Return on Community Investment (ROCI):
A High Impact Institute

Pre-Conference Data Collection
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Return on Community Investment Survey Responses

Respondent Name:

Tammy Stoltz

E-Mail Address:

tammy@pcap.cc

Organization Name:

Pima Community Access Program (PCAP)

Phone:

(520) 694-2755   Ext.

Fax:

(520) 694-0410

Address:

655 E. River Road   

City, State, Zip:

Tucson, AZ    85704
Category: Your Community

What is the service area of your initiative (counties, city, etc.)?

Pima County and Maricopa County, Arizona (Tucson and Phoenix area)

What is the total population in your service area?

900 and 3 million respectively

What percentage of the total population lives below the federal poverty level?

35% or 1.6 million non-elderly individuals

What percentage of the total population is uninsured?

18-25%
Category: Your Program Initiative

Indicate which of the following categories your initiative falls in:

Outreach and navigation
Common registration and enrollment
Securing public and private insurance coverage
Primary care capacity and access
Volunteer physician networks
Emergency room usage reduction
Access to affordable pharmaceuticals

Describe the purpose of your initiative (in one sentence, if possible):

PCAP and MCAP first screen for possible public assistance/insurance and then links low-income, uninsured, residents with an affordable, comprehensive and coordinated network of health care providers. 93% of individuals seeking health care coverage are finding it through our automated, electronic eligibility application process.

Describe the scale of your initiative in terms of budget, capacity, etc.:

PCAP's operating budget is $620,000. The delivery system has a capacity of 15-20K individuals. PCAP's enrollment is currently over 8,000. MCAP will replicate PCAP's successful model and will launch in early June 2004. MCAP's targeted population is 114,000 low-income uninsured Maricopa county residents. MCAP plans to enhance PCAP's model and include children that do not qualify for public programs. (S-CHIP) Budgetary concerns with regards to enhancing the MIS system for eligibility changes is under consideration.

Describe the operational components of your initiative:

PCAP and MCAP are discounted, pay-as-you-go alternative delivery systems. It is not insurance, not free, and not for everyone. PCAP's eligibility criteria are simple: Enrollee must live in Pima County, be within 100-250% of FPL and not have other insurance options available to them. PCAP serves the truly uninsured/uninsurable population of its community. PCAP contracts with providers at highly discounted rates. PCAP has one of the largest delivery systems in the county with all hospitals participating and over 600 for profit specialty providers, labs, and radiology facilities. PCAP fist screens persons for public insurance before enrolling in its safety net program. PCAP bridges the health care gaps for thousands of Pima County residents. It cost $20.00 every 6 months to enroll in PCAP's program.

Describe your initiative's staffing level:

10 FTE 1 Executive Director (now shared with Maricopa project) 2 Provider Relation Reps 1 Eligibility Manager 3 Eligibility Coordinators 1 Office Administrator 1 Date Quality Coordinator 1 Marketing Rep

If applicable, please describe your strategic use of an information system:

PCAP uses a web-based eligibility system called Health-e-Arizona to screen persons for public assistance. All FQHCs are participating with this tool and it has essentially replaced the paper universal Medicaid form. Within 10-20 minutes, PCAP can interview an entire household of uninsured persons and can pre-determine them eligible for some form of health care coverage. Eliminates 40% errors due to mistakes on prior paper process. Our other web-based system call MDServe.com tracks referrals and encounters and gives information of the utilization of our membership, demographics, employment, payment compliance, and savings due to the deep discounts. We are considering another web-based system called iNetMD to interface enrollment of PCAP/MCAP members with Health-e-AZ and avoid duplication and enhance efficiencies.

Please list the major, time-framed, measurable objectives your initiative is designed to achieve:

PCAP became sustainable last Sept. 2003. With a county grant to perform the eligibility screening at a local hospital, along with the membership fees, PCAP is meeting the operating expenses. PCAP's membership goal for this Aug. 2004 is 7,500. We have already exceeded that target. PCAP ultimately wants to help more people find affordable access to health care and expand to other counties. Maricopa is the first expansion project. Santa Cruz county may be next target market place. Working with Ascension.
Category: Measurable Results

Which of the following results can be attributed to your program initiative? Please check all that apply.

