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Community Choice Regional Access Program
Overview & Structure: Community Choice’s strong regional organizational infrastructure is already in place to affect major improvements to our regional healthcare systems. We took significant care in recruiting, screening and selecting a top-notch group of individuals with a wide array of background experiences and expertise to have a well-rounded team with members whose skill, knowledge and expertise complemented one another. Our current Community Choice team includes four field Access Coordinators, a CAP Program Manager/Lead Access Coordinator, a CAP program Customer Service Representative, a Director of Contracting & Marketing, an Administrative Assistant and the Executive Director. Features: The goals of this CAP project are to:
Community Choice proposes to continue with a minimum number of straightforward, achievable objectives to accomplish these goals, each of which can build upon the success of the others. Outcomes: Over 3000 individuals (adults, women and children) have been assisted in applying and securing some form of affordable health insurance coverage or healthcare assistance. Additionally, over 100 individuals have received assistance through our Community Provider Groups, which included multidisciplinary care-management to better manage their complex health conditions. The Electronic Medical Records (EMR) program has established a system at one clinic where six physicians are utilizing the selected EMR. This system will be saving providers significant costs and improve the delivery of care for the patients served. Our estimate is that 325,000 electronic medical records have been created at this site alone. We contracted a low monthly cost to use the EMR system and then provided a wireless, compact computer system and broadband, high speed Internet connections for the clinicians. Our ability to provide a HIPAA compliant EMR system and wide area network was key to successful implementation. Eligibility / Number Served: Our effort to reduce the number of uninsured in our service areas makes full use of state and federal health insurance programs such as: Medicaid, Basic Health Plan of Washington and other DSHS programs. For most of these programs eligibility is based on family size and an income under 200% of the established federal poverty level. Our Access Coordinators make a great effort to learn of any other resources that can provide relief in the cost of healthcare such as free medication programs, support from local agencies and religious-based organizations. Financing / Costs: The Regional Access Program began with initial funding from our Federal CAP grant. As this program proves its worthiness, we are transitioning to self-sustainability by having hospitals and providers support the program with the revenues caused by our work. We are not able to track 100% of revenues caused so far, but in just one program (Medically Indigent Program), we have been able to document $137,500 of revenue caused to these hospitals in a six-month period. Currently, some of our hospitals have begun to support part of the Access Coordinator’s salary costs and we expect more of this participation next year. Our CPG program had initial funding from a federal CAP grant that provided the start-up funds for one year, with a slight possibility of continuation funds for an additional year. Additionally, all our programs follow a social enterprise business philosophy that gradually begins to rely on more sustainable revenues from the private sector and fee for service arrangements. Community Choice has relied on the experiences and knowledge accumulated by other communities who have successfully implemented similar projects. Our goal is to demonstrate that these best practices will work in our community to reach our desired outcomes. Once having demonstrated the effectiveness, we expect to be able to secure the financial support from participant organizations to sustain these activities that will improve their financial stability. Our expectation, for the CPG program, is to
transition it from grant funding and volunteers to ongoing
financial support from insurers who will benefit from the
better-coordinated, community-based care management that will
reduce their claims and improve their bottom line. Lessons Learned: Some of the challenges we face are new and others are the same challenges we have faced before in accomplishing our program objectives. Most of the new challenges have to do with shrinking resources in our state and an increasing need for healthcare benefits, especially for adults over the age of 19 and undocumented children. During this reporting period, the state of Washington eliminated Medicaid benefits to undocumented children in our state and plans to drastically reduce the Basic Health Plan. The Basic Health Plan of Washington is the only healthcare coverage program for low-income adults over the age of 19. The children that lost Medicaid benefits are being allowed to transition to Basic Health Plan benefits. This appears to be a temporary solution since the state has reported that the Basic Health Plan is projected to run out of funds in the near future this year. EMR - The rollout of a standard EMR has hit several significant snags. Among those are the distraction all regional healthcare providers have faced implementing HIPAA Privacy policies and procedures. This has essentially completely taken any programmatic developmental time that was available at provider’s clinics and facilities, and we anticipate that not all that implementation is complete, and that it will be several months before providers are ready to look at another significant initiative. Additionally the declining profit margins of our providers make them very resistant to implementing new services that have an immediate cost, but a long-term payback. The explosive rise in malpractice insurance premiums is a component of this profitability downturn. One entire town is teetering on the edge of losing the entire healthcare community of a public district hospital and four attendant clinics. The hospital is overdrawn financially, and the County no longer has the funds to bail the hospital out. Naturally ALL the professional providers that were eager to sign on to the EMR a year and a half ago, have done a complete 180 degree turnaround, and are steadfastly holding up their acquisition. Additionally, we probably made a mistake in the selection of the initial EMR test clinic. We installed high-tech web-tablets nearly a year ago, only to find out that the walls of the clinic had steel re-bar reinforcement in solid concrete INTERIOR walls that made passing a signal among exam rooms an absolute nightmare. The news of the intermittent signal failures had become the regional standard by which this product is (unfairly) judged. Turning this opinion around will require a great deal of effort. Other challenges of developing a regional EMR have been:
Contact: Thomas M. Jones, Executive Director
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