CCN case profile #2: Rural-urban mix
CCN case profile #2: Rural-urban mix
The Cancer Consortium of El Paso (TX) Inc. serves women dispersed over huge geographic distances in 12 rural counties. This underserved population is largely Hispanic. Many are migrant workers who have never been in the formal health care system. The consortium, founded in 1989, targets cervical and breast cancer. As an advocacy and fiscal agency, it pulls together disparate providers and funding sources. Before the consortium was formed, area residents went to medical school clinics or health departments for screening. Then, due to the vagaries of governmental funding, they would wait six weeks to six months for cancer treatment.
Pat Graham-Casey, the consortium’s executive director, began her work by building partnerships with private sector providers and hospitals. Since, eventually, the patients would end up there for nonreimbursed treatment, she reasoned that the organizations could benefit from an initiative to deliver care at the earliest stage possible.
On visits with providers, Graham-Casey asked what they expected of the consortium. "They told us that while breast and cervical cancer screening were important, screening was actually causing problems if people couldn’t get timely follow-up care. The physicians who screened and diagnosed cancer patients were potentially liable because they had no means of doing the follow up," she explains. From that point forward, the Cancer Consortium’s role was clear.
"Flexible funding" is the way Graham-Casey describes the fiscal quilt that covers the area’s indigent women. Sources include the federal and local governments, private foundations, and community fundraising events. Funds are administered and coordinated by the consortium.
The bulk of reimbursement dollars go for services instead of reporting and record keeping for the funding sources. Unlike pre-consortium days, private sector providers receive at least some payment for care. And of course, early-stage treatment represents a better value for health dollars than late-stage treatment. For patients, this means a higher survival rate and less invasive therapy:
• Five years ago, breast and cervical cancer screenings consistently turned up Stage 3 and 4 cancers.
• Today, the overall average is Stage 1 and 2.
• Today, all cervical cancers are diagnosed at Stage 1 and 2.
The consortium tailors a reimbursement package for each recipient depending on her circumstances. "Patients are assured their care is covered even if their insurance runs out," Graham-Casey observes. Compliance is high because the consortium trains community residents as outreach workers to help women navigate the medical system. "It gives us better access to the community because the workers are friends of the patients."
The outreach workers come prepared with inside knowledge of the social structure, as well as credibility among their peers. Their stipends are lower than the salaries social workers would require, so they help stretch resources. The high rates of early diagnosis, follow-up, and treatment are partially due to their work:
• Cervical cancer, 1992 through July 2000
— Cervical cancer screenings: around 18,000
— Treatment not needed following suspicious Pap smear: 277 cases
— Treatment initiated or completed: 171 cases
— Treatment refused: five cases
— Lost to follow-up: four cases
— Pending: two cases
• Breast cancer, 1992 through July 2000
— Breast cancer screenings: around 12,400
— Treatment initiated or completed: 99 cases
— Treatment refused, lost to follow-up or pending: no cases
The Cancer Consortium parlayed a $40,000 grant into $300,000 from various sources and distributed the funds to 13 clinics, five rural hospital systems, and a few private physician practices. This means that patients now can receive care from 22 sites instead of one. The best news is that the consortium’s financing covers screening as well as treatment.
One question that invariably arises with grant-funded programs is how long they will last. In this case, funding is in its 10th consecutive year. That track record, as well as the consortium’s policy of weaving together diverse revenue sources, offers about as much security as can be expected in this period of uncertain health care financing.
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