Florida Department of Health Low Income Pool Primary Care/Hospital Diversion Projects

1. Florida Department of HealthLow Income PoolPrimary Care/Hospital Diversion Projects Florida Hospital Association Readmission Webinar February 18, 2010

2. Low Income Pool • $1 billion Medicaid Reform program • 94% of pool distributed to hospitals

3. LIP Council • 24 members • Provides pool $ distribution recommendations to Legislature

4. LIP “Non-hospital Projects” • $51.3 million for current state fiscal year • $3.2 mil – Poison Control • $18.3 mil – FQHCs • $16.1 mil – Premium Assistance • $1.2 mil – ER Diversion • $3.0 mil – Hospital Primary Care • $9.5 mil – DOH Primary Care/Diversion

5. LIP Primary Care Funding History • SFY 2006-07 - $2.0 mil • 6 projects • SFY 2007-08 - $3.0 mil • 7 projects • SFY 2008-09 - $6.5 mil • 11 projects • SFY 2009-10 - $9.5 mil • 13 projects

7. Project Goals • ED Diversion • Primary Care Medical Home • Chronic Disease Management Services • Link uninsured persons to health coverage

8. Project Components • Hospital based navigators or formal referral arrangements with hospitals • Expanded primary care clinic capacity and operating hours • Trained chronic disease management case managers and educators

9. Project Components • Pharmacy assistance services • Linkages to specialists through We Care Networks or other volunteer provider organizations • Eligibility assistance staff

10. Project Statewide Summary Statistics January 1, 2009 through June 30, 2009

11. Key Project Successes • High proportion of LIP project referrals are enrolled in a primary care medical home and return for subsequent health care services • Patients have much improved access to needed and appropriate health care services • Significant expansion of disease management capacity and improved health status of enrollees • Excellent utilization of pharmacy assistance programs that help reduce hospital re-admissions

12. Project Challenges • Meeting the need for basic clinical primary care – demand is greatly challenging supply • Providing timely access to specialty services • Complexity of the chronic disease clients • Transient nature of the targeted population

13. Project Challenges • Educating the target population on the concept of a primary care medical home • Hiring physicians and nurses at state pay scales • Partnerships can be a double-edged sword – usually a great asset but sometimes a liability

14. To Where from Here? • Recommend expansion of primary care/disease management projects • Develop more direct partnerships with hospitals • Use primary care/chronic disease management programs to help reduce hospital readmissions

15. Questions?