DuPage CountyHealth Safety Net Plan

2012

In Illinois, counties have many permissions, almost no mandates

Six nonprofit general hospitals, no public hospital

Historically affluent, suburban area Rapidly becoming more diverse, less

affluent International immigration accounts for all

population growth since 2000

About DuPage County

(So where is DuPage County?)

Medicaid distribution in DuPage

The DuPage County Health Safety Net system will be a model for others to follow in managing the health of a defined low-income population effectively and efficiently across the entire continuum of care.

Vision

Low-income persons – i.e. ◦ those enrolled in or eligible for Medicaid

(>104,000)◦ those medically uninsured adults with household

incomes under 200% of the Federal Poverty Level. (>38,000)

Target Population

1989 DuPage Community Clinic Founded Late 1990’s DCC reaches capacity of its

model 2001 Access DuPage Founded 2003 FQHC #1 Established 2003 Medical Access Plan developed 2005 FQHC #2 Established 2007 FQHC #3 Established; Oral Health

Plan Mental Health Plan 2010 Southeast DuPage Health Initiative

Background

Every person within the target population who identifies him/herself will: Be enrolled in every public benefit plan or access program for

which he/she is eligible; Have access to regular primary care; Have access to the diagnostic services, specialty care, hospital

services, and prescription medications that he/she requires;

Have access to essential mental health and oral health services;

Have access to those services required to manage many chronic diseases; and

Have access to medical care that is delivered in an increasingly linguistically and culturally competent manner.

When the plan is implemented:

Includes all organizations whose missions compel them to be involved in the issue: hospitals, health department, County, etc

Able to clearly demonstrate effectiveness, efficiency, and a solid return on investment on all resources used to develop and maintain the Health Safety Net; and

Have the necessary political support and financial backing to fully implement this Plan.

DuPage Health Safety Net Coalition

Collaboration Asset Focus Fair Share (no blank check) Mosaic Approach System Focus

Guiding Principles

Goal 1: Every individual within the target population who is eligible for ◦ public health insurance coverage and/or a ◦ health care program providing access to care is properly enrolled in that program in a timely fashion.◦ DuPage County Health Department has

taken responsibility to get people enrolled◦ 28 community agencies are enrollment sites◦ New SOAR Capability lets us get people who

are diagnosed with qualifying conditions onto Medicaid or Medicare.

Enrollment

Goal 2: Every individual within the target population has a primary care “medical home” from which to receive regular primary medical care.◦ Federally Qualified Health Center◦ Private Doctors◦ Free Clinic◦ Three Federally Qualified Health Centers

have been opened; We’re working on a fourth

◦ Second site of Free Clinic has opened◦ 1/3 of the doctors in the County participate

Essential Medical Services

Goal 3: Every individual within the target population has access to the medical specialists required to maintain good health.◦ Weak Spot in the plan◦ Specialists are asked to donate services

without charge.◦ For some, this is a lot to ask◦ Not enough participating specialists◦ Working on getting specialty clinics in

FQHC’s, etc.

Goal 4: Every individual within the target population has access to the diagnostic services required to maintain good health.◦ All the hospitals, pathologists donate labs, ◦ Radiologists donate imaging

Goal 5: Every individual within the target population has access to the hospital services required to maintain good health in a timely manner.◦ All the hospitals treat Access DuPage

patients under their charity care policies◦ Federation is working with hospitals on

Frequent User initiative

Goal 6: Every individual within the target population has reasonable access to those prescription medications that are required to maintain good health, and especially those medications that will keep medical conditions from worsening.◦ Samples◦ Manufacturer’s Free Drug Programs◦ 97% Generic Efficiency◦ Other Strategies

Goal 7: An array of essential mental health services is available for those within the target population who need such services.◦ Circuit Riding Psychiatrist spends time at

nonprofit MH agencies, substance abuse agency

◦ FQHC’s – Spanish Speaking MH providers◦ Interns and Externs at Free Clinic,

supervised by large, reputable mental health provider

◦ More to be done

Goal 8: Every individual within the target population has reasonable access to the oral health services that are required to maintain good health◦ Health Department in the lead◦ Expanded its crisis clinic to include Medicaid◦ Other strategies for elderly and disabled

persons◦ Newly developed Dental School to open

clinic

Goal 9: Persons within the target population with certain chronic diseases are enrolled in Disease Management programs and making progress in managing those diseases◦ Access DuPage has NIH funded navigator

program for breast and cervical cancer◦ Exploring wider use of navigators for

Frequent Users

ENABLING SERVICES

Goal 10: All health services described in this Health Safety Net Plan are provided in a manner that is linguistically and culturally competent to patients with limited English proficiency (LEP).◦ Language Access Resource Center trains

interpreters, provides interpreters to health and human services agencies

◦ 7 Executive Directors doing plan for their agencies on CLAS

◦ 250 Interpreters trained

Goal 11: The effectiveness and efficiency of the entire Health Safety Net is demonstrated by means of a robust system of information retrieval, analysis, and evaluation.◦ SF-12 Data tracked for many years shows

improvement in mental health, stable physical health

◦ Utilization data shows efficient use of system that is low where it should be low (ED use), high where it should be high (Primary care)

Goal 12 The coalition of organizations taking accountability for this Health Safety Net Plan is organized and structured in a manner that allows the Health Safety Net Plan to be most successfully implemented◦ Coalition formed in 2001 stronger than ever◦ New collaborative efforts forming every

year.

ORGANIZATION

Goal 13 Obtain all necessary political support to insure the success of the DuPage Health Safety Net Plan

Goal 14 The DuPage Health Safety Net Plan is marketed in a way that insures optimal participation from Coalition partners, and optimal support from key external parties.◦ Need to continually work on this.

GARNERING SUPPORT

Goal 15 The DuPage Health Safety Net Plan is sufficiently well funded to effectively implement all components of the Plan.◦ FY 2010 Donated Services worth $80 million◦ 11,000+ persons enrolled

FUNDING

Legal Residents < 130% FPL to Medicaid Categorical restriction for Medicaid removed Some employed low wage earners will get

coverage at Exchanges Net effect: Enrollment in Access DuPage will

drop somewhat but the need for the program will not go away.

Health Reform Impacts