In 1999, when two local hospital emergency departments (EDs) and a small primary care clinic closed, the remaining local EDs struggled to serve one of the stateâ€™s largest uninsured patient populations. Orange County providers, including Orange County Government, hospitals, federally qualified health centers (FQHCs), free clinics, the Health Department, the Medical Society and others established a collaborative to improve the access, quality and coordination of health care services for the countyâ€™s uninsured and underinsured residents. Today, the Primary Care Access Network (PCAN) includes public, private, faith-based and government agencies and provides a full range of primary and secondary services.
In 1999, when two local hospital emergency departments (EDs) and a small primary care clinic closed, the remaining local EDs struggled to serve one of the state’s largest uninsured patient populations. Orange County providers, including Orange County Government, hospitals, federally qualified health centers (FQHCs), free clinics, the Health Department, the Medical Society and others established a collaborative to improve the access, quality and coordination of health care services for the county’s uninsured and underinsured residents. Today, the Primary Care Access Network (PCAN) includes public, private, faith-based and government agencies and provides a full range of primary and secondary services.
Serving as medical homes, FQHCs provide primary care for the uninsured and make referrals for specialty care, behavioral health and substance abuse, dental and pharmacy services. Services are provided on a sliding-fee scale; Medicaid, Medicare, public and private payments are accepted. Faith-based clinics provide urgent care at no cost, and a centralized secondary care clinic helps patients to access specialty, diagnostic and hospital care. Continuity of care and care quality are supported by electronic medical records and case management systems. In addition to more than $12.6 million in donated volunteer services, funding includes $12.9 million in county general revenues that leverage state Inter-Governmental Transfer (IGT) funds. Partners also accept Medicare, Medicaid, sliding-scale fees, and governmental and private grants.
As a result of PCAN’s efforts, the number of patients served has grown from three percent of the uninsured population in 2000 to 50 percent of the uninsured population in 2012, while reducing Orange County Government’s per patient cost from $2,000 per patient in 2000 to $160 per patient in 2012. Other outcomes of PCANS efforts include:
- An increase in patient enrollment from 5,000 served by two clinics to 110,000 served by 12 clinics
- A 25.4 percent reduction in non-urgent, uninsured ED visits between 2001 and 2007
- A 94.4 percent report of health improvement by patients, including 83.3 percent with decreased cholesterol, 68.4 percent with decreased blood pressure, and 22.4 percent with glucose levels reduced to normal limits
- A 98 percent patient satisfaction rate and a 90 percent partner attendance at monthly board meetings
PCAN has grown to 12 primary care “medical homes,” nine free urgent care clinics, and one secondary care clinic in Orange County. When the 22 PCAN partners came together in 2001, the goal was to expand from the existing two clinics to eight primary care centers, but PCAN continues to grow. All but one medical home are FQHCs that serve an average of 92,000 patients annually – nearly half the county’s uninsured. Specialty care services serve 10,000 very low-income county residents. Orange County Government contributes $12.9 million per year in general revenue funds to leverage Disproportionate Share/Intergovernmental Transfer funds. Through an interagency agreement with Florida Hospital and Orlando Health, the matched dollars supplement secondary care services and the FQHCs. The hospitals also donate in- and outpatient services to PCAN patients and, in 2012, the volunteer provider programs reported $12.6 million in donated services. The PCAN board continues to find ways to expand access to affordable care, negotiate affordable rates with diagnostic vendors, and grow its 1,600- person volunteer component.
PCAN officially became a 501(c)(3) in January 2013 to facilitate future collaborative grant opportunities. The Board is carefully monitoring – and preparing for – implementation of the Patient Protection & Affordable Care Act (ACA) at both the national and state levels.
Advice to others
PCAN has identified the following eight-step process for replicating their model:
- Crisis – Mobilizing partners around the community’s health care crisis.
- Research – A data-driven analysis of the factors creating the crisis leads to definition of the problem and a framework for solutions.
- Vision – Establishing high-level objectives and long-terms goals creates consensus among providers.
- Guiding principles – Determining and articulating principles of operation provides clarity to all providers and helps define responsibilities.
- Convening – Bringing all providers and stakeholders together to achieve the network’s vision helps maintain continuity and consistency.
- Plan development – Setting short-and long-term goals based on research data creates a realistic framework for operating the program.
- Evaluation – Determining metrics of success that are tailored to meet the interest of stakeholders ensures that the program is relevant.
- Sustainability – Aligning partner cultures and values around a shared mission promotes the program’s long-term viability. Ongoing communication and documentation of success are the keys to sustainability.
A finalist for the 2009 Innovations in Government award from the Ash Institute of the John F. Kennedy School of Government at Harvard University, PCAN has used the award to create a “tool kit” containing information about the program and steps for replicating it. The tool kit is available at http://pcanorangecounty.com/docs/toolkit.pdf
Contact: Debbie Belanoff
Orange County Medical Clinic