Edwin Fonner,
Jr., DrPH
Purpose. This document summarizes the evaluation of the Community Health Council’s Community Access Program (CAP). Overall, the CAP program has been effectively managed during its first two years of operation and significant progress has been made in meeting the original objectives. Given strides made to date, there is a great opportunity for CHC to facilitate the development of an even more integrated system of care for the uninsured and medically underserved in the region.
Evidence. Information used to evaluate the CAP initiative was gathered from a survey of clients, interviews, studying status reports and other printed materials, and making comparisons with other CAP sites. Some valuable information was collected from the Community Access Program Satisfaction Survey although the response rate was 12 percent. Over three-dozen interviews were conducted, resulting in useful observations and recommendations. A needs assessment survey with questions on health insurance status, travel barriers, use of health services, recent exams, access to care, and health status was deferred until a better outreach and distribution strategy can be formulated.
Survey Results. The Data Book accompanying this report summarizes survey findings. The sample of respondents was slightly older and had more females than the CAMS database. Nearly three-quarters of the respondents were “extremely satisfied” or “satisfied” with their healthcare. About half stated that their healthcare providers always listened carefully, explained things clearly, and showed respect for them. Only about one-third felt that providers always spent enough time with them. The proportion delaying purchases of health related items ranged from one-third to about forty-seven percent. Over half of the respondents had missed a healthcare appointment in the last year due to transportation difficulties. Many relied on taxis (8 percent), pubic transit (24 percent), or walking (11 percent) to get to their appointments. About 30 percent were uninsured. Seventeen percent had recently lost health insurance. Emphysema/chronic bronchitis and depression/anxiety were the most frequently reported chronic health problems. About 43 percent had three or more chronic health problems. Many respondents stated they had never heard of or used CAP, but among those that had, over 84 percent were satisfied with services received. Some respondents commented that CAP needed to secure more resources, improve public awareness, or expand services.
CAP Objectives. The CAP objectives are to (1) enhance the system of care for the area’s uninsured, (2) develop the safety net’s infrastructure, (3) help stem growth in numbers of new uninsured, and (4) facilitate leadership development and regional identity. Here is a summary of CAP’s progress and areas needing attention:
Progress Made – The CAP program has caught the attention of the public and brought care to a significant number of persons. Access points have been conveniently located across the region and CHRSs staffed in a number of participating agencies. A critical mass of providers has been engaged and most basic services have been made available to those in need. Agencies have been effectively linked together with service agreements, the CAMS system, and communications between CHRSs and providers. Healthcare, dental, mental health, prescription drugs, laboratory and diagnostic tests, medical equipment, and other services are being made available to eligible clientele. CHC has received a contract from SRS to enroll children in the HealthWave program. Proficiency has been developed in developing and submitting funding proposals. A telehealth initiative is ready for initial release. CHC is effectively facilitating communications with community leaders in Manhattan and, increasingly, across the region.
Areas Needing Attention – The unmet medical and related needs of vulnerable populations in the region are significant and growing. The capacity of the CAP program to meet these needs is limited because most of HRSA’s grant funds are for infrastructure development. Less is earmarked for direct patient care. CHRSs are unable to follow-up on much of its caseload. Non-participation by some major provider organizations has limited the potential of case management. Some providers are less happy with the program because effective CAP outreach tends to increase their burden of uncompensated care. Agreements have been needed with out-of-area providers, while some local providers have required full compensation to take CAP clients. The medical society and local physicians have participated to a lesser extent that originally planned. The health insurance product for small businesses was unable to generate significant sales and prospects for state premium subsidies are small. CHC has limited diversification of revenue sources and relies heavily on external grant funding.
Recommendations. Although the CAP program has been effective, providers in the region still take a fragmented approach to providing safety net services to needy persons. Some recommendations for continued enhancement of the safety net include:
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Minimize additional outreach and regional expansion of the CAP program until local providers can regroup and agree to address needs on a more targeted basis. Additional successful outreach can place additional demands on providers already squeezed by limited reimbursement. |
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Explore with the medical society ways for CHC to engage and provide value to physicians in the area. Given evidence of declining proportions of physicians seeing Medicaid patients and providing charity care, more organized approaches are needed to help physicians address declining reimbursement and growing uncompensated care. |
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Convene a short-term, action-oriented dialogue with CEO’s and CFO’s of major provider organizations focusing on a more efficient and effective safety net. Help shape consensus on the geographic area and specific population needs to be addressed. Design and test a delivery model that balances uncompensated care more equitably and provides a positive ROI for each participating provider. |
Perhaps the greatest service delivery issue facing the region is how to best cope with increasing demands and strains on the safety net as available resources dwindle. CHC’s leadership through the CAP program can play a major role in helping provider organizations adapt to change, make the safety net more viable, and meet future needs. [Back to Main Page]