Specialty Care Access Network Concept - PowerPoint Presentation

Great Basin Primary Care Association www.gbpca.org/cchac

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Specialty Care Access Network

A Concept Presentation

presented to the

Clark County Health Access Consortium

Dr. Carl HeardMedical Representative to the

Great Basin Primary Care AssociationBoard of Directors


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4321

Describe theGeneralConcept

Outline KeyElements for

Success

Offer aGlossary of

Terminology

Create aFramework

for Dialogue

This presentation will . . .

The Specialty Care Access Network will be a healthcare referral

organization committed to theuninsured population of Clark County.


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CCHACClark County Health Access Consortium

PROVIDERSNevada’s Safety Net

GBPCAGreat Basin Primary Care

Association

PlanningDevelopment & Implementation

Interim FundingOn-going

Facilitation &Consultation

Leadership in Work

Groups and Processing

ProposedPartnership


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What is a Specialty Care Access Network?

Specialists Hospitals Diagnostic Centers Ancillary Formulary Pharmaceuticals

Enrolled, eligiblepatients requiring

specialty care(most likely

working, uninsuredadults)

Safety-net Providers Community Health Centers Primary Care Physicians Participating Providers

Electronic Networking: Referral Tracking

Case Mgmt Tracking Record Transfers

SCAN


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HistoryConcept offered by key players in theyears past – CCHAC & BoardOther States and Cities have done thisFunded models


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Margin of Generosity Concept


Influenced by -payer mix -subsidizing grants -revenue relative to overhead

No organization can provide exclusively un- reimbursed care, except to the degree it receives outside funding (grants)

Strictly indigent care programs are potentially dehumanizing to patients & providers

The percentage of un-reimbursed care a given organizationcan afford to provide without threatening its own existence.


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Margin of Generosity Concept

Private practice limits: 0-5% depending on payer mix, profit margin & benevolence

Safety Network limits: 0-100% depending on payer mix & Program limitations

Limits on -grants -clientele -geography -mission -etc.

The percentage of un-reimbursed care a given organizationcan afford to provide without threatening its own existence.


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Relative Value of Efforts

Federal Funds Other Funds

Homeless Healthcare$130 Million

Community Health Centers$1.5 Billion

Un-reimbursed CareBy Private Hospitals

$21 Billion

Un-reimbursed Care by Private Physicians

$10.5 Billion


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A professional with post residency training of a very focused field or subfield

Facilitated exchange of information & services amongstpeers for the achievement of a specific goal

Organizations & individuals striving to carefor patients regardless of their ability to pay & have a sliding fee scale

term meaning

Primary Care Providers

Case Management

Sliding Fee Scale

A Physician, Nurse Practitioner or Physician Assistant in OB/GYN, Pediatrics, Internal Medicine or Family Practice

The process of assessing a patients needs & assisting in the attainment of the agreed upon results

A guide assessing a patients ability to pay relative to federal poverty level comparison & number of dependants

Significantly less expensive consultation orancillary services

Specialist

Network

Safety-net

Discounted Services


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A. SpecialistsB. Hospitals & CentersC. Ancillary D. Pharmaceutical E. Case ManagementF. Electronic Networking

Elements of Consideration


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A. Roster of Specialists

11 Type of Specialties

22 Relative Availability

33 Ancillary Services Compatibility

44 Sliding Fee Scale

55 Location & Service Area

66 Language/Cultural Abilities


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B. Roster of Hospitals & Centers

11 Type of Services


33 Ancillary Services Compatibility



44 Sliding Fee Scale


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C. Roster of Ancillary Services


33 Compatibility of Service

44 Discounted Fee Schedule



11 Type of Services


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D. Roster of Pharmaceutical Services

22 Formulary

33 Discounted Fee Schedule

44 Location and Service Areas


11 Pharmacies


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E. Case Management

22 Fair Distribution of Cases

33 Patient Transportation & Advocacy

44 Scheduling & Referral Tracking

55 Clinical Records Transfers

66 Language Abilities

11 Unified Application Process


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F. Electronic Networking

22 Real-time Provider Networking

33 Patient Referral System

44 Scheduling & Tracking

55 Records Transfers (bi-directional)

66 Multi-organizational Compatibility

11 Automated Application Process


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Example ofa currentlyfunded &operating

model


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Pima County (Tucson) Arizona

Pima Community Access Program, also known as "PCAP", is a not-for-profit organization that provides access to professional health care at discounted prices that theuninsured adult can afford.

PCAP links low-income, uninsured residents of Pima County with an affordable, comprehensive and coordinated network of health care providers.

PCAP Offers:Affordable co-payments only if services are used. No monthly premiums. Low membership fee of $20.00 every six months.

This model is the concept used by the Arizona PCA’s “MCAP” project in Maricopa County (Phoenix) Arizona

3 year HCAP grant awarded in November 2003


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Pima County (Tucson) Arizona

Services OfferedDoctors’ visitsexcluding obstetrics

Hospitalizations

Laboratory Services

Radiology

Specialty Care

Pharmacy Discount Plans

Discounted Transportation

Eligibility18 Years or older and noteligible for any otherinsurance programs (Medicaid, Medicare, Employer-based, commercial or private) Eligibility will be determinedprior to enrollment

Pima County Resident

Pre-determined Income levels based on dependents

Pima County is a recipient of an HCAP Grant Award along with other state & local funding. They are in the 3rd year

of the project. Web site: http://www.pcap.cc


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Member BasedExample:30,000Enrollees paying$20 twice ayear = $1.2 Million

GBPCA and otherorganizations include

costs of partsrelative to mission

in grant applications

CCHAC apply forfederal, state & localfunds after buildingsuccessful network(Arizona PCAawarded 3-year HCAPgrant for similar model)

Other fund raising byparticipants of the CCHAC from localgovernments and

businesses

Sustainability


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Centralized single-site for:Single source to refer all uninsured patients for safety-net to look for needed servicesObjective data collection

• Collection of data on unmet ancillary services (i.e. diagnostic & interventional services)

• Data useful for taking action on needs of community(including providers of services)

• Allows for SCAN to begin to prioritize service needsin population

Offers a means of efficient referral to primary care services by specialists Does not interfere with existing referral relationships


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Time Line ?Time Line ?

Specialty Care Access Network Concept - PowerPoint Presentation

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