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COORDINATING CARE FOR THE UNINSURED: RESOURCES FOR BUILDING COLLABORATIVE NETWORKS OF CARE IN YOUR COMMUNITY

CHANGES IN HEALTH INSURANCE COVERAGE IN NC: 2000

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COORDINATING CARE FOR THE UNINSURED: RESOURCES FOR BUILDING COLLABORATIVE NETWORKS OF CARE IN YOUR COMMUNITY

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    1. COORDINATING CARE FOR THE UNINSURED: RESOURCES FOR BUILDING COLLABORATIVE NETWORKS OF CARE IN YOUR COMMUNITY 17th Annual Healthy Carolinians Conference and NCIOM Prevention Summit October 8th, 2009 Anne Braswell Senior Analyst for Research and Development NC Office of Rural Health and Community Care

    2. CHANGES IN HEALTH INSURANCE COVERAGE IN NC: 2000 – 2007 More than 1.5 million nonelderly (18.9%) were uninsured in NC in 2006-2007 Approximately the population of the Charlotte metro area Between 1999-2000 and 2006-07: North Carolina experienced DOUBLE the increase in the percentage who were uninsured than nationally (NC: 29%, US: 12% increase) North Carolinians lost employer-sponsored insurance at nearly DOUBLE the national rate (NC: 12.5%, US: 6.8% decrease)* * Mark Holmes, PhD, Vice President, North Carolina Institute of Medicine “The NC Uninsured: Who Are They, Why Do We Care, and What Can We Do?” Annual New Hanover County Health Access Summit, Access to Care and Impact on Our Community, 19 September, 2008. 2

    3. 2000: HEALTH RESOURCES AND SERVICES ADMINISTRATION ANNOUNCED COMMUNITY ACCESS PROGRAM (CAP) New federal grants program supporting community indigent care initiatives to increase access and quality of care for the uninsured and underserved Expanded access for the uninsured by increasing effectiveness and capacity of the nation’s health care safety net at the community level 3

    4. COMMUNITIES RECEIVING CAP FUNDS EXPECTED TO: Build integrated health care delivery systems offering a seamless continuum of care for the uninsured and underinsured Eliminate unnecessary and duplicative functions in service delivery and administration, resulting in savings to reinvest in the system Increase access to health care for low-income uninsured and underinsured persons 4

    5. FIRST COMMUNITY ACCESS PROGRAM IN NORTH CAROLINA June 2000: Office of Rural Health and Community Care applied for CAP funding on behalf of Community Care Plan of Eastern Carolina for Pitt, Greene, Edgecombe & Bertie Counties September 2000: ORHCC awarded one of only 23 CAP grants in nation -- $897,000 for Pitt et al 5

    6. 2000: COMMUNITY CARE PLAN OF EASTERN CAROLINA AND ORHCC CREATED HEALTHASSIST Built upon administrative infrastructure of Community Care of North Carolina (CCNC) Established 4 Community Resource Centers Co-located services with other community non-profits (e.g. JOY Soup Kitchen; Pactolus’ Fire/Rescue) Provided health care services, care coordination, wellness and prevention services, adult continuing education, and job skills training for low-income and uninsured 6

    7. BEGINNING 2001: HRSA REPLACED CAP WITH HEALTHY COMMUNITIES ACCESS PROGRAM (HCAP) Additional indigent care networks were initiated throughout NC with HCAP funding: Cabarrus, Guilford, Buncombe, Moore, Beaufort, Durham, Henderson, Orange/Chatham Several communities initiated programs, but were not awarded federal funding: Mecklenburg, Wake, Vance/Warren, Wilkes, Wilson, Mitchell/ Yancey, Watauga, New Hanover, and others 7

    8. 2005: HCAP NO LONGER FUNDED BY HRSA After 2005, former HCAP sites and other programs in NC struggled to maintain the same level of programs and services with limited resources Early in 2007, the last HCAP “carryover” funding ran out In the summer of 2007, The Duke Endowment provided 4 months of emergency funds 8 Former HCAP sites and other indigent care programs WERE COMPETING FOR SCARCE RESOURCES AND DEPENDENT UPON VOLUNTEER PROVIDERS AND OVER-BURDENED SAFETY NET PROVIDERS. Former HCAP sites and other indigent care programs WERE COMPETING FOR SCARCE RESOURCES AND DEPENDENT UPON VOLUNTEER PROVIDERS AND OVER-BURDENED SAFETY NET PROVIDERS.

    9. IMPACT OF HCAP PROGRAM IN NC Between 2000 and 2005, HCAP helped: Induce physicians and hospitals to provide more free care and services for the uninsured Local governments and philanthropic organizations to provide matching investments of funds and resources Bring about both perceived and measurable improvements in the health and wellness of participants Reduce inappropriate use of hospital EDs and other costly services by participants 9

    10. A KEY LESSON LEARNED FROM HCAP: There must be sustaining funds to support the infrastructure needed to effectively operate community indigent care programs. 10

    11. 2007: “HEALTHNET” INITIATIVE In SFY 2007-08, NC General Assembly made a one-time appropriation to ORHCC of $2.88 million to implement HealthNet to support North Carolina’s safety net primary care provider networks and develop community-based systems of care serving the uninsured. 11

    12. NC HEALTHNET: Links local safety net organizations and indigent care programs providing free and low-cost health care services with Community Care of North Carolina’s networks of physicians and services. 12

    13. HEALTHNET NETWORKS INCLUDE: Physicians Hospitals Public Health Free Clinics Rural Health Centers Community Health Centers Departments of Social Services Behavioral Health Other Community-Based Safety Net Organizations 13

    14. HEALTHNET TARGET POPULATION: Uninsured adults, 18-64 years old, whose family income is below 200% of FPL 14

    15. HEALTHNET ENROLLEES: Provided a Primary Care Medical Home and access to: Specialty Care Wellness Education Prevention Services Prescriptions Medications Care Coordination for Chronic Medical Conditions Other Needed Services 15

    16. HEALTHNET NETWORKS: Receive technical assistance and grants from ORHCC to support the community’s ongoing efforts to: Increase access and quality of care through a coordinated delivery system Share and conserve limited resources through collaborative partnerships 16

    17. 2007: HEALTHNET IN YEAR 1 Funded 16 HealthNet Networks providing services for the uninsured in 27 counties 40,000+ individuals were provided a medical home 25,000+ individuals had access to needed prescription medications 17

    18. 2008: HEALTHNET IN YEAR 2 In SFY 2008-09, ORHCC received $2.8 million in recurring appropriations to sustain existing HealthNet Networks and $975,000 in non-recurring funds to develop new collaborative networks. 18

    19. 2008: HEALTHNET IN YEAR 2 Funding 21 HealthNet Networks that provide services for the uninsured in 38 counties 50,000+ individuals have a medical home 38,000+ individuals have access to needed prescription medications 19

    20. 2009: HEALTHNET IN YEAR 3 For SFY 2009-10, ORHCC has received $4.8 million in recurring appropriations to sustain the existing HealthNet Networks and develop new programs as available funding will permit. 20

    21. ORHCC TECHNICAL ASSISTANCE: Office of Rural Health and Community Care staff provides: Community Needs & Gap Analysis Strategic & Business Planning Network Development Medical, Dental, and Psychiatric Provider Recruitment for Underserved Areas & Educational Loan Repayment Architectural Design Support for Capital Projects 21

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