ACCESS to HEALTH
St. Louis, MO

April 2000

        §       Background

The Access to Health Project (AHP) is the work of a broad-based group of healthcare providers and community leaders dedicated to improving health in the St. Louis region.  St. Louis 2004 convened this group in January of 1997.  St. Louis 2004 began four years ago under the leadership of former Senator John C. Danforth with the mission of fostering a rebirth of the St. Louis region.  The organization has acted as a catalyst for bringing people and organizations together throughout the region to address complex issues facing the community.

St. Louis 2004's first step was to conduct a series of "visioning sessions" involving more than 10,000 citizens to assure that the issues they assembled reflected those our citizens thought were important to the future of the region.  This process generated over one hundred ideas, which were subsequently narrowed to eleven priorities through an extensive community process.  Among these eleven in this initiative to provide access to healthcare to the uninsured.  The Access to Health Project is the entity now charged by the community to focus on improving access in the St. Louis Region.  The AHP is governed by an Executive Committee, which includes representatives from the four private hospital systems, three health plans, the county-run clinics, the city financed clinics, county and city officials, the Federally Qualified Health Centers, medical society, the Catholic Health Association, and religious leaders.

Currently, the uninsured receive care through several safety net facilities and through care provided at private hospitals, often in the emergency room.  The safety net is a critical component of our healthcare community, and any initiative that improves care through better access to health insurance coverage must include a corresponding high priority for the safety net delivery system.

Financing Strategy

Funding sources for the administration of the project will come from a mix of private healthcare corporations, federal, state, and local dollars, as well as local and national foundations.  Over the coming year, we will implement near-term priorities, which focus on reducing barriers to accessing healthcare.

Outreach Strategy

The AHP's community engagement strategy is centered on the access barriers reduction component of our program.  The assessment of non-financial barriers to access will involve a rigorous community engagement process.  Through this effort, we will connect with community leaders, advocates, providers, and the uninsured themselves.  Each of these contacts will provide a valuable opportunity to inform key constituencies about available insurance coverage, to build trust, and to understand where efforts beyond providing insurance coverage are needed.

In addition, the AHP works closely with other projects designed to improve access through Medicaid outreach and enrollment efforts.  For example, the "Missouri Covering Kids" program is a priority of AHP, and we collaborate with the Area Resources for Community and human Services (ARCHS) by providing funding and other resources to implement outreach efforts (no funds from Communities in Charge are used for Medicaid outreach and enrollment efforts).  Many of the marketing and communication strategies developed out of this effort are a part of the AHP as well.

Delivery System

The near-term priority for the project focuses on the safety net delivery system, which is the primary access point for the uninsured.  This delivery system has many strengths including access to specialty care through ConnectCare and the Washington University School of Medicine.  In addition to providing primary care services, ConnectCare provides numerous services internally and on a referral basis from FQHC's, County, hospital and medical school clinics, and private physicians.  These services include specialty care, subspecialty care, emergency care, inpatient care, dialysis care, transportation and dental care.  In addition, St. Louis's system of federal qualified health centers form a stable foundation of access to healthcare services for the uninsured.

• Identifying new sources of funding to sustain the existing safety net delivery system

• Identifying systems-level improvements in the safety net delivery system that are mutually beneficial to safety net providers and that measurably improve access to health care for the uninsured

• Overcoming distrust of the health care delivery system by the grassroots community

Lack of access to health resources for low-income populations has proven to be a persistent problem in the St. Louis region, and like with most communities, the problems of access are complex and not easily solved. Ensuring that health insurance is available for low-income uninsured individuals, through existing and new mechanisms, is an important component of the AHP. However, health insurance will not in and of itself provide access to health care for the uninsured. Thus, the AHP focuses on assuring an effective delivery system, as well as understanding and then working to eliminate non-financial barriers to accessing care.

Of the 1.34 million people living in the St. Louis City and St. Louis County, approximately 150,000 are uninsured. Of these 150,000, approximately 55% have incomes below 200% of the federal poverty level. Of the more than 38,000 uninsured in St. Clair County, 35% are low-income. The low-income uninsured in the St. Louis region will be the target of the AHP's efforts to understand and then work to alleviate any barriers to access.

Dan Body
Executive Director
Access to Health Partnership, Corp.
c/o Mercy Health Plan
1508 South Grand Blvd.
St. Louis, MO 63104
Phone: (314) 214-8007
Fax: (314) 214-8031
E-mail:  dbody@accesspartnership.org