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Gateway to Care
Harris County Community Access Collaborative
Community Size: Harris County 3,400,000
Program Started: May 2000
 

Overview & Structure

Gateway to Care is a Community Access Program funded by HRSA. It is the program arm of the Harris County Community Access Collaborative and serves Houston / Harris County, Texas. The County has a population of 3,400,000 with 804,000 uninsured persons. One out of every 36 uninsured Americans lives in Harris County or one of the contiguous to it.

Vision Statement: 100% access to healthcare for the uninsured and underinsured residents in Harris County, Texas. Mission Statement: To facilitate access to adequate healthcare for uninsured and underinsured citizens in Harris County by establishing a mechanism for health care agencies, health service related coalitions, and advocacy groups to coordinate common administrative and service delivery requirements to provide a seamless service delivery system.

Features:

• Growth in Member and Affiliated organizations from 6 in May 2000 to 96.
   
• Navigation Service initiated providing assistance to over 18,000 people and their families needing help with access to a health homes during 26,000 interventions. In addition to the five Navigators paid for out of HRSA funding, resources have been procured to add four additional Navigators from local foundations.
   
• A successful funding request was submitted to the Texas Health and Human Services which will provide funding beginning in May 2003 for 5 additional full time Navigators and staff to recruit, train and coordinate up to 50 volunteer Navigator Associates. It is expected that this will provide capacity to assist an additional 20,000 persons per year to overcome barriers to access.
   
• An after hours nurse triage service called Ask Your Nurse was launched in May of 2002 operational during one evening shift and additional funding has been procured to allow the service to become operational 24 hours per day / seven days per week on May 1, 2003. The service is designed to provide uninsured persons an alternative to going to the emergency room for primary care by providing a free, quick, and easy alternative. When fully operational, the service is expected to serve at least 10,000 persons per month.
   
• Using May of 2000 as the benchmark, the number of children enrolled in CHIP in March 2003 had grown from 0 to 93,780. In addition 61,061 children and 10,200 additional adults were enrolled in Medicaid. In other words, in March of 2003, 165,041 more people had access to Health Homes via increased Medicaid or CHIP enrollment.
   
• To support the development of a Provider Health Network designed to provide a means for physicians to provide volunteer resources to persons with no other means of access to health care, Gateway to Care sought and has received funding from the Office of the US Surgeon General to develop a Medical Reserve Corps. These funds are specifically designed to recruit Nurses and Physicians to support the health care service delivery system in the event of a disaster resulting from a natural or terrorist event. While creating the Medical Reserve Corps, the coordinator of the program will also develop the Provider Health Network. The goal is to identify 2,000 health care professionals that can and will serve 30,000 uninsured persons per year. In addition, it is expected that most will be prepared to provide assistance in the event of an emergency.

Outcomes:

Recognizing that Harris County had too few primary care services, the Collaborative set a goal of facilitating the development of 11 additional access points through the development of Federally Qualified Health Centers by January 2005.

• Due to the fact that there were only 9 scattered Medically Underserved Area (MUA) and or Population (MUP) designations in Harris County, Gateway to Care working with staff at the Texas Department of Health, completed the paper work to establish 22 MUA / MUP designations. This opens the door to the development of FQHCs by communities and organizations in Harris County.
   
• Support and facilitation is now being provided in 9 member organizations to assist them to develop FQHC applications and staff is working with four other communities that are in the early stages of development. One 330(h) (Health Care for the Homeless-Houston) application was submitted and was successful. That Center, Health Care for the Homeless - Houston, will serve an additional 5,000 persons per year. Two others were submitted. Although unsuccessful, the efforts are helpful as teaching / learning tools for the other member organizations that are working together to develop applications. On April 30, 2003, three applications for 330(e) funding will be submitted and four to five additional community groups are expected to be ready to submit in November.
   
• With facilitation from Gateway to Care, the organizations working to develop FQHCs are developing plans to insure that the service system that develops will be coordinated. To this end, coordinated mental health services, dental services and information management are now actively being planned. In addition the identification and procurement of resources in the form of Community Development Block Grant funds, local and national foundation resources, and in kind support tools are being developed to insure the financial stability of the Network of Centers that will emerge. It is now projected that $5,000,000 in local resources will have to be procured to support the development of the centers. By no means will all those resources flow through Gateway to Care. Most will go directly to the individual member organizations. The role of Gateway to Care working with other member organizations of the Collaborative is to support and facilitate the identification and procurement of the resources.

In addition to these activities, the Harris County Community Access Collaborative has served as a forum for the many additional areas of focus including:

• Bringing the Drug Abuse Warning Network to Harris County.
• Facilitating the Reach Our Communities Kids Committee to focus on the mental health treatment needs of children.
• Facilitating the Elder Health Promotion Committee to focus on unmet health care needs of the seniors.
• Facilitation of the Make the Right Call public information campaign to encourage the populace to call appropriate telephone services such as Ask Your Nurse or the Crisis Hotline instead of 911.
• Affiliation with and support for the Save Our ERs campaign designed to reduce the number of days our two level 1 trauma care centers are on diversion.
• Coordination of advocacy related to health policy issues.

Eligibility/number served:

Target population is the 804,000 uninsured and the additional 500,000 underinsured residents in Harris County, Texas.

Financing/costs:

Gateway to Care is funded by the Community Access Program, several local foundations including the Rockwell Fund, March of Dimes, and the McIntosh Foundation. In addition funding has been procured to continue a Telephone Triage Service initiated with CAP funding from the Harris County Hospital District, Memorial Hermann Health System, and other Hospitals. We also have funding from the Office of the US Surgeon General to develop a Medical Reserve Corps and the Texas Health and Human Services to provide Navigator Services in our Community.

Lessons learned:

The key is Collaboration.

Contact:

Ronald R. Cookston, Ed. D.
Executive Director, Gateway to Care
3611 Ennis, Houston, Texas 77004
Phone: 713-783-4616, Fax: 713-785-3077
ron.cookston@gatewaytocare.org
www.gatewaytocare.org

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