Seeking health care for all in Eugene
This may be the only way we'll ever get universal health care -- through local action. State and federal governments seem to be frozen in place. Try putting pressure on local officials, and see if you can get them to move. Poor people are dying in this country for lack of medical care.
The Register-Guard, Eugene, Oregon
July 3, 2005
A new community organization's goal is health care for all
By Tim Christie
In a perfect world, anyone and everyone would be able to see a doctor when the need arose, regardless of ability to pay.
Instead, getting access to health care in Oregon and the United States today is often a function of whether a person has health insurance.
For 45 million uninsured Americans, including more than a half-million Oregonians, getting medical treatment often means waiting as long as possible, then heading to the nearest emergency room, a costly and inefficient way to deliver health care.
To address that disparity, a group of community leaders in Eugene and Springfield is embarking on an ambitious project whose name is its goal: 100 Percent Access.
The multipronged effort is intended to make sure everyone who needs health care has access to health care, to get more people health insurance and to promote healthy living. About 66,400 Lane County residents, or 20 percent of the population, lack health insurance, according to Lane County statistics.
Leaders of 100 Percent Access include health insurers, doctors, hospital leaders, public health providers, social service agencies, employers and educators.
The Lane County project is part of a growing national trend in which communities, tired of waiting for health care solutions that never come from state and federal legislators, take it upon themselves to take care of their own.
The idea is to take former U.S. House Speaker Tip O'Neill's old saw - that all politics is local - and apply it to health care.
"I think it's what communities are really about - a basic grass-roots effort," said Ken Provencher, chief executive of Eugene health insurer PacificSource Health Plans and chairman of 100 Percent Access. "That's where the action is, that's where they can make things happen."
The project's genesis was the 2004 "State of Caring" survey undertaken by United Way of Lane County that found that the three most common concerns in Lane County households were related to health: lack of money to see a doctor, lack of money for medical insurance and lack of money for prescription drugs.
And the numbers of people reporting those concerns were the highest they'd ever been, said Priscilla Gould, United Way executive director.
One-third of all Lane County households have been unable to get needed health care at some time in the previous 12 months, the survey found.
"It didn't matter if they were rich or poor, urban or rural," she said.
Organizers plan to seek $1 million to $2 million in grants to get the project off the ground, Provencher said. Organizers haven't yet determined exactly how to pay for the program over time, he said, but one notion is that cost savings could be used to sustain it.
"Ultimately, it's about changing the way the health system works," he said. "It's about reallocating costs."
The Lane County effort is still very much in its planning stages. Organizers had a summit meeting in May, and task forces are moving ahead with plans to address five specific areas:
Medical home: The goal is to establish a system under which every resident of Lane County has a "medical home" - a clinic or doctor's office where their records are kept and where they can return for care as needed. Currently, various community and school-based clinics provide a medical home for about 30,000 people, including RiverStone Clinic in Springfield, Volunteers in Medicine and White Bird in Eugene, and various rural clinics and student health centers. That leaves 36,550 uninsured people without a medical home.
"If people can't get good, ongoing preventive medical care, they wait until they have an emergency and show up in the emergency room," Gould said.
Prescription drugs: A single community-based system would be established to connect patients to free and reduced-price medicine programs offered by drug companies. Such patient assistance programs are a godsend to many, but they can be tricky and time-consuming to navigate. Under this plan, the project would establish a consolidated medical assistance program that would provide counseling, help fill out applications, make sure patients get their drugs when they're ready and alert them when refills are needed.
Mental health: 24-hour, seven-day-a-week telephone triage service would be established to help people who need mental health care. Mental health professionals would provide advice, refer people to immediate care in urgent cases and schedule appointments for nonurgent care. A "community mental health champion" would be named to develop the mental health line, strengthen connections between primary care and mental health services, and engage the faith community.
Preventing illness and self-management of chronic disease: This combines disease prevention efforts - such as promoting physical activity, combating childhood obesity, helping people quit tobacco and screening for cardiovascular risk factors - with plans to help people with chronic diseases such as diabetes and HIV to better manage their condition. Exercise is one of the most vastly underutilized tools for promoting health in Lane County, organizers say. So they would encourage workplace incentives for exercise, buy pedometers in bulk and create community walking events and challenges.
Medical access card and nonprofit insurance pool: The Medical Access Program would connect uninsured patients with appropriate programs and providers.
Medical Access Cards would be issued to eligible residents, providing access to hospitals, medical groups, safety net clinics and drugs, based on negotiated "fair share" principles.
In addition, local nonprofit organizations would band together to create an insurance pool to provide health coverage to their employees.
Kevin Hayden, a 52-year-old unemployed Springfield man, is used to not having health insurance. But at least since December, he's had a medical home, seeing doctors at RiverStone Clinic, a federally funded community health center operated by Lane County.
Hayden gets regular treatment for sleep apnea, depression and, on Monday, for a persistent, deep wart on his right thumb. Having a regular clinic keeps him from having to visit the emergency room, he said.
"It takes an enormous amount of stress off me," he said.
Organizers of 100 Percent Access have borrowed ideas from similar projects that have emerged around the country in recent years.
Asheville, N.C., is home to one of the early efforts that since has spread beyond the South. Called Project Access, it was founded in 1996 by the Buncombe County Medical Society. Local doctors, particularly specialists, are enlisted to donate their care to a predetermined number of low-income, uninsured patients in their practice each year, said Alan McKenzie, the medical society's chief executive officer.
"The focus is on creating a continuum of care that includes access to a full spectrum of care for the low-income uninsured," he said.
Primary care already was provided at the community's safety net clinics. But specialty care - including general, heart, neuro- and orthopedic surgeries - often is the most difficult for people without insurance to obtain, he said. Now specialty care is provided in a coordinated fashion with the safety net clinics.
The project has reduced the cost of charity care by 38 percent and saved the Buncombe County hospital $3 million in avoided charity care each year, McKenzie said.
In Michigan, the Muskegon Community Health Project, founded in 1993, pioneered what is known as the three-share model designed to get more people covered by insurance.
The effort focuses on employers who couldn't afford to provide insurance for their employees.
Businesses kick in about $50 per month per employee, employees contribute about $50 a month and another $50 comes from state and federal sources, executive director Vondie Woodbury said. So for $150 a month per person, previously unemployed people now are covered for primary care, hospitalization, cancer care and prescription drugs.
The program returns $2.3 million each year to providers, most of which goes to the two hospitals in Muskegon, a city of 170,000 on the eastern shore of Lake Michigan. Employers report major reductions in employee turnover and draw a better caliber of worker because of the health coverage, Woodbury said.
Similar efforts are under way in Oregon in addition to the fledgling Lane County project.
Union, Wallowa and Baker counties have formed the Northeast Oregon Network with a goal to provide 100 percent access to primary care, long-term care, public health, mental health, and drug and alcohol treatment, said Laura Brennan, a health policy analyst in the Oregon Health Policy and Research office.
She's also a board member of Communities Joined Together in Action, a national organization that supports community health care initiatives.
The Northeast Oregon Network is building an integrated network of providers in those three rural, sparsely populated counties. For example, if there's a single psychologist in the three-county region, the network would look for ways that he could work in different communities.
It's these kinds of community-based efforts that are making a difference, Brennan said, even while people advocate for the long-term goal of universal care in the United States.
"That's a keep-on-keeping-on" goal, she said. "But what are you going to tell that uninsured man with diabetes and neuropathy - don't worry, hopefully your grandchildren will have access? You have to work on comprehensive reform while taking action today."
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