Public-private partnership in Alabama plans health-care system for 250,000 uninsure
AL Healthcare / Uninsured
Faced with a 30% uninsured rate and shrinking public dollars for charity care, an unusual partnership of public and private health-care providers in Jefferson County, Ala. is planning to develop an integrated, accessible health-care system for the county.
The Jefferson County Medical Society, Hospital Association, Health Department, and Cooper Green Hospital, a public hospital which provides much of the charity care in the county, have teamed up to form the Council for a Coordinated Health Care Delivery System. Some $35 million in funding for the project comes from Jefferson County’s Indigent Care Fund, with additional financial support from Council members.
"We’ll use that money, leverage it with Medicaid, and work with Medicaid to make sure Medicaid dollars stay in the public setting," says Dr. Max Michael, Cooper Green’s CEO and founding member of the Council.
"What’s unique about this plan is that it’s coming from key stakeholders in the community who know the needs of their community," says Ann Keehn, project manager for John Snow Inc., a Boston health-care consulting firm that is helping to develop a plan for covering the 250,000 uninsured in the county, and also those who are underinsured.
"Rather than the usual top-down approach, this could prove to be the most effective type of health care reform," Ms. Keehn says.
Other hospitals and physicians in the community say they are prepared to do their share, according to Dr. Michael.
The joint planning effort grew out of an assessment of the scope of the charity care needs in the county by the Medical Society and the Hospital Association.
Cooper Green Hospital, the county’s public hospital, has long been the mainstay for charity care in the county. But the hospital can no longer continue to shoulder the burden and still remain financially viable. "We could see the only way to go was with a public private partnership," says Dr. Michael. "There wasn’t going to be a federal or state solution."
"Everybody agrees that the system will probably have to be something that looks like a managed care product, if it’s going to work," says Dr. Michael. While a primary care provider will be identified for all enrollees, because stakeholders recognize that access to care is a major barrier to appropriate care, there will no gatekeepers. Instead, the system is being built around the concept of a "medical home."
Poor health status is also a concern. Alabama ranks in the top six states with the poorest health status for adults, according to a Northeastern Life Insurance study. Alabama also has the second highest rate of low- birthweight babies.
"The sense of the Council thus far is that people are already getting care," notes Dr. Michael. "It’s just bad care, but not any worse than in any other part of the country."
By January 1997, organizers hope to have in hand the system assessment and design recommendations from John Snow Inc., which include plans for the system’s infrastructure, definition of the target population, and timetable for implementation. Council members are working on task forces evaluating system design.
"We’ve designed the project to be very process-oriented and inclusionary," says Ms. Keehn. "Our hope is to get buy-in all along the way so we can go right into implementation."
Existing resources will be used whenever possible, rather than adding on new services. Dr. Michael sees Cooper Green Hospital as providing the core services for the system, with the rest of the providers in the community, both hospitals and physicians, providing specialty/subspecialty care and specialty/ tertiary care services.
Right now, building the primary care access piece is a major thrust of the project. Specialists account for 70% of the county’s 3,000 physicians, and primary care doctors are poorly distributed in the inner city. Neighborhood primary care sites are expanding. The Health Department will soon add a fourth community primary care site. Cooper Green also expects to bring on line another six to eight primary care providers in the next few months.
In designing the system, planners recognize they have a formidable task ahead in redirecting patients who don’t use primary care providers to use care more appropriately, i.e. to avoid the emergency room when possible.. Hoping to better understand how the target population uses services so the new system is sensitive to their needs, planners are talking with as many potential users as possible.
Contact Dr. Michael at 205-930-3600 or Ms. Keehn at 617-482-9485.
This article was written for SHW by Laura Newman, a New York-based health-care writer.
Public-private partnership in Alabama plans health-care system for 250,000 uninsure
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