Coordinated System of Care Savings
Reduction of ER usage for non-urgent care
Savings from operational improvements within integrated system
Qualifying people for government subsidized programs
Increasing awareness of programs and services
Services brought into the community
Pharmaceuticals acquired on behalf of clients
Volunteer contributions
Improved health status
Improved productivity
Social justice implications
Increased attendance at work
Increased attendance at school

Please list any other actual, measurable results of your initiative:

93% of all persons seeking health care coverage are finding it through our Health-e-Arizona application system. 100% of hospitals participate in PCAP. 53% of all physicians participate in PCAP. 100% of Community Health Centers participate in PCAP. 2 major for-profit private primary care clinics participate in PCAP. 100% of providers were surveyed for satisfaction with the PCAP model. 100% were either highly satisfied or satisfied with the market solution. Provider retention is 95%.
Category: Your ROCI Strategy

How do you define ROCI?

Community involvement and participation Savings to workforce Reduction in ER cost Increase in insured persons in a community Business participation for employees Medical participation in providing better access at lower costs to residents School site screenings for early detection and prevention PSA's Healthy Employees = Health Community Awareness Powerful Partnerships at work to build a healthier community Collaboration with other safety net providers and systems

Describe your ROCI objectives and strategy:

see above

Describe the players involved in the ROCI conversation (by title and/or function):

Medical community (Providers) Business community (Small, medium and large employers) Government, local, state and federal Residents and consumers of the product Media Ascension Arizona Association of Small Business Arizona Association of Community Health Centers Local Chamber of Commerce Arizona Health Care Cost Containment System (AHCCCS), Arizona's solution to Medicaid. Department of Economic Security (DES) Board of Supervisors at county level Local, state and national legislators.

List the milestones in your ROCI strategy that pertain to deal making (a prospective approach):

Discounted contracts with all major providers allowed for more people to get affordable access to health care Endorsement from employers paying for employees to sign up with PCAP for coverage Endorsement from Medicaid agency to help design the electronic eligibility screening website to enroll more persons in Medicaid programs...increasing Medicaid enrollment to over 1 million in state Replication of successful model in another county County funding for successful use of eligibility screening tool. Replication of successful model in other parts of the country Serving as consultant to other grantees

List the milestones in your ROCI strategy that are tied to outcomes (a retrospective approach):

see above

List the milestones in your ROCI strategy that are linked to sustainability:

see above
Category: Your ROCI Methodology

Describe the analytic or economic logic underlying your ROCI method:

see above

Is your method supported by scientific research? If yes, please describe:

no

Describe the measures that you used to define "returns" or value:

Membership targets Equitable distribution of health care Encounter data by physician/provider, billed charges vs. discount charges. Saving to members based on discounted contracts ER diversion Health-e-arizona applications submitted, predetermined eligible and subsequently accepted/denied.

Describe the measures that you used to define investments or costs:

see above

Please briefly describe your data collection methods.

Health-Arizona web-based system MDServe.com Market surveys Focus groups Local, state, national repositories of population-based data Health Plan data of utilization Satisfaction surveys of members, providers, consortium members
Category: ROCI Communication and Negotiation

Describe the conversations that define your ROCI process:

PCAP's steady growth of members. Physician/member satisfaction surveys Employers' involvement and commitment to employee health insurance Member/provider testimonials Member savings due to affordable network of providers

Describe how ROCI conversations are tailored to specific audiences:

see above

Describe what enabled effective conversations to occur:

Consortium involvement and their marketing efforts. Friendly media National problem
Category: Results from the ROCI Process

Describe the outcomes, the successes of your ROCI strategy:

Sustainability as of Sept. 2003, with membership fees and County Grant. Ability to replicate successful model to other areas. National interest in PCAP Satisfaction surveys Savings to members utilizing PCAP
Category: Lessons

What do you see as the critical success factors that can guide others?

Consortium/Board of Directors commitment and support Accurate evaluation of market place needs assessment Ability to evolve with the market needs and changes with government Automation thru technology

Do you believe that your results can be replicated successfully with other similar initiatives? Can you suggest how replication may be facilitated?

Yes, we have successfully proven such replication.