Transcript Community Collaboration Primary Care Access Network (PCAN

Orange County
Primary Care Access
Network
Pete Clarke, Deputy Director
Margaret Brennan, PCAN Administrator
Orange County Government
Dennis Cahill, Executive Director, CFFHC
Bakari Burns, Executive Director, HCCH
Orange County, Florida
“The Vacation Capital of the World”
Overview of Orange County’s
Uninsured
• Orange County
trends
• Tourism, service
and retail
industries
• Who are our
uninsured?
The Perfect Storm
Catalyst
• A Public Hospital closed
• An Emergency Room closed
• Health Department abruptly ceased
providing primary care services
• The uninsured accessing emergency rooms
for non emergency healthcare increased
• 180,000 Orange County uninsured
“Whose Problem Is It?”
Leadership Response
• Healthcare Leaders Sound The Alarm
 Requested the County take a
leadership role
 Create access for the underserved
area
• Strategic Health Care Task Force
• Created to reassess our local
healthcare delivery system
 Resource/Needs Analysis
 Research Best Practice Models
Business Approach
• Creation of the Primary Care Access
Network (PCAN)
– 20 public/private member agency
partnership
– Committed senior level leadership
– Shared goals and objectives
– Complementary assets
– Contributing members
– Actively engaged
PCAN Partners
• Orange County Government
• Orange County Health
Department
• Medical Society/Special Care
• Florida Hospital
• Orlando Regional Healthcare
• Health Central
• Community Health Centers
• Central Florida Family Health
Centers
• Pathways to Care
• Healing the Children
• Orange County Healthy Start
Coalition
• Health Alliance
• Winter Park Health
Foundation
• Central Florida Health
Care Coalition
• Health Council of ECF
• Lakeside Alternatives, Inc
• Center for Drug Free
Living
• Shepherd’s Hope, Inc.
• Health Care Center for the
Homeless
• Emergency Medical
Services
Our Initiative
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Provides high quality, comprehensive and
family-ready system for the delivery of
health care
Comprehensive community-based clinics
− Primary care, OB/GYN, Pediatrics,
X-ray, Laboratory, Pharmacy & Dental
Medical case management
Expanded network of support services
Medical home for uninsured residents
Performance
•
•
Expanded access while containing costs
 Expanded community-based clinics
 Redefined the role of the Medical
Clinic to include secondary care
Contained costs:
 Minimized capital costs
 Maximized partnership opportunities
 Leveraged existing resources
Attributes
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Developed an adaptive system for changing
community conditions
Fluid delivery system that focuses on
services and not infrastructure
System that can be quickly and efficiently
expanded or downsized
Best practice model
PCAN Operational and
Governance Structure
Executive
Committee
Public
Education/
Community
Partnerships
VolunteersMedical and
Dental
PCAN
Board
Data Research
and Evaluation
Prenatal and
Pediatrics
Executive
Roundtable
Funding and
Finance
Mental Health
and
Substance Abuse
Case
Management
Cultural
Competency
Pharmacy
PCAN Accomplishments
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Increased Access Points
Public Education
Case Management
Culturally viable resources
Dental Foundation
Pharmacy Co-op
Data, Research &
Evaluation
PCAN Enrollment
FY 2000
• 2 clinics
• 5,000 patients
served
• $120,000 in
donated services
• 79 volunteer
physicians
FY 2008
• 11 clinics
• 100,000 patients
served
• $7.2m in donated
services
• 1,600 volunteer
physicians
Outcomes
PCAN Growth 2000-2007
120,000
100,000
80,000
60,000
40,000
20,000
0
100,000
79,000
65,299
46,246
27,611 32,359
17,610
Fiscal Year
00
8
07
/2
00
7
FY
20
06
/2
00
6
FY
20
05
/2
00
5
FY
20
04
/2
00
4
FY
20
03
/2
00
3
20
FY
20
02
/2
00
2
FY
FY
20
01
/2
00
1
5,000
00
/2
20
FY
Unduplicated Patients
Enrolled
Program Growth
PCAN Flow Chart
All roads lead to a...
Diagnostic
Testing
Medical Home
Specialty Care
Referral
(free or paid)
Patient –
Free Clinic
Patient –
Hospital ER
Patient –
Self-Referral
Treatment
Pharmacy
Co-op
Medical Home
(FQHC)
Referral
Other PCAN
Partner Referrals:
Behavioral Health,
Dental, Health Dept….
PCAN
Medical
Home
– permanent source of
affordable primary care
Volunteer Network
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1,600+ healthcare professionals
$7.2 M donated annually
Sovereign Immunity
Volunteer Organizations
—Special Care, Inc.
—Shepherd’s Hope, Inc.
—Health Care Center for the Homeless
—Dental Care Access Foundation
—Orange County Health Department
Health Care Center For The Homeless
Measuring Collaboration
ED Non-Urgent Visits vs.
FQHC Visits for Self Pay Patients
2001-2003, by quarter
20,000
18,000
16,000
14,000
12,000
FQHC
10,000
ED
8,000
6,000
4,000
2,000
0
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
2001
2001
2001
2001
2002
2002
2002
2002
2003
2003
2003
2003
Financial Impact
PCAN - ED Study
Non-Urgent Self Pay ER Visits by Quarter
2001-2007
10000
8000
6000
4000
2000
Q
1
20
01
Q
3
20
01
Q
1
20
02
Q
3
20
Q 02
1
20
03
Q
3
20
03
Q
1
20
04
Q
3
20
04
Q
1
20
05
Q
3
20
Q 05
1
20
06
Q
3
20
06
Q
1
20
07
0
•
Initial study reflected 32.2% drop in ED non-urgent visits from first quarter of
2001 to last quarter of 2003 = 2,080 visits per quarter
•
From January 2001-June 2007, non-urgent, self-pay ER visits decreased by 25.4%.
Figures from Florida CHARTS, estimate an 8.2% population growth in Orange
County from 2004-2007. Based on the 2004 Florida Health Insurance Study, the
rate of uninsured in Orange County was 18.7%. Despite these factors, ER trend
data for 2004-2007 demonstrates fairly even utilization of non-urgent care by selfpay patients.
Sustainability
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Commitment from partners
County Government funding
In-kind partner support
Grants and awards
PCAN Foundation
Donated services
Funding Sources
• County General Revenue
Same financial investment by Orange County
1999: $2,000 per patient
2007: $640 per patient
• Inter Governmental Transfer
• Federal Medicaid and Medicare
• Other third party payers
• Self pay (sliding scale)
• Federal, state and local grants
IGT Process
County Tax Dollars
Agency for Health Care Administration
ORHS
Florida
14.4 million
returned
IGT Process
ORHS
Florida
Third Party
Administrator
Clinics
Secondary
Care
Inpatient
Leveraging Dollars
Clinic Site Funding
Other
31%
Orange
County
26%
Federal
43%
In Closing
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Leadership Commitment
Partnerships & Collaboration
Understand Your Community Resources
Strategic Planning
Maximize Resources/Contain Costs
Adaptable to Changing Environment
Awards and Recognition
• NACIO award – 2003/2004
• Orlando Business Journal Community Outreach
award – 2003
• Florida Medical Business
PPL award – 2003
• Astra Zeneca Partnership
award – 2004
• AHA Nova Award- 2006
Community Collaboration
Primary Care Access Network
(PCAN)
Orange County, Florida
For more information, contact:
Margaret Brennan, PCAN Administrator
(407) 836-2649
[email protected]
or visit
Pcanorangecounty.org