Lincoln, Neb., leaders want everyone to have a medical home

April 1, 2011

Catholic Health Initiatives funds the primary care match-up initiative

Jaci Augustin of Lincoln, Neb., a maintenance worker without medical insurance, is receiving charity treatment for breast cancer. What she had trouble finding was routine care for high blood pressure.

Enter Health Hub, a new project in Lincoln to arrange primary care for people who are uninsured, with the goal of finding "medical homes" for everyone who doesn't have one. It is supported in part by Saint Elizabeth Regional Medical Center of Lincoln, part of Englewood, Colo.-based Catholic Health Initiatives.

The inspiration for Health Hub was a bold recommendation in November 2009 by Lincoln Mayor Chris Beutler's task force on health care: Create a system for finding medical homes for everyone in Lincoln.

The Health Hub, which opened Oct. 1, has six employees who work from space provided by the Center for People in Need, a local antipoverty agency. Health Hub staff get referrals from their agency neighbor, from two local hospitals and from community doctors. Patient advocates at Health Hub help people navigate the health care system, and determine if clients are eligible for Medicaid or a county-based health program for the indigent. The advocates also can arrange medical appointments.

Augustin, 50, found out about Health Hub from Dr. Joni Tilford, her oncologist at Saint Elizabeth Regional Medical Center. Augustin said she qualifies for charity care at the hospital, and she pays what she can. Tilford referred her to Health Hub after Augustin mentioned wanting to see a doctor for her high blood pressure. Health Hub got Augustin an appointment with the People's Health Center, a local Federally Qualified Health Center. Now her blood pressure is down, and she has a medical home.

Augustin's mind is eased by something as simple as the knowledge there is blood-pressure medication in the bathroom cabinet. "The way I see it, every day is a good day," she said.

There is much discussion these days about the medical home model of primary care. In Lincoln and across the country, the purpose of a medical home is to help patients establish ongoing relationships with physicians and other health care professionals. And, because many of Health Hub's target population are low income, Lincoln's definition includes providing that care to the medically marginalized in locations with easy access to bus routes. 

Shared responsibility
In 2008, the year the mayor's health group began work, the number of uninsured people in Lincoln had risen to 43,560, or about 15.2 percent of the population. The rate fell to 12.8 percent the following year, but it was still almost double that of 2001.

Saint Elizabeth Regional Medical Center is part of the task force. Through the Saint Elizabeth Foundation in Lincoln, CHI provided a three-year grant of $314,776 to help pay for Health Hub. The Community Health Endowment, a local organization, also is helping to underwrite the effort.

"The trends in health insurance are not good," said Donna Hammack, chief development officer of the Saint Elizabeth Foundation. "Too many people don't get care because of the expense or lack of insurance, and then they go to the ER — a very expensive way to provide medical care. Our goal is to help each resident find a medical home. The strategy is to make it a shared responsibility of our safety-net providers."

The plan was to include local clinics and private physicians in the safety net medical home model, but there have been obstacles to that.  

Building resources
In its first three months, Health Hub distributed information on its health care services to more than 7,000 people through food banks, public housing offices, doctors' groups, health clinics and other places. The Health Hub staff helped 542 people complete applications for primary care services.

Augustin is among 284 of those applicants who were referred to People's Health Center, by far Health Hub's biggest medical home partner. Another 71 qualified for Medicaid or veterans' benefits, and 84 could be helped by Clinic with a Heart, a once-weekly clinic at the Center for People in Need that is staffed by volunteer doctors and nurses.

People's Health Center employs three doctors, three nurse practitioners and one physician's assistant. They serve about 10,000 patients. It's a busy place — 37,000 patient visits annually. Deb Shoemaker, the clinic's executive director, said she is seeking federal help and local grants to hire a fourth doctor.

"For us, the value of Health Hub is helping individuals get the (public) assistance available to them, and to help them understand the concept of a medical home," Shoemaker said. "It is doing a fabulous job of finding the uninsured. Now, how do we get all of them the care they need? And how do we fund it?"

The mayor's task force recommended expanding People's Health Center by moving it to a bigger location and establishing satellite clinics.

Sutures and Band-Aids
Listed second on the task force's action agenda was to "engage Lincoln's private medical community" by getting more doctors to accept uninsured patients on a standardized sliding scale of fees.

Two private doctors are on the task force; and Joan Anderson, a nurse and executive director of the Lancaster County Medical Society in Lincoln, is part of the task force staff.

Anderson said the fee scale proved unworkable because private doctors already have varying numbers of uninsured patients in their care — often regular patients who had lost their insurance. She said private doctors have different methods of delaying, reducing or forgiving charges for their uninsured patients. She said that's also why the local medical community can't simply divide up the uninsured, as some task force members suggested.

"It has to be a case-by-case basis," said Anderson. "Sometimes the general community doesn't understand that doctors already are taking care of uninsured people."

Anderson said private physicians are better equipped to help Health Hub when a medical problem calls for a specialist. In the first two months of Health Hub, she said, participating specialists treated 67 patients for such needs as removal of a gall bladder or repair of a hernia. The doctors and patients work out their own payment plan, she said.

Doctors also can help Health Hub patients with prescriptions while they await appointments at People's Health Center, Anderson said.

"It's a huge Band-Aid," she said.

Hammack, of the Saint Elizabeth Foundation, said the task force continues to seek ways to increase the number of private doctors involved in the effort. But, she added, People's Health Center is the primary medical home for Lincoln's uninsured.

Bob Lanik, president and chief executive at Saint Elizabeth Regional Medical Center, said the hospital is grateful for Health Hub's work. "We have seen increasing numbers of uninsured and underinsured individuals at Saint Elizabeth over the last few years," Lanik said. "The Health Hub will help them manage their health programs over time rather than waiting until an early health concern becomes urgent."


STRATEGIES: Finding medical homes for the uninsured

Collaborate: A local task force, including doctors, hospital administrators and public officials, set the goal of finding medical homes for all uninsured people in Lincoln, Neb.

Advocate: Established Oct. 1, Health Hub has a staff of six finding medical homes and specialty care for the uninsured. Staff help qualified clients get public assistance, such as Medicaid.

Colocate: Health Hub is housed alongside an antipoverty agency that provides emergency assistance to poor people — and gets many requests for help on health issues.

Support: The facility is funded in part by a $314,776 grant through Catholic Health Initiatives and the Saint Elizabeth Foundation, an affiliate of Saint Elizabeth Regional Medical Center.

 

Copyright © 2011 by the Catholic Health Association of the United States
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