Anne Arundel County Reach Program

State: MD Type: Model Practice Year: 2003

The Anne Arundel County Department of Health, in collaboration with the Anne Arundel County Medical Society, developed the REACH Program (Residents Access to a Coalition of Health), which provides access to primary, specialty, and ancillary care to eligible, uninsured low income County residents. This was accomplished by building a network of partners, who formally agreed to accept discounted fees for services provided. Health Department staff provides network development, eligibility determination, enrollment, and ongoing case management. Enrollment criteria for the REACH Program states that participants must be 1. a resident of Anne Arundel County, 2. 19 to 64 years of age, 3. not currently covered by any health insurance program and found not eligible for any government program, and 4. have a household income at or below 200 percent of the Federal Poverty Level. Over 3200 County residents have received $4.8 million in uncompensated care since the program began in 1999.
In order to address the previously expressed concerns, the Anne Arundel County Department of Health developed the idea for the REACH Program. The REACH Program provides primary, specialty and ancillary services through a network of volunteer providers and vendors who formally contracted and agreed to a deeply discounted fee for services provided to enrolled members. The REACH Program is administered entirely by the Anne Arundel County Department of Health’s Community Outreach Division. Reaching the initial goal of 1000 enrolled residents the first year was accomplished by the development and distribution of program materials; community, government and network partner referrals; local newspaper articles; medical, employer, religious organizations and community presentations; radio talk shows and the County Department of Health Web site. Developing a program that supported the providers in a way with unobtrusive paperwork and supportive case management was vital. REACH members pay a sliding scale fee directly to providers at the time of service, eliminating the need for billing and collection. Monitoring of care provided to enrollees occurs from all points of contact. Routine office, lab, and radiology visits are tracked, as well as encounters at local hospitals for procedures, emergency services or admissions. The monetary value of discounted care, currently over $4.8 million, is reported regularly to all sectors of the community, including network providers, government and elected officials, community leaders and the general population. In June 2001, responding to the needs of REACH members and providers, the Department of Health contracted for a discount prescription plan which offers significant discounts on all generic and brand medications. The pharmacy cards have saved members over $146,000 in medication costs.
Commitment to develop the REACH Program occurred at many levels. For the program to be successful all the parts had to work together, including the County Medical Society, leadership of area hospitals, corporate vendors and individual providers. It is because these individuals and organizations committed to render health care services at a deeply discounted rate that has enabled members of REACH to have a primary care medical home and access to ancillary and specialty services when needed. Anne Arundel County Department of Health convened many meetings with the leaders of the local hospitals, detailing the objectives of the program and requested the cooperation and support of their organizations and medical staff. This relationship with hospitals proved to be critical to physician recruitment in REACH. Meeting individually with providers helped to allay any fears about unmanageable paperwork, low reimbursement rates, and reimbursement hassles. Thus, the REACH network has partnered with over 440 Anne Arundel County providers and vendors and 3 local hospitals to care for County residents enrolled in the program. Many local government agencies, such as the Department of Social Services and the Department of Aging, use the program on a daily basis as a referral for residents ineligible for government programs. The county’s elected officials are also aware of the REACH Program and have on numerous occasions praised the program at public hearings for being a successful merger of the public and private sectors of the community. Finally, the health department and the County Medical Society have a commitment to the continuance and expansion of the Program. This expansion continues daily in the solicitation of new community providers and services. To ensure continued communication regarding the progress of the program, the REACH administrator provides program updates and issues to the County Medical Society’s Board and General membership on a regular basis.  The Anne Arundel County Department of Health funded the development, implementation and operation of the REACH Program. The Department of Health used stable state public health funds rather than less sustainable grant funds to support REACH. Community providers are wary of grant-funded activities that can leave providers with responsibility for the patients’ care should grant funding end. All ongoing operational costs, associated with the REACH Program, including network maintenance and case management, are funded by the Department of Health. The original budget was for $319,251 and included the following personnel: (1) health care administrator, (2) three full-time case managers, (3) one part-time case manager, and (4) one secretary. Equipment needs included personal computers, printers, fax machine, Internet access, office supplies, and telephones. In addition, the following costs were incurred: (1) advertising/ promotional materials, (2) membership cards, (3) printing of applications, contracts, physician and member information packets, (4) business cards, (5) travel expenses, and (6) staff training. The Department of Health Information Systems staff worked with the REACH staff to develop and fine-tune the REACH MC-ACCESS database. Additionally, as a partner in the REACH Program, the Anne Arundel County Medical Society has supplied office space for the REACH administrator. The budgets for the second and third years of the program were approximately $425,000 per year and included two additional case managers, one of which is bilingual and responsible for the enrollment and case management of the program’s Hispanic membership.
