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Safety Net Resource Center builds assets to improve capacity to deliver health care for the uninsured and underinsured
Maintaining a current assessment of the health status and health services for the uninsured in Detroit and Wayne County has been complicated due to the absence of current, comprehensive information and other support services for safety net providers. A collaboration of local and state providers and health officials has established the Safety Net Resource Center. The Health Authority has been the catalyst in the Center's development and will operate it as part of the Health Authority.
Among its services, the Center will compile an annual report on the state of care for the uninsured. The report will be created through a collaboration between federally qualified health centers and Medicaid qualified health plans. It will also be a tool for attracting financial resources to support safety net providers.
The Center will not only have resources to prepare reports and conduct research that weren't there before, it will also serve as a consultant to safety net providers. It will eliminate duplication, while strengthening the quality of the information through collaborative input. Special attention will be given to project areas such as the East Side Initiative.
Other objectives of the Center include:
· Foster collaboration between federally qualified health centers and Medicaid qualified health plans that expands access to primary care for Medicaid recipients.
· Provide a data resource on Medicaid and uninsured people in Wayne County that can be used for safety net planning and advocacy.
· Conduct demonstration projects on care of Medicaid and uninsured people that show the value of safety net health services.
· Develop mechanisms that attract financial resources for safety net providers that will ensure long term sustainability.
The strength of the Center is in the collaboration of its partners -- something that hasn't occurred often in Detroit/Wayne County health care delivery. Consensus building is a very important initial step toward achieving an effective partnership on information sharing.
Collaborating organizations include Voices of Detroit Initiative, United Way of Southeastern Michigan, Michigan Primary Care Association, Southeast Michigan Health Associates, Greater Detroit Area Health Council, Michigan Department of Community Health, Wayne County and City of Detroit health departments, and the Wayne County Patient Management System.
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Innovative collaboration links school physicals with Medicaid enrollment
There are many ways to reach people who qualify for Medicaid insurance - some of them provide health dividends, such as an innovative school physical. The Health Authority has begun planning such outreach initiatives in Inkster and on the East Side of Detroit, announced Faith Polk, director of Community Outreach.
"The purpose of the Health Authority's school physical initiative is to improve the health and educational outcomes of youth," Polk explained. "Parents are being informed of Medicaid options available to Michigan families in order to ensure continued access to health care for their children."
Athletes are generally the only students who receive physical exams these days. Offering physicals are the first step to introducing young people, and their families, to a medical home. Parents will be asked about their health insurance coverage when they approve the physical exam for their child. If they need Medicaid enrollment, Health Authority staff will assist with enrollment and referrals on the spot.
The first initiative planned is for Inkster Public Schools. 2,100 students will receive physicals through a collaboration involving the Oakwood Health System, Western Wayne Family Health Center, Wayne County Health Department, Wayne State University School of Medicine, and Wayne County Community College Dentistry Program. Students will receive a comprehensive physical exam, including vision and oral health assessment, and health promotion information. Referrals for follow-up care will be made to Western Wayne Family Health Center.
A second school physical project is planned for Detroit's East Side to efforts to provide the estimated 90,000 people in that area a medical home.
As many as one in seven adolescents has no health insurance; one in three low income adolescents is not covered by Medicaid; and private insurance coverage of adolescents is increasingly restrictive, according to "Great Transitions: Preparing Adolescents for a New Century." The book recommends expanding school-linked health services.
"Health and education go hand in hand," according to Former Surgeon General, Dr. Antonia Novello in "Healthy Children Ready to Learn: An Essential Collaboration between Health and Education."
Dr. Novello noted that "Just as our children have a right to receive the best education available, they have a right to be healthy. As parents, legislators, and educators, it is up to us to see that this becomes a reality."
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Outreach workers demonstrate desire to find insurance for mother
Lesa Hall has been on the recipient side of health insurance assistance. To help people find health insurance such a joy that she approaches her job as an outreach worker for Ravendale Community, Inc., with a lot of energy.
On May 5, she read a Detroit Free Press article about Rosa Reyna, an employee of El Rancho in Southwest Detroit, who was without health insurance. She contacted Reyna from her East Side office and determined that she could help. So Hall and her colleague Tywana Smith went to Reyna's home to discuss health insurance options for herself and her children. Reyna was able to qualify for VODI Health and Dental, which doesn't require a premium and has a low co-pay.
Ravendale Community, Inc., is one of 11 community organizations to receive Medicaid outreach grants, helping the Health Authority extend its reach to find people without health insurance and help them enroll in Medicaid or other programs that they qualify for. In the first month, Ravendale's community outreach team has helped over 100 families find health insurance. |
Health Authority helps commemorate Cover the Uninsured Week through Interfaith Prayer Breakfast
The Interfaith Health and Hope Coalition, together with faith leaders and proponents of universal access to care commemorated Cover the Uninsured Week with the Coalition's Interfaith Prayer Breakfast May 1, cosponsored by the Health Authority. The program included presentations on state and federal initiatives, among other topics. Rev. Dr. John Duckworth, chair of the Health and Hope Coalition and member of the Health Authority's Community Advisory Committee, chaired the event.
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Emergency physician explores alternatives for patients who misuse emergency facilities
Creating an alternate site for uninsured people with urgent or general medical problems who routinely use hospital emergency facilities may be more difficult than it seems, according to Gerard B. Martin, M.D., Interim Chairman, Department of Emergency Medicine at Henry Ford Health System. To begin with, incentives don't exist for emergency facilities or patients. Emergency facilities aren't inclined to give up the revenue received from these patients, while offering the uninsured medical care on demand without requesting identification or an appointment - 24 hours a day, seven days a week.
