Improving Access to Primary Care for the Uninsured in Davidson County

1. Improving Access to Primary Care for the Uninsured in Davidson County April 2010

2. Davidson County Access to Care Team • Layton Long – Davidson County Health Department • Cyrus Bush – Thomasville Medical Center • Sandy Motley – Davidson Medical Ministries Clinic • Dale Moorefield – Davidson County Social Services • Robert Hyatt – Davidson County Managers Department • Chris White – Lexington Memorial Hospital

3. Overview • The Problem • Increasing Number of Uninsured Patients • Lack of Access to Preventative Health Care • Davidson Medical Ministries Struggling • Poorer Health Outcomes • Working Toward a Solution • Developing a Leadership Team • The Solution • Transition of Davidson Medical Ministries Clinic (DMMC) to a Federally Qualified Health Center (FQHC)

4. Target Market • Davidson County Residents 18-64 (primary) • Uninsured • Underinsured • Others without a medical home

5. Definition of Plan • The primary safety net provider for the uninsured • Declining Resources with Increasing Demand • Loss volunteers • Reduced Donations and Grants • Reductions in Services • Current Model is Unsustainable • Decision to Transition to FQHC

6. Benefits • Expanded Clinical hours … increased patient capacity • Expanded Dental Services • A Medical Home for residents with a chronic disease • More cost effective care

7. Benefits (cont.) • Hours of Operation • From 29 hours at Lexington to 48 hours • Staffing • From 5 hrs/week MD and 2 Mid Levels to 1 Full Time MD and 2 Mid Levels • From volunteer dentist to 1 paid staff dentist • Increased support staff • Finances • Lessened dependency on grants and donations • Secure payor sources through Medicaid, Medicare, Sliding Fees, and private insurances • Stable annual federal grant funding

8. Operations and Management • Move forward as Satellite with Gaston Family Health Services(GFHS) as sponsoring board. • Corporate Board with 2 members of DMMC advisory board • Fiduciary responsibilities • 51% consumer based • Advisory Board • General Operations oversight • Community outreach and support • Site Administrator • Responsible to Executive Director of GFHS and Board • Operations Model • 5 primary programs with managers: Clerical-Eligibility, Medical, Dental, Pharmacy and Thomasville. • Responsible for staff, volunteers, students, patient services. • 3 coordinators: Hispanic, Social Work, Volunteer • Services provided: • Currently at 4 days per week or 30 hours • Expand to 40 hours immediately and up to 60 hours by end of year 2.

10. Access to Care - Need Indicators • 19% - overall lack any health care coverage • 23.6% - under age 65 lack health care coverage • 15.4% - under age 65 working for wages lack health care coverage • 17.7% - indicated a time when they needed health care but could not afford it.

11. Marketing Low Key Approach • Full advertising not advisable • Unwanted attention could bring negative consequences • Retaining paying patients • Accepting referrals

12. Uninsured Health Care Industry • No direct competition for uninsured • Private providers not competing for uninsured patients • Limited options for care results in costly emergency room visits

13. Safety Net Clinic Models • Free Clinics • Community Health Centers • Federally Qualified "Look-a-like" Health Centers • Federally Qualified Health Center (Independent or Satellites)

14. FQHC Satellite Advantages Partnering with an existing FQHC • Established track record of success • Section 330 Federal Funding - $650,000 annually • Expand primary care services in communities • Administrative Support for FQHC operation

15. Measures of Success

16. Measures of Success (cont.)

17. Risks • Finding a FQHC partner • Comprehensive health care reform • Revenue generation / Medicaid billing • New patients • Retention of existing staff

18. Exit Plan • Continue operation as DMMC • Establishing independent FQHC

19. Budget (Revenue)

20. Budget (Expense)

21. Questions ??