Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
A Concept Presentation
presented to the
Clark County Health Access Consortium
Dr. Carl HeardMedical Representative to the
Great Basin Primary Care AssociationBoard of Directors
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
4321
Describe theGeneralConcept
Outline KeyElements for
Success
Offer aGlossary of
Terminology
Create aFramework
for Dialogue
This presentation will . . .
The Specialty Care Access Network will be a healthcare referral
organization committed to theuninsured population of Clark County.
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
CCHACClark County Health Access Consortium
PROVIDERSNevada’s Safety Net
GBPCAGreat Basin Primary Care
Association
PlanningDevelopment & Implementation
Interim FundingOn-going
Facilitation &Consultation
Leadership in Work
Groups and Processing
ProposedPartnership
Great Basin Primary Care Association www.gbpca.org/cchac
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What is a Specialty Care Access Network?
Specialists Hospitals Diagnostic Centers Ancillary Formulary Pharmaceuticals
Enrolled, eligiblepatients requiring
specialty care(most likely
working, uninsuredadults)
Safety-net Providers Community Health Centers Primary Care Physicians Participating Providers
Electronic Networking: Referral Tracking
Case Mgmt Tracking Record Transfers
SCAN
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
HistoryConcept offered by key players in theyears past – CCHAC & BoardOther States and Cities have done thisFunded models
Great Basin Primary Care Association www.gbpca.org/cchac
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Margin of Generosity Concept
Specialty Care Access Network
Influenced by -payer mix -subsidizing grants -revenue relative to overhead
No organization can provide exclusively un- reimbursed care, except to the degree it receives outside funding (grants)
Strictly indigent care programs are potentially dehumanizing to patients & providers
The percentage of un-reimbursed care a given organizationcan afford to provide without threatening its own existence.
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
Margin of Generosity Concept
Private practice limits: 0-5% depending on payer mix, profit margin & benevolence
Safety Network limits: 0-100% depending on payer mix & Program limitations
Limits on -grants -clientele -geography -mission -etc.
The percentage of un-reimbursed care a given organizationcan afford to provide without threatening its own existence.
Great Basin Primary Care Association www.gbpca.org/cchac
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Relative Value of Efforts
Federal Funds Other Funds
Homeless Healthcare$130 Million
Community Health Centers$1.5 Billion
Un-reimbursed CareBy Private Hospitals
$21 Billion
Un-reimbursed Care by Private Physicians
$10.5 Billion
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
A professional with post residency training of a very focused field or subfield
Facilitated exchange of information & services amongstpeers for the achievement of a specific goal
Organizations & individuals striving to carefor patients regardless of their ability to pay & have a sliding fee scale
term meaning
Primary Care Providers
Case Management
Sliding Fee Scale
A Physician, Nurse Practitioner or Physician Assistant in OB/GYN, Pediatrics, Internal Medicine or Family Practice
The process of assessing a patients needs & assisting in the attainment of the agreed upon results
A guide assessing a patients ability to pay relative to federal poverty level comparison & number of dependants
Significantly less expensive consultation orancillary services
Specialist
Network
Safety-net
Discounted Services
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
A. SpecialistsB. Hospitals & CentersC. Ancillary D. Pharmaceutical E. Case ManagementF. Electronic Networking
Elements of Consideration
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
Great Basin Primary Care Association www.gbpca.org/cchac
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A. Roster of Specialists
11 Type of Specialties
22 Relative Availability
33 Ancillary Services Compatibility
44 Sliding Fee Scale
55 Location & Service Area
66 Language/Cultural Abilities
Great Basin Primary Care Association www.gbpca.org/cchac
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B. Roster of Hospitals & Centers
11 Type of Services
22 Relative Availability
33 Ancillary Services Compatibility
55 Location & Service Area
66 Language/Cultural Abilities
44 Sliding Fee Scale
Great Basin Primary Care Association www.gbpca.org/cchac
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C. Roster of Ancillary Services
22 Relative Availability
33 Compatibility of Service
44 Discounted Fee Schedule
55 Location & Service Area
66 Language/Cultural Abilities
11 Type of Services
Great Basin Primary Care Association www.gbpca.org/cchac
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D. Roster of Pharmaceutical Services
22 Formulary
33 Discounted Fee Schedule
44 Location and Service Areas
55 Language/Cultural Abilities
11 Pharmacies
Great Basin Primary Care Association www.gbpca.org/cchac
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E. Case Management
22 Fair Distribution of Cases
33 Patient Transportation & Advocacy
44 Scheduling & Referral Tracking
55 Clinical Records Transfers
66 Language Abilities
11 Unified Application Process
Great Basin Primary Care Association www.gbpca.org/cchac
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F. Electronic Networking
22 Real-time Provider Networking
33 Patient Referral System
44 Scheduling & Tracking
55 Records Transfers (bi-directional)
66 Multi-organizational Compatibility
11 Automated Application Process
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
Example ofa currentlyfunded &operating
model
Great Basin Primary Care Association www.gbpca.org/cchac
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Pima County (Tucson) Arizona
Pima Community Access Program, also known as "PCAP", is a not-for-profit organization that provides access to professional health care at discounted prices that theuninsured adult can afford.
PCAP links low-income, uninsured residents of Pima County with an affordable, comprehensive and coordinated network of health care providers.
PCAP Offers:Affordable co-payments only if services are used. No monthly premiums. Low membership fee of $20.00 every six months.
This model is the concept used by the Arizona PCA’s “MCAP” project in Maricopa County (Phoenix) Arizona
3 year HCAP grant awarded in November 2003
Great Basin Primary Care Association www.gbpca.org/cchac
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Pima County (Tucson) Arizona
Services OfferedDoctors’ visitsexcluding obstetrics
Hospitalizations
Laboratory Services
Radiology
Specialty Care
Pharmacy Discount Plans
Discounted Transportation
Eligibility18 Years or older and noteligible for any otherinsurance programs (Medicaid, Medicare, Employer-based, commercial or private) Eligibility will be determinedprior to enrollment
Pima County Resident
Pre-determined Income levels based on dependents
Pima County is a recipient of an HCAP Grant Award along with other state & local funding. They are in the 3rd year
of the project. Web site: http://www.pcap.cc
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
Member BasedExample:30,000Enrollees paying$20 twice ayear = $1.2 Million
GBPCA and otherorganizations include
costs of partsrelative to mission
in grant applications
CCHAC apply forfederal, state & localfunds after buildingsuccessful network(Arizona PCAawarded 3-year HCAPgrant for similar model)
Other fund raising byparticipants of the CCHAC from localgovernments and
businesses
Sustainability
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
Centralized single-site for:Single source to refer all uninsured patients for safety-net to look for needed servicesObjective data collection
• Collection of data on unmet ancillary services (i.e. diagnostic & interventional services)
• Data useful for taking action on needs of community(including providers of services)
• Allows for SCAN to begin to prioritize service needsin population
Offers a means of efficient referral to primary care services by specialists Does not interfere with existing referral relationships
Great Basin Primary Care Association www.gbpca.org/cchac
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Specialty Care Access Network
Conce
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Work
gro
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Reso
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Recru
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Develo
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Gra
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B U I L D I T
F U N D I T
Time Line ?Time Line ?