The REACH Program has already surpassed its original membership goals. Over 3200 county residents have received care through the REACH Program. The initial enrollment target was to provide a primary care medical home to 1000 uninsured adult county residents. The outcomes of the program have surpassed expectations by both the Department of Health and the Medical Society in a number of ways. The support and participation by the members of the County medical community has been overwhelming. The improved health indicator and positive result of the REACH Program is a diverse and substantial county-wide network of providers, evaluating and treating a population of uninsured individuals who would otherwise have no medical home and with only the option to wait and seek costly urgent or acute care. Fifty-five percent (55%) of the uninsured postpone getting needed medical care, which results in their being twice as likely to be hospitalized for avoidable complications of pneumonia, hypertension, and diabetes. The REACH Program provides the opportunity for enrolled residents to obtain the following on a regular basis: (1) preventive care, (2) needed medical procedures, and (3) necessary medications as prescribed. Every year REACH member and provider surveys are conducted to evaluate program successes and areas for improvement. The members have stated repeatedly they were pleased with the REACH case managers’ role, the access to multiple types of providers and the security of having a “safely net” to fall back on. The providers are “satisfied to extremely satisfied” with the support, network diversity and operation of the REACH Program. County providers are also pleased to have an avenue to refer their current patients who might find themselves without healthcare coverage.
The REACH Program will continue to be funded by the Department of Health, since ensuring access to care is an essential public health role. Continued participation of the network providers and vendors is critical to the programs' growth and sustainability. The providers in the REACH Program volunteer to see REACH members in their offices knowing they are providing a medical service, at an extremely low cost, to residents who would have no other option than to wait until the problem was acute and be treated at an area hospital. To be successful, the REACH network needed to include a critical mass of providers and services throughout the county, giving residents access to all types of care. It was also important to tap into all free, low-cost or financially supported programs available to county residents. Thus, the REACH network is supplemented by the use of existing Department of Health programs, available health education classes at participating hospitals, and referrals to various pharmaceutical subsidy programs. Case managers needed to supportively aid in the coordination of care, without seeming to act as a "gatekeeper." They serve as mentors, educators, financial counselors and overall support system to many of the members who are very unfamiliar with how to successfully navigate the current health care environment. From the member side, getting the information out to the uninsured took aggressive legwork. Enrollment was accomplished by the use of brochures, posters, county newspaper articles, radio shows, community and hospital presentations, and referrals from providers and government agencies. Continued work with the minority community through attendance at local church and civic meetings is directly reflected in the 44% minority enrollment in the REACH Program. One of the major issues encountered during the initial year of the REACH Program was the extremely high cost of medications to the members. The Department of Health evaluated the need and proceeded to contract with a national pharmacy benefits manager to make prescriptions available to members at the best rate possible. The initial motivation for obtaining a prescription discount arrangement was to assist the enrollees in the REACH Program. The Department of Health quickly recognized that many residents of the County, without prescription coverage, could also benefit from this program. That program has been expanded and has assisted over 3400 county residents saving them just over $146,000 with their medication costs.   The Anne Arundel County Department of Health and the Anne Arundel County Medical Society leadership came together to begin to resolve an issue plaguing County residents. It was this collaboration that led to the Program’s success. REACH offered County providers a way to give back to the community without leaving their own offices, being forced to see an overwhelming number of patients or having to screen individuals for financial need. If the local department of health, medical society, hospitals and area providers work together, the REACH Program can be duplicated elsewhere. However, the population, number of available providers and community “culture” regarding probono care will make a difference in how the program operates. The jurisdiction must have a sufficient supply of providers and thus cannot be an underserved area. There needs to be an organization or entity to take the lead role, whether it be a medical society, hospital, community health center, foundation, or in the case of REACH, the local health department. The importance of a knowledgeable network development staff understanding the needs of the community, both residents and providers, to establish a countywide network of services is critical. The REACH Program does not purchase any services for enrolled members. Having the enrollees pay the providers a designated reduced fee at the time of service is a part of the Program that all parties felt would keep the commitment to the Program by both enrolled members and participating providers. Another critical piece in the development of a program like REACH is that the case managers are not gatekeepers; instead, they offer administrative support to providers, which is an incentive for enrollment in the provider network. Each case manager manages a subset of the REACH enrollees and controls referrals and needs outside the physician office, thus preventing providers from becoming overwhelmed and giving them continued control over their practices. Anne Arundel County Department of Health’s outreach, enrollment, case management, and network development activities are essential to the Program’s viability. Continued participation of the providers and vendors is also critical to the sustainability and growth of the Program. Support of the medical society, area hospitals, corporate vendors, and individual providers must continue in order for the Program to remain strong. County elected officials are extremely supportive of the Program and its efforts. The Health Department and the Medical Society are fully committed to the REACH Program. All of these elements help ensure the ongoing strength of the REACH Program. The plight of the uninsured is a longstanding, pervasive problem, and the REACH Program is a limited local approach to provide access to health care at an affordable rate. Through REACH, over 3200 county residents have received over $4.8 million dollars in health care services. As the successes of the REACH Program become evident statewide, other county health officials have met with us to understand how REACH was developed and to look at the possibility of duplication in their county.