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Program Details


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Practice Type: Model
Program Name: The Anne Arundel County Reach Program
Organization: Anne Arundel County
Web site:
Overview: The Anne Arundel County Department of Health, in collaboration with the Anne Arundel County Medical Society, developed the REACH Program (Residents Access to a Coalition of Health), which provides access to primary, specialty, and ancillary care to eligible, uninsured low income County residents. This was accomplished by building a network of partners, who formally agreed to accept discounted fees for services provided. Health Department staff provides network development, eligibility determination, enrollment, and ongoing case management.

Enrollment criteria for the REACH Program states that participants must be 1. a resident of Anne Arundel County, 2. 19 to 64 years of age, 3. not currently covered by any health insurance program and found not eligible for any government program, and 4. have a household income at or below 200 percent of the Federal Poverty Level. Over 3200 County residents have received $4.8 million in uncompensated care since the program began in 1999.

Year Submitted: 2003
Responsiveness and Innovation: In order to address the previously expressed concerns, the Anne Arundel County Department of Health developed the idea for the REACH Program. The REACH Program provides primary, specialty and ancillary services through a network of volunteer providers and vendors who formally contracted and agreed to a deeply discounted fee for services provided to enrolled members. The REACH Program is administered entirely by the Anne Arundel County Department of Health’s Community Outreach Division. Reaching the initial goal of 1000 enrolled residents the first year was accomplished by the development and distribution of program materials; community, government and network partner referrals; local newspaper articles; medical, employer, religious organizations and community presentations; radio talk shows and the County Department of Health Web site. Developing a program that supported the providers in a way with unobtrusive paperwork and supportive case management was vital. REACH members pay a sliding scale fee directly to providers at the time of service, eliminating the need for billing and collection. Monitoring of care provided to enrollees occurs from all points of contact. Routine office, lab, and radiology visits are tracked, as well as encounters at local hospitals for procedures, emergency services or admissions. The monetary value of discounted care, currently over $4.8 million, is reported regularly to all sectors of the community, including network providers, government and elected officials, community leaders and the general population. In June 2001, responding to the needs of REACH members and providers, the Department of Health contracted for a discount prescription plan which offers significant discounts on all generic and brand medications. The pharmacy cards have saved members over $146,000 in medication costs.
Agency and Community Roles: Commitment to develop the REACH Program occurred at many levels. For the program to be successful all the parts had to work together, including the County Medical Society, leadership of area hospitals, corporate vendors and individual providers. It is because these individuals and organizations committed to render health care services at a deeply discounted rate that has enabled members of REACH to have a primary care medical home and access to ancillary and specialty services when needed. Anne Arundel County Department of Health convened many meetings with the leaders of the local hospitals, detailing the objectives of the program and requested the cooperation and support of their organizations and medical staff. This relationship with hospitals proved to be critical to physician recruitment in REACH. Meeting individually with providers helped to allay any fears about unmanageable paperwork, low reimbursement rates, and reimbursement hassles. Thus, the REACH network has partnered with over 440 Anne Arundel County providers and vendors and 3 local hospitals to care for County residents enrolled in the program. Many local government agencies, such as the Department of Social Services and the Department of Aging, use the program on a daily basis as a referral for residents ineligible for government programs. The county’s elected officials are also aware of the REACH Program and have on numerous occasions praised the program at public hearings for being a successful merger of the public and private sectors of the community. Finally, the health department and the County Medical Society have a commitment to the continuance and expansion of the Program. This expansion continues daily in the solicitation of new community providers and services. To ensure continued communication regarding the progress of the program, the REACH administrator provides program updates and issues to the County Medical Society’s Board and General membership on a regular basis.
