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Program Details


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Practice Type: Promising
Program Name: Partners Clinic
Organization: St. Lucie County Health Department
Web site: www.stluciecountyhealth.com
Overview: The St. Lucie County Partners in Medicine Clinic opened in March 2003 as a direct result of a collaborative community effort to address an identified community need—lack of access to health care for primarily uninsured and underinsured adults in St. Lucie County. After months of meetings and data review, a team of dedicated partners formed the action plan described here to meet the health care needs of people who often fall all through the cracks (i.e., the uninsured and underinsured). To ensure the effective use of community resources, partners completed a SWOT Analysis to identify community strengths, weaknesses, opportunities and threats inherent in the situation. Community partners played a key role in developing this program and remain a major factor in its continuing success. The program would never have succeeded without the ongoing financial and programmatic support of HCA Lawnwood Regional Medical Center, the Board of County Commissioners, the Visiting Nurses Association, local volunteer sponsors, and medical champions, and especially the visionary leadership of the SLCHD Director.

This unique project serves as a true model of public/private community collaboration resulting in enhanced access to medical care for the target population. Affordability is ensured through use of volunteer providers to augment paid staff. ER utilization data shows shorter ER wait times and decreased ER usage for non-emergency services. The program achieved a cost savings over $830,000 in the first six months of operations, resulting in two consecutive State of Florida Tax Watch Davis Awards in 2002 and 2003. Client stories illustrate the greatest impact. These are the stories that make this initiative worthwhile!

Year Submitted: 2004
Responsiveness and Innovation: The impetus for this program was the fact that the Martin County Volunteers in Medicine Clinic was closed to St. Lucie County residents in Spring 2001. The St. Lucie CHD administrator and key staff spearheaded an effort to conduct a study on the needs of the uninsured and underinsured in St. Lucie County and what impact this closing would have on residents. Data from a 1998 AHCA study showed that 45.6 percent of residents in the northern part of the county fall at or below 200 percent of the poverty level. A SWOT analysis conducted to identify strengths, weaknesses, opportunities and threats focused on opportunities in four key areas: leadership and coalition building, provision of programs and services, financial, and communication and health Education. Opportunities identified as the highest priority for immediate action were: identification of leadership, champions, and coalition to address the issues; identification of resources; and communication of issues through advocacy and health education.

The Partners in Medicine Clinic is unique in several ways.

  • First, it is a true public/private partnership developed to meet the identified needs of both sectors. The private for-profit hospital contributes $50,000 for lease of space and hiring clerical support, as well as diagnostic tests. The Board of County Commissioners contributes $90,000 to support the salaries of a licensed social worker and an ARNP who acts as clinical manager and is licensed to provide routine services in the absence of volunteer medical providers. Various other community partners contribute additional in-kind and monetary support.

  • Second, it uses paid staff supplemented by volunteer licensed medical providers, who receive sovereign immunity to contain costs. This eliminates the liability concern for providers because they are unpaid volunteers, but allows the Health Department to mitigate some costs by receiving reimbursement from third party providers. Currently, over 60 volunteers physicians, RNs, LPNs and medical assistants provide volunteer services to clinic patrons.

  • Third, the clinic also provides medications to qualified clients. During the first year of operations, the clinic assisted approximately 22 patients who received 45 medications under the Prescription Assistance Program. In addition, physician and pharmaceutical sample donations that were distributed averaged another $42,615 in average wholesale price value.
Agency and Community Roles: As previously indicated, the uniqueness in developing a viable public/private partnership is one of the major strengths of this program and the cornerstone of its success. With the financial support of the community partners, the CHD runs the clinic as a separate entity. This allows for billing on a sliding fee scale and third party payer reimbursements.

Besides the CHD, the Board of County Commissioners and Lawnwood Regional Medical Center, other supporting partners were identified and nurtured. These include the Visiting Nurses Association, who donated $10,000 in services to the clinic, Stuart Medical Group, who donated pharmaceutical samples, South Florida Orthopedic and the Martin County Volunteers in Medicine, who both donated equipment and supplies, and the volunteer medical providers, who donated services valued substantially in excess of $100,000 during the first year of operations.

