Travis County Commssioners Court
September 23, 2003
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Item 37
Item 37. Consider and take appropriate action on proposal from the Travis County medical society jo foundation to provide medical care for area indigents through project access.
>> is there a plan to lay out what the proposal is?
>> yes, judge and Commissioners. Thank you very much, my name is marshal cot ran, from the Travis County medical society. Accompanying me is cliff haynes the project manager for project Texas the subject of which you have before you and to join us chairman of our project access dr. Tom mchorse is in en route, he's been informing procedures in his office, we informed him this has been moved up. If he joins us in mid presentation we will introduce him at that time. We have met with the -- with the -- with the -- with judge Biscoe and with -- with members of the city council, but for those of you who have not, the handout you have before you is just a very brief overview of what project access is. The physicians of the Travis County medical society have embraced this project. The goal of which is to provide 100% access to appropriate and comprehensive health care related services and to have zero disparities in the outcomes. This is for citizens who -- who are falling through the holes in our current safety net, it does not replace the current safety net. The goals are ready access to appropriate health care for those people in Travis County that actually fall on the or below 150% of the federal poverty guidelines. Continuity of appropriate health care in the appropriate setting is the foundation for this. People get care now episode yickly. And they often don't get because of lack of funding insurance follow-up care with specialists or pharmacy or other diagnostic care. The bottom line is better health care deliver to more people. The components on the second page of those slides [indiscernible] to consider seeing up to 10 new patients per year who fall within this -- within this eligibility criteria. That becomes their primary care home for these patients who have otherwise not had one. We have specialty physicians to see up to 20 patients. The theory there is that these are not ongoing relationships as much as primary care. They can see more on a short-term basis. And then for those physicians who for various reasons cannot absorb more patients into their office practice, but they do want to participate in this volunteer effort, then we ask -- then we allow them to volunteer time in existing evening clinics. The patients themselves then have access not just to physician care, but then we have also coordinated through the indigent care collaboration access to hospital diagnostic care like radiology, laboratory and form mass services for free to those patients. We provide distribution of the caseload to physicians so that their commitment does not become an albatros around their next. For us to be able to attract them to volunteer to take up another piece of this load in Travis County we have to make it doable for them. Moving on down, well, another thing is we do, we will provide recognition of their services, that's -- that's one of the -- that is the only payment they get, as a matter of fact.
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>> [one moment please for change in captioners]
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>> to date, we are in our pilot phase. We have physician capacity, we have hospital capacity, and we have radiology lab toefrplt pharmacy is our rate-limiting factor because it's the only thing we cannot provide for free. Somebody does have to purchase those drugs. We have arranged with h.e.b., A discounted drug which is basically at cost. And they have also generously donated the services of their pharmacy benefits manager. And so through that facility we're able to track pharmaceutical usage. And we have so far seen just in the pilot phase of the 100 or so patients we have enrolled -- and by the way, we will not enroll a patient unless we have the pharmacy funds in the bank to be able to care for them for a year. Even if we have physician capacity, which we do, because the concept does not work if we don't provide the full continuum of care. Otherwise we're giving them the same kind of care they've been given. So tar this has resulted in over $100,000 of donated care and physician time just in the few months of this pilot project. And again, well over $100,000 in donated hospital and ancillary care. We don't just rely on purchased drugs. We have a pharmacy tech who for sustaining drugs like blood pressure and so on, we access the various pharmaceutical manufacturing programs to get those drugs for free, and so far we've obtained nearly $18,000 worth of free medications through that program, which is $18,000 worth of drugs that don't have to be purchased with dollars in Travis County. That's the overview of the program. This concept was piloted in buncom county, north carolina, replicated in wichita, kansas, frederick county, and we're trying to replicate it here. They have proven under their demonstration projects that this is a program that does successfully bring volunteer caps to it the existing safety nets, and it does so for relatively little money, even though pharmacy is not little any way you look at it. The whole key is the leveraging of those dollars. We have asked as has been the model in both buncom and sed wick counties, we are asking local governments to be the sustainers of that pharmacy component with the promise and actually the demonstration that for every dollar they put in, and this has been demonstrated certainly in these other communities, the private community is putting approximately $12 back into the community in terms of free services rendered. And the thing that the pharmacy dollar does is it provides the final component that complete the continuum of care and keep toght the appropriate setting. We have asked and proposed that $175,000 for this particular transition year be allocated between the city of Austin and Travis County. That's a -- that's a proposal that would allow us to add 250 patients this year without any other dollars. Our goal is to add in increments as quickly as we can to get up to certainly over 1,000 patients. There are more than 1,000 eligible patients. They are not eligible for m.a.p. Or medicaid or other insurance and they are not covered by their employer. Typically they are employed, by the way.
>> what response due get from the city? Have you taken this to them yet?
>> we certainly have. And as -- I don't have to tell what you the city budget looks like, and so far they have indicated a very cute interest, but not a lot of ability to respond on this time frame, and they are already talking somewhat about next year's budget. We also have our hat in the discussions with the proposed health care districts, by the way.