Costs and Expenditures: The Anne Arundel County Department of Health funded the development, implementation and operation of the REACH Program. The Department of Health used stable state public health funds rather than less sustainable grant funds to support REACH. Community providers are wary of grant-funded activities that can leave providers with responsibility for the patients’ care should grant funding end. All ongoing operational costs, associated with the REACH Program, including network maintenance and case management, are funded by the Department of Health. The original budget was for $319,251 and included the following personnel: (1) health care administrator, (2) three full-time case managers, (3) one part-time case manager, and (4) one secretary. Equipment needs included personal computers, printers, fax machine, Internet access, office supplies, and telephones. In addition, the following costs were incurred: (1) advertising/ promotional materials, (2) membership cards, (3) printing of applications, contracts, physician and member information packets, (4) business cards, (5) travel expenses, and (6) staff training. The Department of Health Information Systems staff worked with the REACH staff to develop and fine-tune the REACH MC-ACCESS database. Additionally, as a partner in the REACH Program, the Anne Arundel County Medical Society has supplied office space for the REACH administrator. The budgets for the second and third years of the program were approximately $425,000 per year and included two additional case managers, one of which is bilingual and responsible for the enrollment and case management of the program’s Hispanic membership.
Implementation: In order to address the previously expressed concerns, the Anne Arundel County Department of Health developed the idea for the REACH Program. The REACH Program provides primary, specialty and ancillary services through a network of volunteer providers and vendors who formally contracted and agreed to a deeply discounted fee for services provided to enrolled members. The REACH Program is administered entirely by the Anne Arundel County Department of Health’s Community Outreach Division. Reaching the initial goal of 1000 enrolled residents the first year was accomplished by the development and distribution of program materials; community, government and network partner referrals; local newspaper articles; medical, employer, religious organizations and community presentations; radio talk shows and the County Department of Health Web site. Developing a program that supported the providers in a way with unobtrusive paperwork and supportive case management was vital. REACH members pay a sliding scale fee directly to providers at the time of service, eliminating the need for billing and collection. Monitoring of care provided to enrollees occurs from all points of contact. Routine office, lab, and radiology visits are tracked, as well as encounters at local hospitals for procedures, emergency services or admissions. The monetary value of discounted care, currently over $4.8 million, is reported regularly to all sectors of the community, including network providers, government and elected officials, community leaders and the general population. In June 2001, responding to the needs of REACH members and providers, the Department of Health contracted for a discount prescription plan which offers significant discounts on all generic and brand medications. The pharmacy cards have saved members over $146,000 in medication costs.
Sustainability: The REACH Program will continue to be funded by the Department of Health, since ensuring access to care is an essential public health role. Continued participation of the network providers and vendors is critical to the programs' growth and sustainability. The providers in the REACH Program volunteer to see REACH members in their offices knowing they are providing a medical service, at an extremely low cost, to residents who would have no other option than to wait until the problem was acute and be treated at an area hospital.
Lessons Learned: To be successful, the REACH network needed to include a critical mass of providers and services throughout the county, giving residents access to all types of care. It was also important to tap into all free, low-cost or financially supported programs available to county residents. Thus, the REACH network is supplemented by the use of existing Department of Health programs, available health education classes at participating hospitals, and referrals to various pharmaceutical subsidy programs. Case managers needed to supportively aid in the coordination of care, without seeming to act as a "gatekeeper." They serve as mentors, educators, financial counselors and overall support system to many of the members who are very unfamiliar with how to successfully navigate the current health care environment. From the member side, getting the information out to the uninsured took aggressive legwork. Enrollment was accomplished by the use of brochures, posters, county newspaper articles, radio shows, community and hospital presentations, and referrals from providers and government agencies. Continued work with the minority community through attendance at local church and civic meetings is directly reflected in the 44% minority enrollment in the REACH Program. One of the major issues encountered during the initial year of the REACH Program was the extremely high cost of medications to the members. The Department of Health evaluated the need and proceeded to contract with a national pharmacy benefits manager to make prescriptions available to members at the best rate possible. The initial motivation for obtaining a prescription discount arrangement was to assist the enrollees in the REACH Program. The Department of Health quickly recognized that many residents of the County, without prescription coverage, could also benefit from this program. That program has been expanded and has assisted over 3400 county residents saving them just over $146,000 with their medication costs.

 

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