Insuring Health for the Uninsured in Hinds County, Mississippi
Jackson, MS

§        Objectives

This Program's goals are to provide 45,125 of the uninsured in Hinds County, Mississippi with access to a community-based integrated delivery system (IDS) for comprehensive healthcare by facilitating referral to a "medical home."  The Jackson Medical Mall Foundation will serve as the lead agency.  As of September 2003, 55% of the previously uninsured, or 25,000 residents now have health coverage through SCHIP, Medicaid, or federally qualified community health centers (FQHC's) in the targeted area.

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§        Program Design

Through an innovative project to revitalize an inner city area, an 800,000 sq. ft. declining shopping mall was transformed into a Medical Mall with over $50 million of construction/renovations.  Since opening in 1997, it has served over 600,000 clients.  Network primary care providers include the University of Mississippi Medical Center's Outpatient Primary Care and Specialty Clinics, Jackson-Hinds Comprehensive Health Center (an FQHC), Central Mississippi Health Services, Inc. (an FQHC), University of Mississippi's School of Nursing UNACARE Clinic, the Jackson Medical Society and Voice of Calvary Health Center (a faith-based-organization).

The program is designed to improve access and continuity of care by facilitating referral to a medical home.  The Alliance is serving both urban and rural populations and will take advantage of existing telemedicine capabilities and shuttle services to overcome transportation problems often encountered by the population served.  A thorough community assessment has been conducted through the University of Mississippi's School of Nursing to design a program to meet the unique needs of our communities.

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§        Financing & Outreach Strategies

Financing Strategy

Mississippi is the first state in the nation to set aside its entire Tobacco Litigation Settlement of $3.4 billion in a healthcare Trust Fund to preserve the fund and generate earnings to be spent on healthcare improvements, including $125 million this fiscal year.  The State's Attorney General who helped lead this initiative is actively supportive of seeing part of these funds utilized for a program for the uninsured.  Already the Partnership for a Healthy Mississippi, chaired by the Attorney General, has provided $600,000 of local match for the RWJF Communities in Charge Project in Hinds County from 2001-2003.  Going forward, two of our participating major hospitals and the United Way of the Capitol Area have committed $100,000 or $300,000 respectively for 2004 to continue the work of the Alliance in serving the uninsured.

Program Delivery System

Three Alliance models have been designed for the uninsured to help improve access to care.  They include:

• An ER ReDirect Program whereby uninsured individuals seeking routine care from the ERs are seen, treated, and then advised by a hospital case manager of the 7 primary care community-based facilities that they may choose from, for linkage to a PCP, access to a medical home and continuity of care.  The Hinds County Health Alliance staff assists the client to secure an appointment at one of the network primary care sites, if they do not already have a PCP.

• A disease management program for the uninsured diabetics and hypertensives has been successfully implemented.  If a chronically ill patient who is uninsured indicated to the ER staff that he/she is a diabetic and/or hypertensives, the Alliance staff arranges an appointment within 5 business days to get the patient enrolled in the University Metabolic Clinic Program.  there the patient is seen by a specialist in metabolic disease, provided with needed prescription drugs, counseled on nutritional and exercise needs and home-visited by a professional nurse if needed.  The metabolic physician refers the patient back to a PCP for routine care, but is available for specialty care whenever needed.  The idea is that the uninsured patient is provided with tools for better self-management.  Armed with these skills, the patient (ideally) will no longer seek episodic care by way of the Emergency Room.

• A drug discount program is also available providing 50-60% discounts through a HRSA 340B program and free maintenance drugs for the chronically ill if they are financially eligible, through a pharmacy industry MED ASSIST Program.

Proposed Outreach Strategy

It is imperative to involve all levels of the city, county and state government who deal with the provision of healthcare services.  The four major hospitals and health systems have enthusiastically agreed to work together on this program for the uninsured.  They have begun to refer their uninsured ER and inpatients to the Hinds County Health Alliance for referral to a PCP.  There have been over 6,000 referrals to the Alliance through the ER ReDirect Program.  Of this amount, approximately 20-25% make an appointment for primary care.

We do believe that the business community will support this effort.  The Metropolitan Council of Churches will also partner with us in providing outreach to the uninsured.  In addition, some types of community outreach workers who have experienced firsthand the difficulties of transitioning from welfare to the workforce will be involved.  The local press and television stations have also been asked to promote this program for the uninsured, as was done during "Covering the Uninsured Week" in March 2003.

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§        Accomplishments to Date

• All four major hospitals and health systems in Hinds County are now referring uninsured and Medicaid beneficiaries who are Emergency Room "routine cases" to the Health Alliance for referral to a PCP.

• Three of five outpatient facilities in Health Alliance now offer 340b drug discount programs with up to 50% discounts off retail, as of January 8, 2002.  Impact?  For every $1 spent on needed prescribed drugs, $4 of cost savings are realized from reduced unneeded ER visits and inpatient hospitalizations.

• Alliance staff will participate in eligibility determination training for Medicaid or SCHIP enrollment.  Impact?  Working with The Robert Wood Johnson Foundations Covering Kids and Families grant in Mississippi, the Alliance will help streamline methods of SCHIP enrollment and re-enrollment.

• Transportation services are made available to those who need to get to a PCP office.  A reminder of their appointment will be made 1-2 days before the scheduled visit.  Impact?  Cut down on "no show" rates at clinics and PCP offices that run as high as 50% in some instances.

• United Way of the Capitol Area's social services is completely integrated with the Alliance Health Services Network through Service Point Software.  Impact?  The hospital discharging recovering alcoholics can be immediately placed in an appropriate halfway house for alcoholics in the community.

• Participating physicians for high-risk diabetics and hypertensives are using disease management clinical protocols.  Impact?  As of June 2003, the Hind County Health Alliance in collaboration with the University of Mississippi Medical Center, the Jackson Medical Mall, the Mississippi Primary Care Association, McKesson Health Solutions, Health Alliance Pharmacy and Specialty Disease Management Services, will assist the Division of Medicaid in the delivery of the disease management program.  The program will focus on all 700,000 Medicaid beneficiaries statewide who are suffering from diabetes, asthma, and high-risk hypertension.

• Free blood pressure, pulse and weight recordings at kiosks in the Medical Mall and supermarkets through the County are electronically transmitted to an Alliance member's PCP.  Impact?  Patients will be more knowledgeable of their own health status and be prompted to seek healthcare assistance if these readings are abnormal.

• House-to-house surveys have been conducted of participating uninsured to find ways to further improve compliance with physicians' recommendations for clinic visits and prescription drug usage.  A report of these findings are now available.

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§       Challenges

Sustaining the initiative to help improve the health status and access to needed healthcare services for all uninsured Mississippians.

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§        Contact Us

James Malloy, M.P.H.
Project Director
Jackson Medical Mall Foundation
350 West Woodrow Wilson, Suite 615
Jackson, MS 39211
Phone: (601) 982-0673
Fax: (601) 982-0459
E-mail: jmalloy@son.usmed.edu

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