improving access to care a rural model

Improving Access to CareImproving Access to CareA Rural ModelA Rural Model

NetworkNetwork

Rural Hospitals

Franklin Foundation HospitalTeche Regional Medical Center

Rural Primary Care Clinics

Chitimacha Health ClinicIberia Comprehensive Community Health Center

Teche Action Clinic

State Hospitals

Leonard Chabert Medical CenterLSU-University Medical Center

Social Service

St. Mary Community Action Agency

Community

St. Mary Chamber of HealthCoalition

Public Health

Office of Public Health, Region III

HISTORYHISTORY

1997: 1997: First MeetingFirst Meeting1998: 1998: Incorporated Incorporated 1999: 1999: Rural Network Development GrantRural Network Development Grant 2000: 2000: St. Mary Chamber of HealthSt. Mary Chamber of Health

-501C3, nonprofit status-501C3, nonprofit status-Community Access Program Grant-Community Access Program Grant-Community Based and Rural Health-Community Based and Rural Health-AHRQ-AHRQ-ORHP Outreach Grant-ORHP Outreach Grant

Partnership with LRHAP in 1999Partnership with LRHAP in 1999First Meeting in early 2000First Meeting in early 2000Community Forums & H.A.B.I.T.SCommunity Forums & H.A.B.I.T.S -Faith-Based-Faith-Based -Governmental-Governmental -Educational -Educational -Health Care-Health Care -Social Service-Social Service

Network’s First Strategic PlanNetwork’s First Strategic Plan

Identification of Five Key Needs

Establishment of Respective Committees

Why?Why?

Transportation

LRHAP & SWLAHECPhysician Recruiter*

Information & Help Center

Telemedicine/Education

Pharmaceutical Assistance

Information & Help Center

H.E.L.P

Community Outreach

LibraryHelp Center

Transportation Task Force

Chamber of Health

Chamber of Health

Primary/Specialty Care

ConsumerFinance

Medication

ConsumerEducation

ByNet Executive Director

Executive Assistant

ByNet Board of Directors

ICCHC-Pharmaceutical Coordinators (2)

ByNet Board of Directors Chamber of Health

ByNet Executive Director

Help Center Operations

Director

Franklin Pharmaceutical

Coordinator

Volunteer Coordinator

Help Center Coordinator-Main Office

Marketing Coordinator

Community VolunteersRx/Outreach/Help Center

Executive Asst

Finance Manager

AARP-Pharmaceutical

Coordinator

Chitimacha Pharmaceutical Coordinator (PT)

Help Center Coordinator

-FFH Emergency Dept

Outreach/DME

Coordinator

Help Center Operations

Director

Community Health Team Outreach Sites (Help Center) Extension Sites

MAIN SITE

-Help Center

-Rx

-DME

-Transportation

Non-Grant FundingNon-Grant Funding

Program RevenueProgram Revenue

Transportation DonationsTransportation Donations

FundraisingFundraising

Medicaid EnrollmentMedicaid Enrollment

Administrative Consultation (ED & CFO)Administrative Consultation (ED & CFO)

AmeriCorpsAmeriCorps

Community DonationsCommunity Donations

In-Kind FundingIn-Kind Funding

Space, Phone, Internet, Maintenance, Space, Phone, Internet, Maintenance, Utilities at Five Network LocationsUtilities at Five Network Locations

Network CEO’s Time and Staff Network CEO’s Time and Staff

Partners’ Time and StaffPartners’ Time and Staff

Local Government & CommunityLocal Government & Community

Community VolunteersCommunity Volunteers

Community UnderstandingCommunity Understanding

““Provider-Issue” Vs. Community Problem with Provider-Issue” Vs. Community Problem with Community SolutionsCommunity Solutions

VolunteersVolunteers

> 120 Hours/Month> 120 Hours/Month

Program Program ImplementationImplementation

……assess what is in place?assess what is in place?

