Pima Community Access Program PCAP

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Pima Community Access Program PCAP

• Powerful Partnerships at Work to Build a
  Healthier Community

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MARKET ASSESSMENT

• PCAPs provider partners currently provide over
  75 million dollars in uncompensated care.
• AZ has one of the highest rate of uninsured
  persons in the nation.
• AZ is 6th in the nation for the non-elderly
  uninsured population. 1.6 million non-elderly
  people are uninsured.
• 84 of low-income AZ families work all or part
  year.
• Only 60 of these working low-income families
  have employer-based healthcare coverage.

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MARKET ASSESSMENT

• 30 of employees in firms with 1-9 employees are
  not insured.
• Private insurance premiums are increasing at a
  minimum of 30.
• 99.5 of the full time business firms with
  employees in AZ are small business.
• Pima County has an estimated 70,000 low-income
  uninsured adults. 52 of them are Hispanic.

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PCAPS PURPOSE

• To increase enrollment in public programs, and
  thus reduce the overall percentage of
  uncompensated care in Pima County, through an
  automated electronic eligibility system called
  Health-e-Arizona. 40 of the uninsured are
  eligible for public assistance and are unaware.
• To design a coordinated system of care which
  provides a network of specialists and hospitals
  willing to accept uninsured patients at an
  affordable rate

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PCAPS PURPOSE

• To reduce the avoidable emergency room visits and
  hospital admissions through access to
  coordinated, elective care.
• To produce clinical outcomes comparable to
  insured populations.

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PCAP.WHO ARE WE????

• Community based program with a community board
  and community support!
• Consortia of healthcare providers and community
  leaders!
• All Community Health Centers (8)
• Six Community Hospitals (6)
• Pima County Medical Society (1100 physicians)
• University Physicians, Inc. (300 physicians)
• Over 600 private physicians and ancillary
  providers
• United Way

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PCAPWHO ARE WE???

• Pima County
• AZ Small Business Association
• Fred G. Acosta Job Corp
• Metropolitan Chamber of Commerce
• Clements and Peck Insurance, LLC
• Rural Health Office-Mobile Clinic Program U of A

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PCAP IS

• PCAP links low-income, uninsured residents of
  Pima County with an affordable, comprehensive and
  coordinated network of health care providers.

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PCAP IS

• A Community Access Program (CAP) funded by a
  federal government grant, federal and state
  funding to community clinics, and discounted
  services of participating providers
• A comprehensive system of affordable care for low
  income, uninsured persons in Pima County
• A collaborative system that provides continuum
  of care to the uninsured while offering providers
  more support in delivery of that care
• A healthcare buying/discount service organization

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PCAP IS NOT!!

• Insurance (of any kind)
• Providers of Care
• Free Care
• For Everyone

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PCAP Eligibility Criteria

• Pima county residents, 18 years and older
• Fall within 100-250 of the federal poverty level
• Pay 20/person every 6 months
• Those not covered by other insurance

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PCAP OFFERS

• An entire community fighting for equity in
  healthcare
• A healthcare delivery model that says YES
• A medical home for every enrolled patient
• A continuum of caring

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PCAP OFFERS

• An integrated force to eliminate barriers to
  receiving/delivering healthcare
• A BRIDGE in the healthcare gap for thousands of
  persons in Pima County
• An equitable distribution of services among
  providers

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PCAP OFFERS

• Community partnerships and sustainability
• Outreach and mobile healthcare services to rural
  communities in Pima County
• Accessible and affordable comprehensive services

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Sample Fee ComparisonCommon Procedures

• Inpatient Stay
• Description UCR Cost PCAP Fee
• 1 Day stay-Chest pain 4,144.70 400.00
• 2 Day stay-Gall Bladder Removal 13,715.90
  800.00
• 6 Day stay- Diverticulitis 24,064.70
  2000.00
• Outpatient Procedures
• Description UCR Cost Medicare Allowable PCAP
  Fee
• Hernia Repair 1,124.00 600.00 180.00
• Stress Test 621.50 112.43 33.73
• MRI Cervical Spine 1,416.25
  608.46 182.54
• Breast Needle Biopsy 1,609.00
  426.30 127.89
• Upper GI Procedure 357.00 281.90
  84.57
• Arthroscopy/Knee 1,234.00 591.14 177.44
•  
• Physician Consults
• Description UCR Cost Medicare Allowable PCAP
  Fee
• Initial Hospital Care 105.00 71.02 25.00
• New or Established Pt Consult 160.00 117.18 25
  .00

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PCPs, Specialist Hospitals

• 6 Hospitals
• 579 Specialists
• 63 Private Primary Care Physicians
• 9 Community Health Centerswith 72 Physicians and
  20 sites

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40 Coupon

 What do you do when you don't have health
insurance???   Pima Community Access Program
(PCAP) offers a health care alternative for you.
The advantages are ? No Monthly Premiums ? Pay
only for Services Used (at highly
discounted/affordable rates) ? Doctor Visits ?
Low Membership Fee (20.00) every 6 Months ? Easy
Eligibility/Enrollment ? Hospitalization, Lab
X-Ray   HEALTH NET OF ARIZONA IS PARTNERING WITH
PCAP AND IS COMMITTED TO YOUR HEALTH! WE'LL
PAY YOUR MEMBERSHIP FOR A WHOLE YEAR!! You must
meet PCAP Guidelines

Cut along dotted lines take to PCAP for
validation Good for One-Year Membership in PCAP
Sponsored by Health Net of Arizona Name__________
__________________________________________________
_______ Address___________________________________
______________________________ Phone
number____________________________________________
_________________
For
more information please contact PCAP Tel
520.694.0465 Fax [phone] Website
WWW.PCAP.CC
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40 Coupon
 What do you do when you don't have health
insurance???  Pima Community Access Program
(PCAP) offers a health care alternative for you.
The advantages are ? No Monthly Premiums ? Pay
only for Services Used (at highly
discounted/affordable rates) ? Doctor Visits ?
Low Membership Fee (20.00) every 6 Months ? Easy
Eligibility/Enrollment ? Hospitalization, Lab
X-Ray CARONDELET HEALTH NETWORK IS PARTNERING
WITH PCAP AND IS COMMITTED TO YOUR HEALTH!
WE'LL PAY YOUR MEMBERSHIP FOR A WHOLE YEAR!! You
must apply within 10 days of today's Emergency
Department visit and meet PCAP GuidelinesCut
along dotted lines take to PCAP for validation
Name____________________________________________
_______________________ Address___________________
______________________________________________ Pho
ne number_________________________________________
____________________

For more information please contact PCAP Tel
520.694.0465 Fax [phone] Website
WWW.PCAP.CC
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Employment TypeN 6084 Sept. 01 Present
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Primary Care Clinic
Frequency
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Primary Care Provider Data
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Referrals to Specialists

• N 1752
• Sept. 01 Sept 03

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Encounters for Specialists 1,559Sept 01
Present

• Top Five Specialties Utilized To Date
• Ophthalmology 156
• Gynecology 128
• Ortho Surgery 119
• Geriatric/Fam. Med. 116
• Neurology 101

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Specialty Physicians Services N 2160 (encounters
through Sept. 03)
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Hospital In and Out Patient ServicesN 1049
(Sept. 01- Present)
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In-Patient Billed Charges by Hospital
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Based on Encounters Received Sept. 01 Feb. 03