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Medical Care Access Coalition (MCAC)
Marquette County, Michigan

Community Size: 64,634 residents (2000 census)

Year Program Started: The Medical Care Access Coalition (MCAC) incorporated in September 2000. MCAC launched the direct patient care program, Medical Access Program-Plan C, in September 2001

Overview & Structure:

Medical Care Access Coalition (MCAC) is a faith and community based initiative, and a 501(c)(3) non-profit organization. It is comprised of civic leaders and representatives from medical, public health, mental health/substance abuse, faith-based and consumer groups of Marquette County, Michigan. The vision of MCAC is to provide that "All people will have access with dignity to quality, affordable healthcare." The mission of MCAC is to "Develop a model system to provide needed healthcare to underserved individuals in Marquette County, and to assist other communities in doing the same."

Features:

• Medical Access Program-Plan C: Program for low-income adults who do not qualify for state-based medical coverage and can not afford private healthcare coverage. This program includes access to volunteer primary and specialist physician care, the 10 most requested laboratory panels, radiology, medications, dental, disease management, and limited urgent care. There is no cost to the patient for enrollment into MAP-Plan C and services are provided by volunteers, donated by local agencies, or provided under grant funding.
   
• Medical Access Program-Plan A: State funded medical program for adults under 35% of the federal poverty level who do not have dependants. Eligibility is determined by the Michigan Family Independence Agency (state welfare agency), and the program is administrated by the Medical Care Access Coalition for all 15 counties in Michigan’s Upper Peninsula.
   
• Dental Access Program: Medical Access Program-Plan C patients receive limited dental care through local volunteer dentists and the Marquette County Health Department Dental Clinic. Services include urgent dental care (pain, swelling, and/or bleeding), oral cleanings, and limited dental lab work.
   
• Volunteer Medical Clinic: In June of 2002, the Medical Care Access Coalition, with a grant from the Marquette County United Way, launched a volunteer primary care clinic. This “mobile volunteer clinic” meets for one night every week, in one of two donated medical offices. Primary care is provided by utilizing volunteer physicians, nurse practitioners, physician assistants, nurses, and other volunteer support staff. As part of the Medical Access Program-Plan C, clinic patients are provided access to all other ancillary services (radiology, laboratory, medications, dental, and specialist referrals).

Outcomes:

• Marquette County boasts a tremendous volunteer spirit. 100% of the county’s primary care providers and over 60% of specialists (for a total of over 135 physicians and mid-level practitioners) treat Medical Access Program-Plan C patients on a volunteer basis. Both county hospitals donate care to the volunteer program, providing needed lab work and radiology to uninsured patients.
   
• From September 1st 2000 through November 1st 2003, local hospitals and volunteer physicians have donated $401,194.00 in-kind. Local dentists have donated $46,047 in-kind.
   
• From September 1st, 2000 though November 1st 2003, $360,368 has been dispensed in donated brand name medication samples. MAP – Plan C pharmacy costs are about $10.00 per member per month, or less than 1/6th the cost of state funded programs. 97% of all prescriptions presented are filled. 50% of all MAP – Plan C patients utilize medications sampling programs to secure brand named medications at no cost to the patient.
   
• 18% of all MAP-C enrollments (about 300 persons to date) have been placed into state funded medical programs from September 2000 through December of 2003.
   
• State and Federal funds are combined with local donations and grant funding to provide medical care for Marquette County’s uninsured.

Eligibility/ Numbers Served:

• The Michigan Primary Health Care Profile of Michigan Data Book 2002 records that 7,465 of Marquette County’s 64,634 residents lack state or private healthcare coverage. Of that number, 3,237 qualify for the Medical Access Program – Plan C (those earning less than 200% of the Federal Poverty Level, having no access to state programs, and having limited ability to pay for private insurance).
   
• Since its establishment in September 2001, the Medical Access Program has enrolled 850 to 1000 new persons each year, and maintains an active enrollment population of 550 to 650 persons at any time. 71% of MAP-Plan C patients are working full or part time. Among rates of chronic illness, 12% of MAP-Plan C patients have been diagnosed with diabetes, 29% have been diagnosed with asthma, 12% have been diagnosed with hypertension, and 35% have been diagnosed with depression.

Financing / Costs:

MCAC’s budget is 1.5 million dollars annually, with a majority of those funds earmarked for the administration of the state-funded Medical Access Program-Plan A. Aside from state originated Plan A funds, MCAC’s Plan C program is supported by grant funding, donations from the individuals, community organizations, and the faith communities; volunteers and in-kind donations.

Lessons Learned:

• The vast majority of medical practitioners already provide donated medical care to their uninsured and low-income patients. Creating an organized and easily accessible referral service allows those physicians to save time and effort by avoiding eligibility determination, allows for better donation tracking, helps to secure more medications at greater ease to the medical office, ensures a better continuum of care, and helps to streamline a fragmented referral service to other volunteer doctors.
   
• With proper recruitment and training, community volunteers will constitute a reliable, skilled, and empathetic enrollment staff for a volunteer access program. The use of volunteers will also provide needed manpower for medications programs, clinic programs, and extra help with office clerical needs.
   
• Upon seeing the benefits of an efficient referral agency that utilizes the participation of volunteer physicians, hospitals will support endeavors that can quantitatively prove cost savings through a lowering of non-emergent usage of the hospital’s emergency room.
   
• Providing accessible preventative care, such as that found in the Medical Access Program-Plan C, decreases incidents of non-emergent usage of the emergency department. Such programs therefore save money for uninsured consumers, insurance companies, health insurance purchasers, as well as area hospitals.
   
• Regional organization of access programs provides a stronger voice before state legislatures, higher organization among existing human service programs, and a better service delivery system for a community’s uninsured population.
   
• Enrollment into a community access program will help to locate persons eligible for State Medical Coverage, Medicaid, and/or SCHIP programs. MCAC has seen placement of 18% of their MAP-Plan C population into state covered programs (about 150 people per year). The result is an increase of federal and state funds into the local economy, along with a more healthy local population with a broader field of options for their medical care.

Contacts:

Thomas Viviano, Executive Director
Stacie Ketchum, Director of Finance
Christopher F. Palombo, Director of Outreach and Marketing
1414 W. Fair Ave #26
Marquette MI 49855
906.226.4400
fax 906.226.4407
www.upmcac.org

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