That's not to say it's the most appropriate way of providing care for these patients, Dr. Martin explained to the Health Authority's Provider Advisory Committee. There are several barriers that make the creation of a medical home for these patients difficult:
· Many health centers aren't woven into the fabric of the health services network. There needs to be referral relationships to create the continuity of care required in a medical home.
· Communication between the referring emergency facility and community health center is often poor. Medical records often aren't exchanged between emergency facilities and health centers, requiring re-testing.
· Emergency physicians lack clarity as to the capabilities of community health centers in determining where to refer the patient.
· A lack of transportation may prevent the patient from getting to the health center.
· How does the emergency patient get the medication they need once they are discharged to a community health center?
Among the solutions suggested by Dr. Martin was establishing a clinic environment in or adjacent to the hospital emergency department. It could be staffed by a family practice physician and provide urgent/general medical care as necessary at times convenient for the patient in an environment they're already accustomed to visiting regularly. Also, by keeping the patient within the health system that has their medical history would provide greater continuity of care. This is a concept that the Health Authority endorses, especially considering the possibilities of establishing a federally qualified health center in the emergency facility.
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Backgrounder
New England Journal of Medicine article details obstacles to CHC expansion
President Bush has been consistent in his support for expanding community health centers nationwide, however systemic and staffing challenges prevent them from becoming viable medical homes for the uninsured, according to an article published March 27 in the New England Journal of Medicine.
The president has proposed $2.2 billion for community health centers in fiscal 2009, doubling his initial budget of $1.1 billion in 2002. The National Association of Community Health Centers (NACHC) expects to serve 30 million people by 2015 and 51 million by 2022, but concerns remain as to whether there will be sufficient physicians, nurses, dentists, and other clinical staff to support this growth. According to Dan Hawkins, NACHC senior vice president for policy, "CHCs meet the definition of a 'medical home,' as developed by primary care medical organizations, but we will not be able to reach our expansion goals if we cannot attract a greater number of clinicians to these centers and more federal support from Washington."
In addition, access to specialty care in hospitals for the uninsured is becoming increasingly scarce. The Journal cited a survey of CHC medical directors that noted their inability to secure specialty referrals, particularly for uninsured patients, posing problems that are "pervasive and affect sizable numbers of patients."
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Health Authority Chair: 'Give in order to get' health care reform
Health care reform - specifically, health care for the uninsured - has been given substantial coverage in the national political debate and at the state level. However, Gail Warden, chair of the Detroit Wayne County Health Authority, warned in a Detroit Free Press commentary April 17 that society will need to pay a price to achieve health care coverage for all.
"It is well known that a majority of Americans feel there is a need for not only health care reform, but a universal health care plan. But there are several forces that would prevent a single-payer, government-driven system from succeeding, chief among them cost and political will to bring about such a sea of change.
"So what options are there to fix a system that people believe health care costs too much, falls short in quality and does not provide access for the uninsured?"
Warden advocates for health care reform that is "achievable and doable." One out of three Michigan residents was uninsured at some point in 2006-2007. Although there is federal coverage for children in low-income families (MI Child), but uninsured adults, most of whom are employed in low-wage jobs, are without coverage, he wrote.
"No matter what hat we wear - policy-maker, employer, insurer, provider, union member, or consumer - we all have one thing in common in the health care debate: Each of us is going to have to 'give in order to get' access to quality affordable health care for citizens in Michigan and the United States."
Everyone needs to make changes, from personal deductibles and limited choices for consumers to provider quality incentives and adjusted payment levels, he says, adding that that consumers need to adjust their lifestyles as well. "The question is: Do we have the will to give in order to get?"
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Commissioner Bowman advocates for greater access, universal coverage
Wayne County Commissioner Ronaele Bowman understands the mission of the Health Authority well. To begin with, she has experienced difficulty accessing health care for a member of her family and she has served as a member of the Community Advisory Committee of since the Health Authority's inception. During that time, she has witnessed "tremendous growth" in the number of free and low cost health services available to the uninsured - especially for those outside the inner city of Detroit - and the level of enrollment of people eligible for Medicaid and MIChild. But the situation won't be acceptable until there is access to health care for all people when needed, she says.
Recently appointed to serve the remainder of Commissioner Kay Beard's term, Commissioner Bowman was appointed to the Community Advisory Committee by then Westland Mayor Sandy Cicirelli (now Judge Cicirelli) and Health Authority Board member. "I've seen a tremendous amount of growth since we started, especially the number of new clinics outside the inner city," Commissioner Bowman says. She shares the objectives of the Health Authority to provide access to health care for everyone, and ultimately achieving university health coverage for all.
"We need to have national health care. Every person in the United States should have the opportunity to have health services on demand. I know many people I would characterize as the working poor - some working as many as three jobs to make ends meet - without health insurance. It is a travesty that we label ourselves the most powerful country in the world, but we fail to provide basic health care to all individuals. Lack of health care impacts families, employers, schools, and our economy. It should be at the top of our list of local and national priorities," she says.
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The Detroit Wayne County Health Authority's mission is to coordinate efforts to meet the health needs of the uninsured and underinsured residents in Detroit and Wayne County by assuring access and improving the health status of all people.
"It's about access...for all."
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