CCN case profile #1: Ethnically diverse, urban mix
CCN case profile #1: Ethnically diverse, urban mix
The closing of a neighborhood health center 12 years ago in an underserved area of Vallejo, CA, portended financial crisis for area hospitals. "The closure was strictly because of money, and it would have meant thousands of dollars in nonreimbursed emergency room care for all of the nearby hospitals," explains Patrick Hughes, EdD, director of operations for the Solano Coalition for Better Health in Vallejo.
Institutions in the county headed off a crisis by immediately convening the top leadership of hospitals, health departments, schools, and governmental agencies.
"It became a strong coalition because the people who came to the table are those who can make things happen," says Hughes. Originally, they came to fight it out, he adds, but a spirit of cooperation soon emerged. The result was the Solano Coalition for Better Health.
Six years later, the Solano Coalition inaugurated a partnership with the Health Plan of California, which administers the state’s Medicaid funds (known as MediCal in California). The partnership enables the Solano Coalition to serve as the single source of capitated reimbursement for MediCal recipients. "This means that every MediCal patient has a medical home," Hughes explains. Now assured of receiving payments on time, providers who would not have taken MediCal patients in the past now do so. It may seem like a simple change, but it has brought health services within reach of all the area’s underserved, ethnically diverse population of 45,000.
The year following the change, area hospitals experienced a 50% decrease in emergency room use. The presence of high-powered leadership gives the coalition the ability to devise creative responses to community health issues. And the responses are as diverse as the population itself. "If we are going to preach that we share health, we have to be present and learn the ways each community works," Hughes says. Indeed, the coalition has become a presence in nearly every aspect of community life:
1. The HMO, Kaiser Permanente, extended its substance abuse service to all MediCal recipients. Not because MediCal covers the program, but because Kaiser understands its value in prevention and management of other health issues.
2. A children’s insurance program operates through the schools to enroll eligible children. To date, 3,500 previously uninsured children have become MediCal beneficiaries.
3. A community health outreach system, started by the coalition, has spun off to other agencies. Kaiser targets high-risk pregnant women through neighborhood health care workers. Other organizations assign outreach to cancer patients who live alone. Workers help with shopping, bill paying, social visits, and other needs.
4. African-American beauticians teach their customers to do breast self-exams and encourage them to have regular mammograms.
5. Teams advocate for health issues with each city and county government. They have persuaded city governments to include health elements in their annual planning initiatives. Coalition representatives are active with Solano County’s board of supervisors to ensure that funds from the tobacco companies’ settlement go to health issues. Health fairs and screening programs occur regularly. Cancer and diabetes support groups are active, especially in the Latino community.
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