Development and Implementation Grant
Requirements
                            Phase Two National Press Release

CAREPARTNERS
Portland, ME

  

 

        Objectives

The three goals of the CarePartners program are to improve access to healthcare and existing community resources for low income uninsured individuals; to support health behaviors, appropriate utilization of healthcare services and improved health status for CarePartners enrollees; and to acheive financial sustainability of the program.

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        Program Design

CarePartners improves access to healthcare for low income Mainers by providing eligible persons with access to comprehensive healthcare services, care management and access to low cost or free pharmaceuticals.  Persons are eligible for CarePartners if they are uninsured, have a household income under 175% of the Federal Poverty Level, live in the program service area for at least six months, meet an assets test, and are not eligible for coverage through their employer or school.  All persons enrolled in CarePartners are assigned a Primary Care Provider, (PCP) as well as a Care Manager who is either a social worker or a nurse.  The Care Manager helps enrollees to meet their healthcare needs and access needed social and economic resources in the community.  Patients pay $10.00 for an office visit.  All other healthcare services are free, including diagnostic tests, hospitalizations and procedures.  Members pay $5.00 for a month's supply of prescription drugs.

CarePartners is being implemented by local healthcare systems in three Maine Counties in collaboration with MaineHealth, an integrated delivery system serving southern and central Maine.  Hospital and health systems which administer the program are Maine Medical Center in Portland, Maine General Medical Center in Augusta and Waterville, and Miles Memorial hospital and St. Andrews Hospital in Lincoln County.  CarePartners builds upon the tradition of the hospitals and doctors providing certain amount of their time "pro-bono" to patients in need, and is made possible by all providers who donate their time to serve program members.

CarePartners demonstrates that the private medical sector is willing to provide leadership in addressing the complex problem of improving access for the insured, critically examine the best way to provide free or "charity" care, and allocate its own financial resources to improve the healthcare available for some of the most needy individuals in Maine.  By providing increased primary care, health education and preventive services to CarePartners enrollees, the program can demonstrate to both government and businesses that serving the uninsured can result in improved health outcomes and can be financially feasible.

The geographic region served by the MaineHealth system is extensive, it consists of the counties of southern and central Maine, comprising a total population of approximately 950,000.  CarePartners is currently being piloted in three counties:  Cumberland, Lincoln, and Kennebec.  The program is currently planning expansion in Androscoggin and Oxford Counties.  Ultimately, CarePartners may be implemented throughout the region.

The key features of the CarePartners model include the organization and strengthening of a delivery of charity or free care across multiple communities, and the provision of "added value" services identified as crucial to serving the target population.  The organization and strengthening of each community's free care encompasses multiple activities, including developing a network of providers who agree to provide services to CarePartners enrollees for free or for a nominal patient contribution; tracking and utilization of services delivered by the provider network through the processing and regular reporting claims data, and working with clinics, physician groups and hospitals to improve tracking and coordination of all free care.

Added Value of services included a comprehensive intake system which provides linkages to existing resources and healthcare coverage; care management; and access to free or low cost pharmaceuticals.  Intake staff determine eligibility for both CarePartners and public insurance programs as well as provide resource and referral information for all who apply.  Care management staff assist enrollees in coordinating their healthcare appropriately, accessing services and increasing their understanding of health and healthcare.  Pharmacy assistants work with enrollees and physicians to facilitate access to free or low cost pharmaceuticals through the pharmaceutical companies' Patient Assistance Programs (PAPs).

CarePartners is not an insurance product, but it does provide access to healthcare services traditionally covered under an insurance plan.  CarePartners builds upon and strengthens the existing provision of care and provides a vehicle for community-wide response to improving access to healthcare.  CarePartners does not intend to enroll the majority of uninsured persons, but it does intend to maximize access to existing resources and healthcare coverage; coordinate, track, and document the currently fragmented and uncoordinated provision of free care; and provide access to a comprehensive system of quality for thousands of low income and medically needy individuals.

 

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        Financing & Outreach Strategies

Financing Strategy

CarePartners is financed through the provision of donated services and products and direct funding of administrative and support services.  Donated services and products include healthcare services, claims processing and pharmaceuticals.  Direct funding is provided by hospitals and healthcare systems in each service area, MaineHealth and grants.  Ongoing fundraising is enhanced through the administrative structure of CarePartners which allows for multiple sites to submit combined grant applications.  Current grants include The Robert Wood Johnson Foundation's Communities in Charge Initiative, HRSA's Community Access Program (CAP), and grants from local philanthropies, the Bingham Program, the Davis Family Foundation and beginning in September 2003, the Maine Health Access Foundation.  These grants have been invaluable to the success of the program.

