Lancaster County Project Access

1
Project Access
Lancaster County
2
Project Access Lancaster County(PALCO)

• Leadership Team
• Laurence Carroll MD,
• Bret Daniels MD,
• William Fife MD,
• T. Ray Foley, MD,
• Jerome Gottlieb MD

• Christopher Hager, MD
• Coleen Kayden, R.Ph.
• Chip Mershon, MD
• Scott Silverstein, DO

Project Access
Lancaster County
3
Project Access

• An organized system of healthcare for low
  income uninsured patients led by physician
  volunteers partnering with existing healthcare
  and related resources in the community to give
  better and more cost effective care.

Project Access
Lancaster County
4
Project Access Across the Nation
5
Lancaster County

• Est. population
• 11 est. uninsured
• 60 are low income uninsured
• 25 children

500,000 55,000 33,000 8,250 25,000
75 are low income uninsured adults
Project Access
Lancaster County
6
Lancaster CountyPrimary Care ClinicsServing
Uninsured(most recent 12 month reporting period)
Low-income Uninsured Patients per Year
Southeast Lancaster Health Services
2,972 Welsh Mountain Medical Dental Clinics
1,118 Water Street Rescue Mission
Clinic 2,070 Hope Within Clinic
(began services 1/06)
117 Center City Clinic (takes MA only refers
uninsured to SELHS) Lancaster General Family
Health Services 2,203
Total 8,480
Project Access
Lancaster County
7
Patients Receive

• PALCO card that allows same access to full
  medical services as insured patients
• Free physician visits - primary care and
  specialty
• Free lab and radiology services
• Free hospitalizations - inpatient and outpatient
• Low cost medications
• Assistance with transportation and translation if
  needed

Project Access
Lancaster County
8

• Volunteerism the willingness to work on behalf
  of others without the expectation of pay
• or other tangible gain.

Project Access
Lancaster County
9
PALCOWhy Physicians Do It

• Docs already provide charity care in an
  inefficient
  
  
  and often frustrating manner now it
  can be done in a way that works.
  
• Only a small effort from many docs is involved
  Many hands make light work
  Docs see a maximum of 10 20
  patients
• It is equitable PALCO office keeps track
• There is administrative support PALCO
  office goal is to make it as easy as possible

Project Access
Lancaster County
10
PALCO Why Physicians Do It

• Patients are screened appropriately
  Rescreened every 6 months
  Many patients get on traditional insurance
• Patient are held responsible
• Docs are recognized for the good they do.
• Set high standards for other professionals.
• Lead a community effort.

Project Access
Lancaster County
11
Physician-to-Physician Deal

• Deal Sheet--In return for your commitment to
  provide free care we will provide
• Access to labs, studies, hospitalizations
• Access to specialty care you cannot provide
• Assistance with Rx needs for patients
• Hassle free care of patients with strong PALCO
  administrative support
• Verification of Patient Need
• Increased Patient Responsibility
• Recognition of Profession
• Shared Community Responsibility

Project Access
Lancaster County
12
Coordinated care can provide better health at
lower cost than uncoordinated care

• Increase of patients with a regular source of
  care
• Improves efficiency of low income clinics
• Decreases ER usage
• Decreases hospital admissions and length of stay
• Less wasted time for patients, doctors and nurses

Project Access
Lancaster County
13
Asheville, NC Project Access Outcomes

• Nearly doubled number of patients with regular
  source of care.
• Reduced projected charity care costs by 15-25
  from 1997-2004
• Community clinic capacity increased from
  6,000 pts at 5.2 visits /year to
  10,000 pts at 2.7 visits /year
• ER utilization rate dropped from 28 in 1995 to
  8 in 1998
• 80 report improved health
• Currently providing 8 MM in donated care each
  year--4.3 MM from physicians 3.7 MM from local
  hospitals

Project Access
Lancaster County
14
Dallas Project AccessReducing Costs at Hospitals
FY2005 ED Direct and Indirect Cost Savings -
553,375 Prior to enrollment, PAD enrollees
visited the ED 1.8/year After enrollment, PAD
enrollees visited the ED 0.7/year -- Uninsured
patients (Self-Pay) Direct Indirect ED costs
1,084/visit Projected FY2006 ED cost reduction
of 890,897 based on 800 projected PAD
patients FY2005 Hospitalization Direct and
Indirect Cost Savings - 890,897 Prior to
enrollment, PAD enrollees averaged 1.6
hospitalization days/year After enrollment, PAD
enrollees averaged 0.4 hospitalizations days/year
-- Uninsured patients (Self Pay) Direct
Indirect costs 1,616/day Projected FY2006
hospitalization cost reduction of 1,509,994,
based on 800 projected PAD patients Average
for all PAD Enrollees in Study (n268) ALOS
Average Length of Stay
Project Access
Lancaster County
15
Less Unnecessary Emergency Department
UseIndianapolis, In
Non-Urgent ER Visits AFTER Enrolling in Project
Health
Project Access
Lancaster County
16
Early care is better care and costs less than
late crisis management care

• Better and less costly care to manage a patient
  with hypertension than to care for that patient
  with a stroke.
• Better and less costly care to manage a patient
  with diabetes than to care for that patient on
  dialysis
• Better and less costly care to place a stent for
  a patient with coronary artery disease than to
  manage that patient for multiple complications of
  a large anterior myocardial infarction
• Better and less costly care to remove an
  adenomatous polyp from a patients colon than to
  manage that patients advanced colon cancer

17
Many hands make light work of a
large job.
18
Non-Physician PALCO Partners

• All Lancaster County Hospitals
• Lancaster County Medical Society
• Lancaster County Pharmacists
• APAN American Project Access Network
• Practice Managers from Area Physician Offices
• Managers and Social Workers from Area Clinics
  
• SEL, WMMDC, LGFHS, WSRM, Hope Within Clinic
• Representatives from County Assistance Office and
  PA Dpt of Health
• United Way of Lancaster County
• Lancaster Osteopathic Health Foundation
• Multiple Other Potential Community Partners for
  Funding

19
PALCO To Do List

• Continue to Recruit Physicians
• Complete Work Groups Medical Care Coordination,
  Hospital Care Coordination, Physician
  Recruitment, Pharmacy, Information System,
  Marketing and Outreach, Project Evaluation
• Achieve 501c3 (non-profit) status for Lancaster
  County Medical Foundation
• Achieve Necessary Funding Support
• See First Patient Targeted for Spring/Summer
  2007

20
We make a living by what we get we make a life
by what we give.Sir Winston Churchill
Project Access
Lancaster County
21
Project Access
Lancaster County