Orange County Primary Care Access Network

1. Orange County Primary Care Access Network Pete Clarke, Deputy Director Margaret Brennan, PCAN Administrator Orange County Government Dennis Cahill, Executive Director, CFFHC Bakari Burns, Executive Director, HCCH

2. Orange County, Florida “The Vacation Capital of the World”

3. Overview of Orange County’s Uninsured • Orange County trends • Tourism, service and retail industries • Who are our uninsured?

4. The Perfect Storm Catalyst • A Public Hospital closed • An Emergency Room closed • Health Department abruptly ceased providing primary care services • The uninsured accessing emergency rooms for non emergency healthcare increased • 180,000 Orange County uninsured “Whose Problem Is It?”

5. Leadership Response • Healthcare Leaders Sound The Alarm • Requested the County take a leadership role • Create access for the underserved area • Strategic Health Care Task Force • Created to reassess our local healthcare delivery system • Resource/Needs Analysis • Research Best Practice Models

6. Business Approach • Creation of the Primary Care Access Network (PCAN) • 20 public/private member agency partnership • Committed senior level leadership • Shared goals and objectives • Complementary assets • Contributing members • Actively engaged

7. Orange County Government Orange County Health Department Medical Society/Special Care Florida Hospital Orlando Regional Healthcare Health Central Community Health Centers Central Florida Family Health Centers Pathways to Care Healing the Children Orange County Healthy Start Coalition Health Alliance Winter Park Health Foundation Central Florida Health Care Coalition Health Council of ECF Lakeside Alternatives, Inc Center for Drug Free Living Shepherd’s Hope, Inc. Health Care Center for the Homeless Emergency Medical Services PCAN Partners

8. Our Initiative • Provides high quality, comprehensive and family-ready system for the delivery of health care • Comprehensive community-based clinics • Primary care, OB/GYN, Pediatrics, X-ray, Laboratory, Pharmacy & Dental • Medical case management • Expanded network of support services • Medical home for uninsured residents

9. Performance • Expanded access while containing costs • Expanded community-based clinics • Redefined the role of the Medical Clinic to include secondary care • Contained costs: • Minimized capital costs • Maximized partnership opportunities • Leveraged existing resources

10. Attributes • Developed an adaptive system for changing community conditions • Fluid delivery system that focuses on services and not infrastructure • System that can be quickly and efficiently expanded or downsized • Best practice model

11. PCAN Operational and Governance Structure PCAN Board Executive Roundtable Executive Committee Public Education/ Community Partnerships Volunteers- Medical and Dental Data Research and Evaluation Funding and Finance Case Management Pharmacy Prenatal and Pediatrics Mental Health and Substance Abuse Cultural Competency

12. PCAN Accomplishments • Increased Access Points • Public Education • Case Management • Culturally viable resources • Dental Foundation • Pharmacy Co-op • Data, Research & Evaluation

13. PCAN Enrollment • FY 2008 • 11 clinics • 100,000 patients served • $7.2m in donated services • 1,600 volunteer physicians FY 2000 • 2 clinics • 5,000 patients served • $120,000 in donated services • 79 volunteer physicians

14. OutcomesProgram Growth

16. PCAN Flow Chart

17. Volunteer Network • 1,600+ healthcare professionals • $7.2 M donated annually • Sovereign Immunity • Volunteer Organizations • Special Care, Inc. • Shepherd’s Hope, Inc. • Health Care Center for the Homeless • Dental Care Access Foundation • Orange County Health Department Health Care Center For The Homeless

18. Measuring Collaboration

19. 20,000 18,000 16,000 14,000 12,000 FQHC 10,000 ED 8,000 6,000 4,000 2,000 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2001 2001 2001 2001 2002 2002 2002 2002 2003 2003 2003 2003 ED Non-Urgent Visits vs. FQHC Visits for Self Pay Patients2001-2003, by quarter

20. Financial ImpactPCAN - ED Study • Initial study reflected 32.2% drop in ED non-urgent visits from first quarter of 2001 to last quarter of 2003 = 2,080 visits per quarter • From January 2001-June 2007, non-urgent, self-pay ER visits decreased by 25.4%. Figures from Florida CHARTS, estimate an 8.2% population growth in Orange County from 2004-2007. Based on the 2004 Florida Health Insurance Study, the rate of uninsured in Orange County was 18.7%. Despite these factors, ER trend data for 2004-2007 demonstrates fairly even utilization of non-urgent care by self-pay patients.

21. Sustainability • Commitment from partners • County Government funding • In-kind partner support • Grants and awards • PCAN Foundation • Donated services

22. Funding Sources • County General Revenue Same financial investment by Orange County 1999: $2,000 per patient 2007: $640 per patient • Inter Governmental Transfer • Federal Medicaid and Medicare • Other third party payers • Self pay (sliding scale) • Federal, state and local grants

23. IGT Process County Tax Dollars Agency for Health Care Administration 14.4 million returned ORHS Florida

24. IGT Process ORHS Florida Third Party Administrator Secondary Care Clinics Inpatient

25. Leveraging DollarsClinic Site Funding

26. In Closing • Leadership Commitment • Partnerships & Collaboration • Understand Your Community Resources • Strategic Planning • Maximize Resources/Contain Costs • Adaptable to Changing Environment

27. Awards and Recognition • NACIO award – 2003/2004 • Orlando Business Journal - Community Outreach award – 2003 • Florida Medical Business PPL award – 2003 • Astra Zeneca Partnership award – 2004 • AHA Nova Award- 2006

28. Community CollaborationPrimary Care Access Network(PCAN)Orange County, Florida For more information, contact: Margaret Brennan, PCAN Administrator (407) 836-2649 Margaret.brennan@ocfl.net or visit Pcanorangecounty.org