Indigent Health Care Coordinators Seek Best Possible Patient Outcome
The nuts and bolts of county indigent health care are spelled out in state law. But to many program coordinators, success is based on more than a statute.
“We are all one catastrophic event or one major illness away from need,” shared Candy Blair, Collin County public health director for the last 17 years. “Imagine having to ask yourself, ‘Do I eat, or do I fill my prescription?’ ”
Blair came to Collin County after five years in correctional health care. New to indigent care, she spent two years seeking training opportunities and visiting other counties with one question in the forefront of her mind: What is it that creates the greatest outcome for these patients? During this time, Blair served as a founding member of the Texas Indigent Health Care Association, https://cuc.org/tihca/, with the goal of sharing best practices.
While the Collin County Indigent Health Care Program continues to add new facets of care, Blair and her team have endorsed a multi-tiered approach to delivery by creating community partnerships and paving a path for each client to walk through and rise out of indigent status with as much dignity as possible.
“You don’t want anyone to have to live in indigency,” Blair emphasized. “Our goal is a hand up.”
Using this mindset, Collin County developed a partnership with PrimaCare Medical Centers to provide primary care services to indigent clients. PrimaCare has five locations open until 8 p.m. Monday-Friday and offers weekend hours until 5 p.m.
These free-standing clinics “allow these individuals to be individuals,” Blair explained. “There’s not a big sign above the door that says ‘Indigent Care.’ ” In addition, these clinics are available to clients when they are no longer qualified as indigent thus offering continuity of care.
While the statute does not require counties to cover children, the Collin County Commissioners Court chose to expand care to youngsters.
“If a child is home sick, oftentimes the parent is unable to go to work, thus creating a bigger burden,” Blair observed.
Another advantage of the urgent care partnership is it provides an option other than the emergency room.
A second example of a multi-tiered community approach is county funding of area support organizations, Blair cited. The Commissioners Court dedicates $120,000 in health care foundation money to help sustain non-profits and faith-based groups as they serve indigent families in Collin County.
A third major component of the indigent health care program is Project Access-Collin County (PACC), a foundation created by the Collin-Fannin County Medical Society. PACC partners include the Collin County Commissioners Court, the Collin County Health Care Foundation, local hospitals, local charity clinics, private ancillary/diagnostic service providers, other community and state resources, and last but not least, a team of local physician volunteers. The PACC network currently consists of 67 primary care physicians and 94 specialists. The Collin County Health Care Foundation dedicates $485,000 to Project Access annually.
As explained in the official mission statement, PACC strives “to improve the health of our community by creating access to health care and coordinating necessary resource referrals and other basic services for those most in need through education and empowerment.”
Services include access to routine and preventive health care, diagnostics, specialty care, medications, health education, interpretation services, transportation support, and coordinating and teaching clients to access other necessary resources to overcome the barriers to good health and prosperity, http://www.pacollincounty.org/.
Program administrators continually address obstacles as they arise, Blair said. For example, if patients are not showing up for scheduled visits, an effort is made to check in.
“The goal is to find out why they are missing their appointments,” Blair elaborated. If the issue is transportation or wheelchair access, steps can be made to offer support.
If a large concentration of indigent clients seems to be located in one pocketed area, then efforts are made to find volunteer providers within that area.
“Think about putting yourself in the shoes of the indigent patient who walks through the door,” Blair suggested. “How can I better serve them? If we never lose sight of service, and if we always keep that as our main objective, then we always know we are going to be doing business the right way.”
“Taking care of our most vulnerable residents should always be a top priority for government officials,” shared Fort Bend County Judge KP George. “I am proud of Fort Bend County’s Indigent Health Care Program for providing quality and impactful service to our community.”
Fort Bend County not only treats the immediate medical need, but goes the extra mile in search of all of the services for which the indigent patient may qualify, explained Martha Hernandez, Fort Bend County Indigent Health manager and chair-elect of the Texas Indigent Health Care Association. Examples of other sources of assistance include hospital charitable care, free cell phone application/processing, SNAP (food stamps), prescription assistance, and Medicare, Hernandez detailed.
“Our staff routinely assists individuals with applications for these programs as well as Social Security Administration documentation and follow-up/application processes,” Hernandez continued. “Assessments for outside eligibility are processed for county residents whether or not they qualify for our program.”
Fort Bend County Indigent Health Care has managed their prescription assets in such a way that has allowed their clients to obtain all of their prescriptions, even though the county program is limited to providing only three prescriptions per month for each client, Hernandez reported.
Clients are referred to local free educational classes that can assist them with additional chronic illness management; they are also referred for yearly wellness and preventive exams/screenings, immunizations, and women/men’s health care checks.
“We have been able to help clients get more of what they need by referring them to, and assisting them with, outside applications for patient assistance programs provided by manufacturers who are able to provide benefits beyond what our program can provide,” she continued.
As a result, the number of clients that reach their maximum allowable amount per fiscal year has been reduced by 50 percent, Hernandez summarized, and Fort Bend County has been able to serve clients on a holistic level that best meets their needs.
A Wide Umbrella
When patients become eligible for indigent health care in Ellis County, they are automatically assigned a primary care physician at the Hope Clinic.
The county’s working relationship with Hope Clinic “is absolutely amazing,” declared Terri Klein, Ellis County Indigent Health Care coordinator.
“On top of everything else, Hope offers dental care, women’s health, psychological therapy, and more,” Klein continued. “All of the services under the clinic’s umbrella are open to our clients.” In addition, the patients are not restricted to a number of clinic visits, and they can seek care as often as needed while eligible.
Ellis County Judge Todd Little is a former president of Hope Clinic.
“It is our duty as public servants to invest in and promote quality care for the underserved in Ellis County,” Little stated. “Hope Clinic, our local comprehensive health care provider, will continue to be a cherished partner of the Ellis County Indigent Health Care Program with its mission to share God’s love in community.”
Ellis County also initiates agreements with specialists, although Klein said it is sometimes challenging to secure the specific providers they want due to payments being restricted to Medicaid levels.
While patient care is of utmost importance, indigent care programs are required by state law to follow eligibility requirements and keep up with current rates and coding. Klein credits the county’s software, provided by Indigent Healthcare Solutions, for keeping the business side of the program running effectively and efficiently.
“When it comes to paying the bills, the software program updates the rates and percentages we pay each facility as needed,” Klein detailed. “The software we use keeps track of eligibility and payments, and prevents duplicate billing,” she continued.
Finally, Klein points to an informed and accommodating Commissioners Court as a key to success. Twice a year Klein provides a full report to the Commissioners Court. She also approaches them as the need arises regarding coverage issues or special situations.
“We do have a good working relationship,” Klein observed. “The Commissioners Court has always been supportive.”
By Julie Anderson