Initially Initially through through creation of a creation of a hardcopy hardcopy community community resource resource directorydirectory

Distribution of Distribution of Newspaper Newspaper Resource Resource DirectoryDirectory

Creation of Creation of Database Database for for Electronic Electronic ReferralReferral

Information & Help CenterInformation & Help Center

ByNet’s Main SiteByNet’s Main Site

Franklin Foundation Franklin Foundation

Hospital EDHospital ED

St. Mary Parish St. Mary Parish

Library Extension SiteLibrary Extension Site

Don’t Miss Don’t Miss

thethe

OpportunityOpportunity

EDUCATIONChronic Disease Management/ Prevention -Informative Packets -Support Groups -Community Classes

Patient Responsibility -Fitness/Medication Compliance

SCREENINGS/ VACCINATIONS

-i.e. Blood Pressure Checks, Diabetes Testing, Flu Shots

ENROLLMENTHealth Plans -i.e. Medicaid, Medicare, QMB, LaChip, VA

Assistance Programs -i.e. Food for Seniors, Utility Assistance, Care for the Caregiver

AWARENESS/ ADVOCACY

-Community Involvement/Ownership, -State Partnerships, -Policy Change

Basic Demographics

Program Eligibility: Income…

Resource DirectoryResource Directory

Bi-Annual Newspaper Directory44,000 Distributed end of 2nd Year

Program Service Update

ED HELP CENTER

ED ReferralED Referral

Client TriageClient Triage Eligibility for Medicaid, LaChip & Medicare Eligibility for Medicaid, LaChip & Medicare

SavingsSavings Community Care Community Care Education Education Social Service and Health Care NeedsSocial Service and Health Care Needs

Community ReferralsCommunity Referrals

Tracking & Follow UpTracking & Follow Up

ED Help Center Survey

Community Health TeamsCommunity Health Teams

Food, Education, Enrollment & ScreeningsFood, Education, Enrollment & Screenings

700

1800

2300

0

500

1000

1500

2000

2500

Jan of 2003 August Jan of 2004

Health Equipment Loan ProgramHealth Equipment Loan ProgramH.E.L.PH.E.L.P

Donations: $200,000

Inspection & Repair

Community Donation

RxState Insurance

food

EDUCATION

DME

TransportationTransportation

Coordination of Coordination of Existing ServicesExisting Services

Development of Development of Transportation Task Transportation Task ForceForce

Sharing of hardware, Sharing of hardware, software, coordinator software, coordinator and driverand driver

Triage and ReferralTriage and Referral

Transportation Transportation

Veteran (VA)Veteran (VA)

62+ (Council on Aging)62+ (Council on Aging)

Job Program/In-Parish Public Transit (CAA)Job Program/In-Parish Public Transit (CAA)

Disabled (BIMS)Disabled (BIMS)

Local ChurchesLocal Churches

VeteransAffairs

DiscountFQHC

PharmacyDrug

ManufacturersDiscount Card

Programs

Physician Samples

Private Foundations

Local Pharmacy Assistance

Local Social ServiceOrganizations

Drug Manufacturers’ PAP Programs

2 Charity Hospitals FQHC (TAC) FQHC (ICCHC)

Share the Care

340b

Other

Drug Manufacturer’s Discount Card Programs & PAP

Emergency Aid, Community Action Agency (Social Service)

St. Vincent de Paul (Free Pharmacy)

Medicare Savings

Faith Based Community

…triage according to need and the most cost and time efficient means to obtain assistance.

CAH

T.C.

OPH

LSU

R. H.

LSU

C.H.

C.A.A

FQHC

FQHC

FQHC FQHC FQHC

FQHC FQHC

FQHC

FQHC

CHSL

Tulane

LSU-HSC

DHH

Documentation of In-Kind & ROIDocumentation of In-Kind & ROI

In-Kind Monthly Reporting Procedures in PlaceIn-Kind Monthly Reporting Procedures in Place

Finalizing Incorporation of Reports in Monthly Finalizing Incorporation of Reports in Monthly Finance ReportFinance Report

Continued Focus on ROIContinued Focus on ROI (i.e. Jan. 2003-Oct. 2004, ByNet’s Medication (i.e. Jan. 2003-Oct. 2004, ByNet’s Medication

Assistance Program has procured an estimated Assistance Program has procured an estimated $7,063,320 (Top 4 Meds + VIH Average))$7,063,320 (Top 4 Meds + VIH Average))

Annual In-Kind Donations: >$136,000/yearAnnual In-Kind Donations: >$136,000/year Top Four Medications Procured Total $1,166,685.30/YrTop Four Medications Procured Total $1,166,685.30/Yr

PhysiciansPhysicians

0

20

40

60

80

100

120

Physician Participation Implementation

6 Months

To Date

Health Access Barriers in the StateHealth Access Barriers in the State

0%

5%

10%

15%

20%

25%

Claims of Rx Barrier

2000

2003

Non Emergent ER CareNon Emergent ER Care

% Primary Care Visitsat Franklin Foundation Hospital

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Jan03

Feb03

Mar03

Apr03

May03

Jun03

Jul03

Aug03

Sep03

Oct03

Nov03

Dec03

% PrimaryCare Visits