>> if the city -- well, w-p the city's participation, and the county's participation, what would be the difference as far as the persons that we serve? Is there any way you can estimate that? In other words, if -- of course we participate in how many -- would there be a shortage? As far as services.
>> if you say the county participated but the city did not. Okay. Thank you. I think we can address that. And I would suspect your question is going to the point of would the county be funding care for city patients basically, and I think that's a very valid question. Our eligibility criteria are put into the various screening mechanisms that are available right now that are being used. We do have the ability to fine tune that screening based on your -- where you live. I can tell you, for example, that because it's memorable, our very first project access patient that we enrolled several months ago was from lago vista. I can't tell you today what percentage of that 100 are from the unincorporated city. Let me put it this way. We have been advised that historically joint city-county projects get split maybe 60-40 between the city and county, particularly for health care. And we would have anticipated for $175,000 proposal, for example, that 40%, 70,000, might be considered by the court.
>> okay.
>> > the city failed to come up with their 500,000, we would have the ability to reserve, if you will, that $75,000 commitment from the county for patients enrolled that live outside the city limits of Austin but within the boundaries of Travis County.
>> I have less of a fence to put around this because while it is true that we have the sole responsibility for folks outside the city of Austin, the city of Austin is still part of Travis County. And so i, you know, as somebody that usually has heart ache over these things, I would not have heart ache if the percentage of the county contribution is in relative proportion to the city of Austin numbers because it doesn't make any sense that we would say, hi, our biggest city is ineligible simply because they have ability to come forward with their own dollars. > and if we had equal commitment, we would not be fine tuning --
>> just a point of information.
>> I want to make sure there is coverage outside the city.
>> absolutely.
>> but I would not have heartache if it's in relative proportion --
>> we could say very ownably we would give priority if, for example, there were eligible patients we had to select from, we would give priority to patients outside the city until we had more funding. And we are certainly in what I call a bridge phase entering into that. The pilot phase was to get this established. We do have our volunteers established. We have our infrastructure established with a staff of four including a pharmacy tech, a case manager and so on. And however long it takes to get from pilot to sustained where we are at a model that local government whether it's a combination of city-county or a new health care district funding this pharmacy component at 100%, the bridge phase means we have to look for funds where we can get it, so we are seeking and getting grand funding from organizations. Quite frankly while that's attractive for infrastructure, grant funding for pharmacy is not attractive in the long haul and frankly is not feasible for the long haul, but we think it is for the short term. We have some grants from the Travis County medical society foundation, are seeking some from the st.david's foundation, that's under consideration as we speak. But those are only bridge grants to get us from private to public funding.
>> I think it's great.
>> i'll throw a number out.
>> I would move Travis County commits to $100,000 in one-time category in terms of how we parcel this in our budget. But I would go for 100,000 on this.
>> any more discussion? We appreciate you all's effort.
>> which is more than [indiscernible].
>> a quarter of what we asked for, but thank you.
>> and number of times that -- khraoeufpbts that you are ---.
>> I'm sorry, judge.
>> until there can be an outside city of Austin breakdown that is correct would be appreciated to. The spirit of what I understand we're doing here is serve both as best you can, optimize the use of these funds. I'm assuming it will pass.
>> judge, are you suggesting that that's something come in as far takes report to see how it's working since it is a pilot at a certain time?
>> I'm suggest ago quarterly report, but I know there will have to be a contract and we need to figure out a way to simplify accessing the money for you. And david probable needs to chat with them because if you all are serving clients and immediately sending them for medication, we need to know basically that the money is available somewhere. Whereas is it h.e.b. Pharmacies that you are working with?
>> yes. They billous a monthly basis.
>> we'll work out a contract and try to have a contract in two to three weeks.
>> fits handled similar to grant contracts, the funds, for example, r.g.k. Recently are disbursed and we disburse them as they are called on by h.e.b. Pharmacy so we pay the bills out of that fund.
>> we need to discuss that legally may be more difficult for us, but we'll try to simplify it.
>> thank you so much.
>> thank you.
>> is there -- is project access, is there an administration that operates?
>> yes, there is.
>> this entity.
>> right.
>> and myself and three other full-time people.
>> okay. And how is that funded?
>> so far, Commissioner, that has been funded through grants. And I will tell you we're again going for the model that has been proven in other places. In wichita. It will get there for us. Is funded by a combination of city-county government. Their infrastructure in the 250,000 -- under $300,000 range is funded by united way 100%. We are -- i've been talking with united way, but they have a three-year grant cycle. We can't enter that for a few more months, but we're going to be getting into that cycle. I don't know if we can get that here. We certainly have a good reference in their component sedgewick county. It will be through either united way or one or more sustaining sources. It could be a health care district, it could be private funds, but clearly there has to be some sustaining funds.
>> this 100,000 is --
>> but this 100,000 --
>> is for medications.
>> -- would all be for medications.
>> yes, sir. Absolutely.
>> we would have to address that in the contract. Any more discussion? All in favor? That passes by unanimous vote. Finishes thank you all.
>> thank you.
>> we're overwhelmed and we thank you.
>> no, we thank you all.
Last Modified: Wednesday, September 24, 2003 7:52 AM