The CHD director meets quarterly with the hospital CEO to discuss challenges and promote ongoing financial support. Comprehensive annual reports are submitted to the county annually. The CHD Director and staff regularly attend organization meetings and provide speakers to meet community requests. All volunteers, both corporate and individual, are recognized for their contributions and support at an Annual Volunteer Recognition luncheon supported by other community donations from established business partners such as Florida Power and Light.

Costs and Expenditures: Operating two days a week for a total of 103 clinic days, the clinic saw 583 clients and had 1406 patient visits during the first 12 months,. Billables for the first twelve months of operations were over $93,000. Receipts totaled almost $57,000. Twenty volunteer staff donated over 1150 hours of volunteer services, valued in excess of $100,000 during that time. Clinic expenses for the first six months of operations were just over $155,000. Revenues, including receivables and donations were almost $148,000. This left a gap, which clinic staff worked hard to eliminate during the second six months of operations. However, what is truly significant is the retail value of services provided versus the net cost of services, resulting in a saving to taxpayers in excess of $800,000 for just the first six months of operations and a Florida Tax Watch Davis Award for 2002 and 2003.

Key stakeholders are looking at alternatives to make the clinic more viable in future years. One thought is to move the site of operations farther south and establish the clinic as a separate entity at a mid-south county site. The CHD administrator has also requested additional county financial support for the upcoming fiscal year. A team of CHD employees is currently researching some alternative funding opportunities, such as the Robert Wood Johnson Foundation Local Initiatives Funding and State of Florida GAP funds. The CHD Administrator is exploring is the viability of securing a half-cent or penny of local tax dollars dedicated to health care provision, or establishing a Health Care District. The CHD also worked diligently to form a not-for-profit tax-exempt 501c corporation to help the St. Lucie County Health Department secure funding and augment available resources to meet the vision and mission of the department.

Implementation: The impetus for this program was the fact that the Martin County Volunteers in Medicine Clinic was closed to St. Lucie County residents in Spring 2001. The St. Lucie CHD administrator and key staff spearheaded an effort to conduct a study on the needs of the uninsured and underinsured in St. Lucie County and what impact this closing would have on residents. Data from a 1998 AHCA study showed that 45.6 percent of residents in the northern part of the county fall at or below 200 percent of the poverty level. A SWOT analysis conducted to identify strengths, weaknesses, opportunities and threats focused on opportunities in four key areas: leadership and coalition building, provision of programs and services, financial, and communication and health Education. Opportunities identified as the highest priority for immediate action were: identification of leadership, champions, and coalition to address the issues; identification of resources; and communication of issues through advocacy and health education.

The Partners in Medicine Clinic is unique in several ways.

  • First, it is a true public/private partnership developed to meet the identified needs of both sectors. The private for-profit hospital contributes $50,000 for lease of space and hiring clerical support, as well as diagnostic tests. The Board of County Commissioners contributes $90,000 to support the salaries of a licensed social worker and an ARNP who acts as clinical manager and is licensed to provide routine services in the absence of volunteer medical providers. Various other community partners contribute additional in-kind and monetary support.

  • Second, it uses paid staff supplemented by volunteer licensed medical providers, who receive sovereign immunity to contain costs. This eliminates the liability concern for providers because they are unpaid volunteers, but allows the Health Department to mitigate some costs by receiving reimbursement from third party providers. Currently, over 60 volunteers physicians, RNs, LPNs and medical assistants provide volunteer services to clinic patrons.

  • Third, the clinic also provides medications to qualified clients. During the first year of operations, the clinic assisted approximately 22 patients who received 45 medications under the Prescription Assistance Program. In addition, physician and pharmaceutical sample donations that were distributed averaged another $42,615 in average wholesale price value.
Sustainability: In order to ensure sustainability:
  • Potential threats identified during the SWOT process were reviewed and addressed as deemed appropriate.

  • A preliminary budget was drafted.

  • Multi-year funding commitments were established.

  • A strong effort was begun to recruit and nurture volunteer medical providers to supplement paid staff.

  • A sliding fee scale was developed for payment, and the CHD was able to bill third party providers.
Lessons Learned: The lead agency must have a high level of community credibility, and must be creative and resourceful both in identifying community needs and assets, and in collaborating with local partners to address challenges in a cost-effective way.

 

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