Delivery System

The delivery of healthcare services is provided by members of the provider network.  The delivery of services is guided by medical necessity and by the willingness of providers to participate in the program.  Currently, we have approximately 750 primary care specialty physicians participating in the three service areas, as well as seven home care agencies, ambulances, and speech and physical therapists.  CarePartners is still building its provider network.  The program will continue to add physicians as well as other types of providers such as mental health providers and durable medical equipment suppliers.  Efficiencies of scale are achieved whenever possible.  For example, an information system which support all program activities is being developed with funds from HRSA's CAP Grant.  The system will allow not only standardized data tracking and reporting, but will also allow for the easy addition of new sites.

Outreach Strategy

Marketing and outreach is currently focused on the following sub-populations:  active or new patients within a physician practice, patients referred from the emergency room; referrals from social service agencies, referrals from Medicaid offices, and referrals from hospital charity care roles.  As a result of the marketing and outreach strategy CarePartners does not enroll a disproportionate share of medially needy persons.

CarePartners has developed brochures, posters and a Member Guide which clearly describes the program and enrollee roles and responsibilities.  The Member Guide was tested on enrollees prior to its publication and distribution.  Staff work with physician groups and hospitals to send letters and information to persons who are potentially eligible and make brochures available in physician offices, clinics, emergency rooms, Medicaid eligibility offices and service organizations.  Staff also conduct trainings at these organizations for personnel who are likely to come in contact with potentially eligible persons, including front office staff, nurses and social workers, and healthcare providers.  Many of these organizations who participate on the community advisory committees also assist in developing outreach strategies and conducting outreach to their organizations.

 

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        Accomplishments to Date

A household telephone survey, Profiling The Uninsured in Three Maine Counties, was conducted in Cumberland, Kennebec and Lincoln Counties in April 2000.  The survey found that there were significant differences in the overall rate of uninsured in each county:  Cumberland (10%), Kennebec (14%), and Lincoln (18%).  Previous studies determined that Maine had an average rate of 15% uninsured, the highest rate in New England.

These findings support a growing base of anecdotal information that describes what it means to be uninsured and why people are uninsured.  For example, the survey found that 70% of all uninsured persons are working at least part time, and that the majority is either self-employed of working for an employer with less than 25 employees.  The survey also revealed that persons who live below the federal poverty level are 400% more likely to report fair or poor health status than a person whose income is 2-3 time the federal poverty level.  12% of uninsured persons report that they "always" delay taking prescription medication due to cost, while 48% report they "sometimes" delay taking their medications.

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       Challenges

There are many challenges to this program, including long-term financing, prescription drug prices, and assuring sufficient network or providers.  In addition, the state and the overall healthcare system has a serious impact on this program.  As providers receive less reimbursement from both publicly and privately insured patients, they are less incline to donate their services.  As providers are required to fill out more paperwork for managed care organizations, they are less likely to want to participate in "yet another program."  CarePartners is one more piece to the patchwork of healthcare coverage in Maine.  Until universal healthcare coverage is achieved, CarePartners needs to constantly assess how it can best work with providers, how it can leverage resources and provide cost effective services, and how lessons can further improve access for all Mainers.

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        Contact Us

Carol Zechman, LCSW
Director
CarePartners
241 Oxford Street
Portland, ME 04101
Phone: (207) 775-7000 ext 223
E-mail: 
zechmc@mmc.org

For Information on Kennebec County CarePartners:

Jan Murton, LSW
Program Coordinator
CarePartners
C/O Family Medicine Institute
15 East Chestnut Street
Augusta, ME  04330
Phone: (207) 626-1887
Fax: (207) 626-1980
Email:  jan.murton@manegeneral.org

For Information on Greater Portland CarePartners:

Carol Zechman, LCSW
Director
CarePartners
241 Oxford Street
Portland, ME  04101
Phone: (207) 775-7000 ext 223
Email:  zechmc@mmc.org

For Information on Lincoln County CarePartners:

Jennifer MacDonald RN
Lincoln County Carepartners Plus
Program Coordinator
40 Belvedere Rd
Damariscotta, ME 04543
207-563-4170

 

 



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