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Hospital, health centers team up to get uninsured into care

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CHARLESTON, W.Va. -- Sixteen years ago, directors of 11 Southern West Virginia hospitals, clinics and community health centers started meeting regularly to kick around ideas.

"This was long before we knew there would be a health-reform law," said Craig Robinson, director of Cabin Creek Health Systems, "but we knew what the problems were."

When they started meeting, health-care costs were already spiking, as were the numbers of uninsured people.

People with no insurance and no regular doctor were using hospital emergency rooms more and more for routine care. Hospitals were shifting rising unpaid bills onto the backs of paying customers.

West Virginia also was topping the charts in diabetes, asthma, high blood pressure and various forms of cancer.

"We had a lot to talk about," Robinson said.

They wanted to collaborate. "We knew we could get a lot more done if we worked together instead of separately," said Bob Whitler, a Charleston Area Medical Center vice president who helped start the group.

In 2001, CAMC, Boone Memorial Hospital and three community health centers (Cabin Creek, FamilyCare and New River Health Association) decided to work as a team to get low-income uninsured people into regular health care.

People who have no regular doctor end up in the hospital more often, researchers have found. About 49 percent of West Virginia's uninsured say they have no regular doctor, often because they can't find a doctor who will see them, according to a West Virginia University study.

To attack that problem, the partners got a grant to start a http://www.pihn.org/CAP Brochure 2009-2010.pdf" target="_blank">Community Access Program, or CAP. Since 2002, more than 5,000 uninsured West Virginians have enrolled in regular care -- and have cut their hospital use in half.

This is the plan: Identify people who use the emergency room for routine care, who make less than 200 percent of the federal poverty level. Encourage them to enroll at a community health center, where staff help them manage problems like diabetes and high blood pressure on a week-to-week basis.

If people enroll, they get a card that entitles them to hospital care -- if it's needed -- for $25 to $35 a year. That low cost is still worth it to the hospital, Whitler said, because people at that income level qualify for hospital charity care anyhow. Also, the program will probably improve their health, and they'll use the hospital less.

People often go to the E.R. for routine care because they think they have no other option, Robinson said, but West Virginia's network of 160 community health centers and 11 Health Right clinics charge on a sliding scale and don't turn away people who don't have insurance or money.

Community health centers do not offer hospital care, but the partnership with CAMC fills that gap.

"When we collaborate, we can offer people a fuller package of services," Robinson said.

When the program started, the hospitals assigned an employee to the emergency room, to tell low-income uninsured patients with no regular doctor about the CAP program and the community health center near them.

Patients were told that CAP patients also receive hospital services at CAMC or Boone Memorial. To get that deal, a person has to be a patient at a participating community health center.

Since 2002, more than 5,000 people have taken them up on that offer. By 2005, people in the program had cut their emergency room and hospital visits in half over two years, according to a statistical analysis.

"They know the hospital care is there if they need it, but it's our job to keep them too healthy to need it," Robinson said.

Between 2003 and 2005, there were only 44 hospital admissions for every thousand CAP enrollees. That's well below the expected rate for the uninsured, Whitler said.

"This has been very effective," he said. "It's a fine collaboration."

All community health-center patients visit doctors and get checkups, labs and X-rays. They also receive ongoing chronic illness management, help with stressful events from social workers, some dental and vision care and options like healthy cooking classes.

"We use a team approach, a preventative approach to health care," Robinson said. "It works."

Patients also set detailed medical goals, and medical workers follow up to make sure they are, for instance, checking their blood pressure or exercising on a regular basis.

"This is a high-risk group," Robinson said. About 65 percent have high blood pressure, 45 percent are diabetic and 53 percent have asthma. Such chronic conditions account for a third of West Virginia's health-care costs, legislative studies say.

So, when people learn to manage them, the state saves money, Whitler said.

The federal grant that funded the original CAP program ended in 2005, "but CAMC has kept doing it," Whitler said, "because it works."

Now the partners want to expand it.

 

A model others could duplicate

The CAP program is small, compared to at least 100,000 uninsured West Virginians who have no regular doctor.

Health-care reform will pay to expand such efforts, he said, especially when hospitals and community caregivers collaborate, says health-care consultant Tom Susman.

In late August, he helped the Partners in Health group put together a proposal to use health-care reform money to expand the CAP program. Among other things, they want to pay an actuary to calculate a fee schedule and financial blueprints.

"It's a dream, but maybe the CAP program can be the start of an accountable care organization," Susman said. "Maybe it can eventually become a program people can choose on the [health insurance] exchange."

Three years from now, West Virginia's health-care exchange will go online, and West Virginians will be able to choose among health insurance plans.

Partners in Health hopes an expanded CAP program could be offered as a non-insurance option to satisfy that requirement.

"The law appears to allow prepaid programs to be listed, too," Susman said. "That would give people a low-cost alternative that provides real health care."

Partners thinks it would cost about $100 a person per month for primary and hospital care, with some specialized care included. Each person would pay between $25 and $100, depending on income.

Meanwhile, the group is expanding. Partners in Health now includes 23 hospitals, clinics and health centers within 100 miles of Charleston. Hygeia Facilities Foundation in Raleigh and Boone counties has joined CAP. Roane General and Roane County Family Health Center might join.

FamilyCare, Cabin Creek and New River also are managing the care of 1,200 disabled people with chronic disease, while CAMC provides hospital care. "In that program, we have practically eliminated re-admissions to the hospital," Robinson said.

"These are models that can be duplicated," he said. "We keep trying to show what can be done when people work together."

Reach Kate Long at katelong@wvgazette.com or 304-348-1798.

Learn more

For information about . . .

| Community health centers: Visit www.wvpca.org. For a list, click on "Members."

| The CAP program: Visit www.pihn.org. Click on "Download CAP brochure"

| WVRX free prescription pharmacy: Visit www.wvrx.org.

| West Virginia Health Right: Visit www.wvhealthright.org


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