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Specialty Care Access Network Concept - PowerPoint Presentation

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Specialty Care Access Network Concept - PowerPoint Presentation

  1. 1. Specialty Care Access Network <ul><li>A Concept Presentation </li></ul>presented to the Clark County Health Access Consortium Dr. Carl Heard Medical Representative to the Great Basin Primary Care Association Board of Directors
  2. 2. Specialty Care Access Network 4 3 2 1 Describe the General Concept Outline Key Elements for Success Offer a Glossary of Terminology Create a Framework for Dialogue The Specialty Care Access Network will be a healthcare referral organization committed to the uninsured population of Clark County . This presentation will . . .
  3. 3. Specialty Care Access Network Planning Development & Implementation Interim Funding On-going Facilitation & Consultation Leadership in Work Groups and Processing Proposed Partnership CCHAC Clark County Health Access Consortium PROVIDERS Nevada’s Safety Net GBPCA Great Basin Primary Care Association
  4. 4. What is a Specialty Care Access Network? <ul><li>Safety-net Providers </li></ul><ul><li>Community Health Centers </li></ul><ul><li>Primary Care Physicians </li></ul><ul><li>Participating Providers </li></ul>Electronic Networking: Referral Tracking Case Mgmt Tracking Record Transfers SCAN <ul><li>Specialists </li></ul><ul><li>Hospitals </li></ul><ul><li>Diagnostic Centers </li></ul><ul><li>Ancillary Formulary </li></ul><ul><li>Pharmaceuticals </li></ul>Enrolled, eligible patients requiring specialty care (most likely working, uninsured adults)
  5. 5. Specialty Care Access Network <ul><li>History </li></ul><ul><ul><li>Concept offered by key players in the years past – CCHAC & Board </li></ul></ul><ul><ul><li>Other States and Cities have done this </li></ul></ul><ul><ul><li>Funded models </li></ul></ul>
  6. 6. Specialty Care Access Network <ul><li>Influenced by </li></ul><ul><ul><li>-payer mix </li></ul></ul><ul><ul><li>-subsidizing </li></ul></ul><ul><ul><li>grants </li></ul></ul><ul><ul><li>-revenue </li></ul></ul><ul><ul><li>relative </li></ul></ul><ul><ul><li>to overhead </li></ul></ul><ul><li>No organization </li></ul><ul><li>can provide </li></ul><ul><li>exclusively un- </li></ul><ul><li>reimbursed care, </li></ul><ul><li>except to the </li></ul><ul><li>degree it receives </li></ul><ul><li>outside funding </li></ul><ul><li>(grants) </li></ul><ul><li>Strictly </li></ul><ul><li>indigent care </li></ul><ul><li>programs are </li></ul><ul><li>potentially </li></ul><ul><li>dehumanizing </li></ul><ul><li>to patients & </li></ul><ul><li>providers </li></ul><ul><ul><li>The percentage of un-reimbursed care a given organization can afford to provide without threatening its own existence. </li></ul></ul>Margin of Generosity Concept
  7. 7. Specialty Care Access Network <ul><li>Private practice </li></ul><ul><li>limits: 0-5% depending </li></ul><ul><li>on payer mix, </li></ul><ul><li>profit margin & </li></ul><ul><li>benevolence </li></ul><ul><li>Safety Network </li></ul><ul><li>limits: 0-100% </li></ul><ul><li>depending on </li></ul><ul><li>payer mix & </li></ul><ul><li>Program </li></ul><ul><li>limitations </li></ul><ul><ul><li>Limits on </li></ul></ul><ul><ul><li>-grants </li></ul></ul><ul><ul><li>-clientele </li></ul></ul><ul><ul><li>-geography </li></ul></ul><ul><ul><li>-mission </li></ul></ul><ul><ul><li>-etc. </li></ul></ul><ul><ul><li>The percentage of un-reimbursed care a given organization can afford to provide without threatening its own existence. </li></ul></ul>Margin of Generosity Concept
  8. 8. Relative Value of Efforts Federal Funds Other Funds Homeless Healthcare $130 Million Community Health Centers $1.5 Billion Un-reimbursed Care By Private Hospitals $21 Billion Un-reimbursed Care by Private Physicians $10.5 Billion
  9. 9. Specialty Care Access Network A professional with post residency training of a very focused field or subfield Facilitated exchange of information & services amongst peers for the achievement of a specific goal Organizations & individuals striving to care for 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 or ancillary services Specialist Network Safety-net Discounted Services
  10. 10. Specialty Care Access Network <ul><ul><li>A. Specialists </li></ul></ul><ul><ul><li>B. Hospitals & Centers </li></ul></ul><ul><ul><li>C. Ancillary </li></ul></ul><ul><ul><li>D. Pharmaceutical </li></ul></ul><ul><ul><li>E. Case Management </li></ul></ul><ul><ul><li>F. Electronic Networking </li></ul></ul>Elements of Consideration
  11. 11. Specialty Care Access Network
  12. 12. A. Roster of Specialists 1 Type of Specialties 2 Relative Availability 3 Ancillary Services Compatibility 4 Sliding Fee Scale 5 Location & Service Area 6 Language/Cultural Abilities
