite services to customers.
• Garner support of local and state officials and health agency administrators by communicating a vision for change that provides invaluable opportunities.
• There are no “rules” in developing innovative systems. If you’re committed to making a difference, you must have the courage and the flexibility to begin, even if you don’t have all the answers (you never will), and to continue amending and improving as you move forward while determining what works best.

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