Community Health Visioning 2017

1. Community Health Visioning 2017 Primary Care Alternatives Lalai S. Hamric President/CEO Family Health Centers of Southwest Florida, Inc.

2. Primary Care Alternatives Convene stakeholders to develop a comprehensive, community-based system of primary care alternatives to the Emergency Room, targeting areas of greatest need. (Key elements may include neighborhood centers/clinics, mobile units, 24/7 access, service for under/uninsured, and possible roles for retired physicians and major employers.) Develop a method for educating non-emergent patients to use the appropriate care settings.

3. Status Report: Key Accomplishments • Establishment of the Dunbar United Way House… • Opening of the East Fort Myers United Way House… • Renewal of Lee We Care as the Volunteer Health Care Connections specialty referral program serving patients living below poverty level… • Establishment of a pediatric Healthy Living and Weight Management Clinic utilizing fixed sites and a regional Ronald McDonald mobile van… • Regional expansion of the CenteringPregnancy pre-natal care program… • Launch of Area Health Education Centers smoking cessation program… • Institution of new emergency room patient follow-up referral process… • Doubling of breast and cervical cancer screenings for uninsured low-income women under the Healthy Body-Healthy Soul Program… • Offering of pre-school dental exams and annual school physicals… • Launch of three First Choice Pediatrics offices in Lee County.

4. Status Report: Barriers/Challenges • Current provider shortages, particularly for adult medicine, as a function of a physician “unfriendly” professional environment… • Rapid growth of the number of uninsured people in Lee County @ 30%+ • Rising level of uncompensated care given by primary care providers in Lee County (e.g.-LMHS = $68 million/FHC = $14.2 million)… • Uncertainty of revenue sources to pay for uninsured patient care (e.g.- Low Income Pool, DSH, Medicare reimbursement, etc.)… • Lack of adult medicine specialists to provide care for working uninsured patients earning income just above the poverty level… • Lack of a regional electronic health records “network” to promote medical homes and access to preventive medical care for all patients… • Limited hours of primary care providers coupled with patient work schedule and transportation challenges.

5. Status Report: Critical Success Factors • Establishing a local primary care “network” that maximizes the coordination and use of existing and future provider resources… • Development of a regional health information system that improves patient care and health outcomes through improved sharing of clinical data among local care givers… • Creation of the medical home concept that encourages all patients living in Lee County to have a local provider of primary, preventive and chronic disease care… • Building a community consensus on how best to fund uninsured patient care via existing and proposed public and private revenue streams… • Expansion of the specialist care network for uninsured patients… • Recruitment and retention of primary care physicians and critical area specialty providers (e.g.- orthopedics, cardiology, oncology/chemotherapy, dermatology, gastroenterology, rheumatology, endocrinology, etc.).

6. Status Report: Next Steps Convene a local stakeholder task force to create a model community-based primary care system by pursuing… • Achieve connectivity of existing electronic medical records systems utilized by local primary care providers… • Creation of a medical home initiative to include examination of appropriate emergency room use by all patients… • Study of how to finance care for the uninsured/working uninsured… • Examination of local provider service networks that use a capitated fee approach to providing managed care that allows residual funds to be used for uninsured patient care… • Expansion of existing neighborhood-based “clinics” to emphasize preventive medicine and chronic disease management programs… • Development of a regional physician recruitment/retention strategy.

7. Questions & Answers • What are your top of mind reactions to what you have heard? • Are there other accomplishments for this area you would like to share?