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The local system for referring the uninsured did
not seem to be working. The number of uninsured persons successfully
appointed for specialty care was declining.
In 2007, the PHPDA retained MCPP Healthcare Consulting to evaluate
the specialty referral processes for uninsured patients. They looked
at specialty referrals from public health and community health centers
in King County to Pacific Medical Centers and King County Project
Access. The PHPDA funds the latter organizations to provide or arrange
for specialty care for the uninsured.
A number of community partners participated in the
work on this issue, including those who agreed to serve on the Oversight
Committee. The
participants included:
- Community Health Plan of Washington
- Country Doctor and Carolyn
Downs Community Health Centers
- International Community Health Services
- Health Point (formerly
Community Health Centers of King County)
- King County Project Access
- Neighborcare Health (formerly Puget
Sound Neighborhood Health Centers)
- Pacific Medical Centers
- SeaMar Community Health Centers
- Seattle-King County Department
of Public Health
The project goals were:
- Evaluate the current processes
for eligibility determination and clinical referral
- Recommend
changes to the referral system that would increase specialty care
referrals (and visits) for uninsured patients.
Initial Status:
- Only 42% of uninsured patients referred
for specialty care at PMC were submitted with eligibility application
forms. Of the 42%
of referrals
with applications, approximately 70% were approved.
- 58% of uninsured
patients referred for specialty care at PMC had NO PMC eligibility
application form: hence, their
referred
was pended.
Lack of an eligibility application form was the reason for 89%
of pended referrals. This means that no eligibility application
form or any supporting documentation
was submitted.
Conclusions:
This is a classic systems study—which
showed that well-meaning individuals were attempting to work in
a system fraught with barriers and problems. The following changes
were implemented:
- Uniform eligibility criteria were developed
(for PMC and KCPA) using the same definitions of income and King
County residency
and the same acceptable documentation. A single application was
developed that was then translated into multiple languages.
- Improved
regular communication, standard
reports and timely notification between PMC, KCPA and Public Health
and Safety Net Referral
Coordinators.
- Made improvements to the FAX system, which
continues to be monitored for periodic problems.
As of March 31, 2008, implementation of these recommendations had
led to an 83% increase in successful referrals.
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