This application is being submitted on behalf of the Indigent Care Collaboration of Austin Texas as part of the unified submission of Ascension Health for Community Access Program funding. The Austin area safety net providers are working creatively to develop a regional health care consortium that can respond more effectively to the needs of the medically indigent in the area. Cities like Austin, San Marcos, Round Rock and Georgetown in the three-county region of Travis, Hays, and Williamson counties are documenting record population increases. This growth is a result of an economic boom based on the development of technology sector and related services. Despite the remarkable prosperity of many families, more than 190,000 people (over 25% of the population) have incomes below 200% of the federal poverty level. Of these, more than half live below the poverty level with a low level of Medicaid enrollment.
It is estimated that in this tri-county area, over 200,000 individuals --155,854 adults ages 19-64 and 62,549 children ages 0-18 -- are currently uninsured for health care. The number of uninsured is increasing, due not only to increasing numbers of low income families, but also to changing demographics of the area workforce: many more people either work in small businesses that do not provide insurance or are in low-paid service positions. These increases-in the number of uninsured have strained the local health care safety net, resulting in a rising number of residents who delay care or seek non-urgent care in hospital emergency rooms. There is inadequate capacity to meet demands for specialty care, dental and behavioral health services; limited service integration; little case management; inadequate information systems; and poor linkage and coordination between different components of the healthcare system. Faced with these issues, public and private area safety net providers came together in 1997 to form the Indigent Care Collaboration (ICC) to develop joint projects that increase access, improve continuity and quality of care, and lower the cost of providing care.
The ICC has initiated a number of activities to carry out these goals including integrating after-hours call systems, adopting common eligibility protocols, and more effectively incorporating behavioral and dental health services and developing continuing medical education programs. In 1998, the collaborative officially united government and non-government entities into one corporate structure as a tax-exempt non-profit association (TUTJNA). This coalition is currently engaged in a major planning effort through the Robert Wood Johnson Foundation Communities in Charge initiative. Through Communities in Charge the ICC has identified subpopulations of groups that are not receiving adequate health care because of lack of insurance, lack of enrollment in public programs or lack of resources to pay premiums, deductibles or co-payments for needed services. The group has examined the current regional safety net; identified problems that could be solved through a new model of integrated services; and developed recommendations to improve (1) access, (2) continuity of care, and (3) financial support.
This planning has underscored the need for a shared information system for safety net service providers. An ideal shared network system can assist patients in accessing services, enable providers to share information to improve continuity of care, and provide mechanisms that enable providers to be more cost effective and more effectively garner financial support. New technology and Internet applications are making new solutions possible in the ongoing challenge of linking health care resources and consumers. The initial cost to establish this technology is substantial and requires external funding beyond the current resources of ICC members. This proposal requests funds to create an Internet-based information and communication infrastructure for shared data access to link safety net providers more effectively. The development process offers unique opportunities for providers, consumers and the business community in the Austin area to work together on critical health issues.
Funds from the Community Access Program and Ascension Health will be used to establish a flexible Internet-based network to enable members of the Indigent Care Collaboration and their partners to improve affordable access to healthcare. This network will enable safety net providers in all three counties and other regional healthcare providers to more effectively share information and use Internet technology to improve health care delivery and quality of care. A linked communication an~1 information network can help the medically indigent get access to primary and specialty services. It can create mechanisms that assist in monitoring benefits eligibility and providing information on eligibility to reduce duplication and decrease need for indigent patients to prove income at every access point. It will also improve reimbursements because of better data. The network will assist providers in sharing important diagnostic information within a system that protects patient privacy and provides security safeguards. Project activities will include developing standards and procedures which maximize integration of information while respecting confidentiality of sensitive information conforming to HIPAA standards; selecting appropriate Internet-based systems; purchasing or enhancing existing equipment to enable ICC members and partners to access the ICC-CENTEX.NET; customizing web-based applications to meet provider needs; training ICC members and partners to use the new technology; phasing in applications; evaluating project results; and creating systems for ongoing use of data to monitor care, more effectively understand the population, and assist with public policy decision making. This effort will be governed by the ICC Board and managed by SETON. Activities will be coordinated by a paid Project Coordinator working with technology specialists and ICC committees. Participants include the ICC member institutions of public and private health clinics, hospitals, mental health and behavioral services, social service agencies, and foundations. Additional partners include dentists, private physicians providing pro-bono indigent care, and technology advisors from area businesses.
The JCC-CENTE)ç.NET will be developed with the potential to provide for on-the-spot eligibility testing and enrollment for public support, enable providers to quickly obtain test results, permit hea1~th care providers to spend more time on patient care rather than administrative tasks, and support research on health care utilization patterns. Once it is functional, linkages to area social service providers will enable more effective coordination between agencies and provide better support for individuals and families needing assistance.
The outcome of this project will be a regional information network for safety net providers. Specific outcomes include better customer service; increased access to appropriate care; reduction in duplication of services or procedures; reduction in inappropriate emergency room admissions; reduction in inappropriate hospitalizations; and increased enrollment in insurance programs. Long term, ICC-CENTEX.NET provides a foundation for the Communities in Charge efforts to restructure indigent health care in the Austin area.