# Presentation: 355325

## Pima Community Access Program  PCAP:  Tammy Stoltz, Executive Director, tammy@pcap.cc or 520-694-2755

- Powerful Partnerships at Work to Build a Healthier Community

## MARKET ASSESSMENT

- PCAP’s provider partners currently provide over 75** million dollars** in uncompensated care.
- AZ has one of the **highest rate** of uninsured persons in the nation.
- AZ is 6th in the nation for the non-elderly uninsured population.  1.6 million non-elderly people are uninsured.
**84%** of low-income AZ families work all or part year.
- Only **60%** of these working low-income families have employer-based healthcare coverage.

## MARKET ASSESSMENT

**30%** of employees in firms with 1-9 employees are not insured.
- Private insurance premiums are increasing at a minimum of **30%.**
**99.5%** of the full time business firms with employees in AZ are small business.
- Pima County has an estimated **70,000** low-income uninsured adults. 52% of them are Hispanic.

## PCAP’S   PURPOSE

- To increase enrollment in public programs, and thus reduce the overall percentage of uncompensated care in Pima County, through an automated electronic eligibility system called Health-e-Arizona.  40% of the uninsured are eligible for public assistance and are unaware.
- To design a coordinated system of care which  provides a network of specialists and hospitals willing to accept uninsured patients at an affordable rate

## PCAP’S   PURPOSE

- To reduce the avoidable emergency room visits and hospital admissions through access to coordinated, elective care.
- To produce clinical outcomes comparable to insured populations.

## PCAP....WHO ARE WE????

- Community based program with a community board and community support!
- Consortia of healthcare providers and community leaders!
- All Community Health Centers (8)
- Seven Community Hospitals (7)
- Pima County Medical Society (1100 physicians)
- University Physicians, Inc. (300 physicians)
- Over 600 private physicians and ancillary providers
- United Way

## PCAP...WHO ARE WE???

- Pima County
- AZ Small Business Association
- Fred G. Acosta Job Corp
- National Bank of Arizona
- Clements and Peck Insurance, LLC
- Rural Health Office-Mobile Clinic Program U of A

## PCAP IS:

- PCAP links low-income, uninsured residents of Pima County with an affordable, comprehensive and coordinated network of health care providers.

## PCAP IS:

- A Healthy Community Access Program (HCAP), originally funded by a federal government grant, federal and state funding to community clinics, and discounted services of participating providers
- A comprehensive system of affordable care for low income, uninsured persons in Pima County
-  A collaborative system that provides continuum of care to the uninsured while offering providers more support in delivery of that care
- A healthcare buying/discount service organization

## PCAP   IS   NOT!!

- Insurance (of any kind)
- Providers of Care
- Free Care
- For Everyone

## PCAP Eligibility Criteria

- Pima county residents, 18 years and older
- Fall within 100-250% of the federal poverty level
- Pay $20/person every 6 months
- Those not covered by other insurance

## Slide 12

| Family Size | Hourly Rate | Gross Mo. Income | Gross Yr. Income |
| --- | --- | --- | --- |
| 1 | $4.31-10.79 | $748-$1,871 | $8,980-$22,450 |
| 2 | $5.82-$14.56 | $1,010-$2,525 | $12,120-$30,300 |
| 3 | $7.33-$18.34 | $1,272-$3,179 | $15,260-$38,150 |
| 4 | $8.84-$22.11 | $1,533-$3,833 | $18,400-$46,000 |

## PCAP   OFFERS:

- An **entire community **fighting for equity in health care
- A health care delivery model that says **YES**
- A **medical home** for every enrolled patient
- A **continuum of caring**

## PCAP   OFFERS:

- An **integrated force** to eliminate barriers to receiving/delivering health care
- A **BRIDGE** in the health care gap for thousands of persons in Pima County
- An **equitable** distribution of services among providers

## PCAP   OFFERS:

- Community **partnerships** and sustainability
**Outreach** and mobile health care services to rural communities in Pima County
**Accessible and affordable** comprehensive services

## SUSTAINABILITY:  WHY WE ARE “STILL” HERE!

- Provider Network is satisfied.  100% of providers surveyed report either satisfied or highly satisfied with PCAP.
- Less than 10 PCAP members have been dis-enrolled due to non-compliance.
- PCAP members are engaged and financially participate in their health care decisions.
- Members sign a “rights and responsibility” contract with PCAP.

## SUSTAINABILITY:  WHY WE ARE “STILL” HERE...CON’T!

- Low operating expenses
- Streamlined processes
- Commitment to follow the money
- Flexibility and ability to morph and evolve quickly and situationally
- Replication
- New revenue streams

## LOW OPERATING EXPENSES!

- Budget Neutral.  Revenue had to cover expenses
- Staffing changes to reflect new model of sustainability
- Developed multi-functional positions and eliminated departmental lines

## STREAMLINED PROCESSES!

- Re-engineered processes and eliminated duplication and excess paperwork
- Automation
- Focused on priorities using data collected for most effective ROI
- Eliminated procedures that were not “patient focused”

## FOLLOW THE MONEY!

- Know your audience and satisfy
- Keep finger on the market pulse
- Utilize consortium as marketing champions
- Identify ROI and capitalize on methods that are proven successful
- Don’t sell out...but do SELL!

## FLEXIBILITY AND ABILITY TO MORPH AND EVOLVE!

- Adaptation is essential and exhilarating
- Speed and situational awareness is key
- Keep staff involved with evolution
- Focus on the willing and able mentality
- Can do approach - fake it ‘til you make it!
- What was successful in the beginning may be dated and useless now
- Eliminate the Fear Factor
- Celebrate and move on

## REPLICATION

- Design and replicate successful models to other communities/counties
- Offer “lessons learned” and expertise to other HCAP projects via technical assistance
- Be resourceful and serve as a resource
- Consult with HRSA and other Management Assistant Programs to share, create and assist fellow grantees
- Develop a compelling story – then SHOW and TELL

## DEVELOP NEW REVENUE STREAMS:

- Develop new alliances – strange bed fellows make great partnerships
- Consulting services
- Fundraising
- Seek out partners and sponsors of events
- Grant development
- Community Collaboration
- Health-e-Arizona

## HEALTH-E-ARIZONA

- ELIGIBILTIY AND ENROLLMENT SOLUTION