An estimated 45,000 individuals, or 18 percent of Sarasota County residents under the age of 65, do not have health insurance, and that number is increasing over time. As in many communities, uninsured patients in the Sarasota area seek treatment through local emergency departments because they do not have a medical home or may be unfamiliar with locally available healthcare resources.
In 2005, three of four Sarasota County hospitals logged approximately 53,000 emergency department (ED) visits by uninsured patients, representing 21 percent of the total ED visits. Many of these visits were for symptoms or conditions that can be more cost effectively managed in a primary care setting. (An average ER visit costs over $1,000.)
Sarasota Health Care Access is a public-private partnership established to address access to healthcare services for low-income and indigent residents. The proportion of uninsured persons in the Sarasota and Bradenton region (19.2%) places it fifth among 17 regions in the state for its proportion of uninsured residents.
The largest proportion of uninsured residents are impoverished, with 48% earning less than 150% of the federal poverty level guidelines and 25.9% earning between 151-200%. Residents ages 25-44 represent 52.5% of the uninsured with another 25% between ages 45-64. Rates of uninsurance increased notably for working-age adults. Hispanics had the highest rate of uninsurance, followed by African Americans, at 31.8% and 22.6% respectively. As the cost of living and health insurance coverage has skyrocketed, coupled with the collapse of construction and real estate markets in Sarasota County, access to insurance coverage and medical care have substantially declined in the region.
Agency Community RolesSCHD’s internal project management team is responsible coordinating the Sarasota Health Care Access project and is currently responsible for day to day operations. In addition, as one of several safety net primary care and oral health provider project partners, SCHD has assumed a key role in the provision of direct client services for uninsured patients referred for services through the Sarasota Health Care Access initiative.
Costs and ExpendituresProject implementation was preceded by submission of an initial concept proposal and request for funding in FY 2007 submitted by SCHD to the State’s Low Income Pool Council through the Florida Department of Health in August 2006. In response, the health department received $200,000 to support implementation of a small-scale pilot of Sarasota Health Care Access. This award came with a 43 percent health department match requirement, which was met by using a portion of the organization’s DOH general revenue allocation that year. These funds were used to support the establishment of an internal health department project management team and to establish three positions critical to the success of the project initially: a nurse case manager, a patient pharmacy assistance program technician, and a dedicated hospital liaison.
ImplementationThe SCHD, in collaboration with members of the CHIP, and local hospitals, submitted a proposal requesting Low Income Pool (LIP) funding through the Florida Department of Health, to establish a county-wide system of care for the uninsured and medically underserved populations in Sarasota County, entitled Sarasota Health Care Access.
The program was implemented by establishing a formalized coordinated community outreach plan as outlined below:
August – December 2006: Developed mission and vision for the model project.
Submitted 2006-2007 LIP funding proposal for a pilot project. Developed and implemented the hospital diversion system component that included hospital liaison, case/disease management, and system navigation. Formalized a volunteer healthcare provider network. Clarified opportunities for coordination or integration in the community. Assigned responsibility for development and management of LIP project budget. Identified and secured required resources. Assigned responsibility for development and management reporting requirements mandated by LIP Council/Department of Health. Established project management team and identified a team coordinator. Developed weekly team meetings and methods for documenting metrics. Established project-specific relationships, lines of communication, site visits, and meetings with potential and key network providers.
Through the Hospital Diversion Program component, between April 20, 2007, and February 29, 2008, 1,500 uninsured individuals who recently received in-patient or emergency department care/services, including triage services, have been enrolled in primary care with network safety net providers. More than 100 of these individuals have received (or are receiving) ongoing disease case management services. These patients have already received system navigation, eligibility, and prescription assistance services, including 12,597 free or low-cost prescriptions.
Operating as one of 67 local health departments under the direction and authority of the Florida Department of Health, SCHD has served as the lead safety net healthcare provider for uninsured and medically underserved populations in Sarasota County for more than 60 years. Last year, SCHD provided primary care services to more than 21,000 low-income uninsured/underinsured individuals in the community during some 70,000 patient care visits. SCHD’s dental program provided care for more than 5,600 patients during more than 11,000 encounters during this period; SCHD’s pharmacy program filled more than 95,000 prescriptions for this population.