  13. 13. B. Roster of Hospitals & Centers 1 Type of Services 2 Relative Availability 3 Ancillary Services Compatibility 5 Location & Service Area 6 Language/Cultural Abilities 4 Sliding Fee Scale
  14. 14. C. Roster of Ancillary Services 2 Relative Availability 3 Compatibility of Service 4 Discounted Fee Schedule 5 Location & Service Area 6 Language/Cultural Abilities 1 Type of Services
  15. 15. D. Roster of Pharmaceutical Services 2 Formulary 3 Discounted Fee Schedule 4 Location and Service Areas 5 Language/Cultural Abilities 1 Pharmacies
  16. 16. E. Case Management 2 Fair Distribution of Cases 3 Patient Transportation & Advocacy 4 Scheduling & Referral Tracking 5 Clinical Records Transfers 6 Language Abilities 1 Unified Application Process
  17. 17. F. Electronic Networking 2 Real-time Provider Networking 3 Patient Referral System 4 Scheduling & Tracking 5 Records Transfers (bi-directional) 6 Multi-organizational Compatibility 1 Automated Application Process
  18. 18. Specialty Care Access Network <ul><ul><li>Example of a currently funded & operating model </li></ul></ul>
  19. 19. Pima County (Tucson) Arizona <ul><li>Pima Community Access Program, also known as &quot;PCAP&quot;, is a not-for-profit organization that provides access to professional health care at discounted prices that the uninsured adult can afford. </li></ul><ul><li>PCAP links low-income, uninsured residents of Pima County with an affordable, comprehensive and coordinated network of health care providers. </li></ul><ul><li>PCAP Offers: </li></ul><ul><ul><li>Affordable co-payments only if services are used. </li></ul></ul><ul><ul><li>No monthly premiums. </li></ul></ul><ul><ul><li>Low membership fee of $20.00 every six months. </li></ul></ul>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
  20. 20. Pima County (Tucson) Arizona <ul><li>Services Offered </li></ul><ul><ul><li>Doctors’ visits excluding obstetrics </li></ul></ul><ul><ul><li>Hospitalizations </li></ul></ul><ul><ul><li>Laboratory Services </li></ul></ul><ul><ul><li>Radiology </li></ul></ul><ul><ul><li>Specialty Care </li></ul></ul><ul><ul><li>Pharmacy Discount Plans </li></ul></ul><ul><ul><li>Discounted Transportation </li></ul></ul><ul><li>Eligibility </li></ul><ul><ul><li>18 Years or older and not eligible for any other insurance programs (Medicaid, Medicare, Employer-based, commercial or private) Eligibility will be determined prior to enrollment </li></ul></ul><ul><ul><li>Pima County Resident </li></ul></ul><ul><ul><li>Pre-determined Income levels based on dependents </li></ul></ul>Pima County is a recipient of an HCAP Grant Award along with other state & local funding. They are in the 3 rd year of the project. Web site: http://www.pcap.cc
  21. 21. Specialty Care Access Network <ul><li>CCHAC apply for federal, state & local funds after building successful network (Arizona PCA awarded 3-year HCAP grant for similar model) </li></ul><ul><li>Other fund raising by participants of the CCHAC from local governments and businesses </li></ul>Sustainability <ul><li>Member Based Example:30,000 Enrollees paying $20 twice a year = $1.2 Million </li></ul><ul><li>GBPCA and other organizations include costs of parts relative to mission in grant applications </li></ul>
  22. 22. Specialty Care Access Network <ul><li>Centralized single-site for: </li></ul><ul><ul><li>Single source to refer all uninsured patients for safety-net to look for needed services </li></ul></ul><ul><ul><li>Objective data collection </li></ul></ul><ul><ul><ul><li>Collection of data on unmet ancillary services (i.e. diagnostic & interventional services) </li></ul></ul></ul><ul><ul><ul><li>Data useful for taking action on needs of community (including providers of services) </li></ul></ul></ul><ul><ul><ul><li>Allows for SCAN to begin to prioritize service needs in population </li></ul></ul></ul><ul><li>Offers a means of efficient referral to primary care services by specialists </li></ul><ul><li>Does not interfere with existing referral relationships </li></ul>Advantages
  23. 23. Specialty Care Access Network Concept & Discussion Workgroups & Interim Resources Recruitment & Development Grant Applications & Fund Raising Implementation B U I L D I T F U N D I T Time Line ?
  24. 24. Click to edit headline Click to edit text Click to edit text Click to edit text classification item Click to edit text Click to edit text Click to edit text Click to edit text Click to edit text Click to edit text Click to edit text Click to edit text Click to edit text Click to edit text Click to edit text
  25. 25. Click to edit headline result1 ▲ 7% up result2 ▲ 7% up result3 ▲ 7% up
  26. 26. Specialty Care Access Network <ul><ul><li>A Few </li></ul></ul><ul><ul><li>Advantages </li></ul></ul>

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