100 Percent Access Initiative for Manhattan KS and Seven County Region for the Community Health Council, 2000.

Edwin Fonner, Jr., DrPH edfonner@gmail.com [Back to Main Page]

Applicant Community and Safety Net System. The Community Health Council of Manhattan KS (CHC) is the applicant. Our partners represent the city, nearby communities (e.g., the Ogden neighborhood), and the surrounding seven county rural and frontier area. Our target population includes lower income uninsured and underinsured children, adults, and elderly. The first phase of the 100 Percent Access Initiative focuses on Riley and Pottawatomie Counties. A post-grant second phase will add Geary County. Work will expand to four other counties in the out years. Partners. CHC has been a vehicle for collaborations since 1992. Among CHC’s members are twelve providers, city and county government, the local school district, Kansas State University, the Chamber of Commerce, and the League of Women Voters. Representatives from two hospitals, a county health department, a regional mental health center, the university student health center, three long term care facilities, a Medical Society, a mental health alliance, a pharmacy, and dental clinic are our providers. All of these organizations play some safety net role for the area’s uninsured. Proposed System Enhancements. We will provide 100 percent access to integrated healthcare for about 700 uninsured in two locations over a 15-month period. In the next nine months, an additional 300 uninsured will be reached in the expanded area. These initiatives will help determine needs and costs associated with a region wide, seven-county effort. We will evaluate effectiveness and make modifications as needed. This trial aligns with our longer-term effort to develop a regional, integrated healthcare system. Vision. Our vision is a medical home for the area’s uninsured and better utilization of resources by the underinsured. Our objectives are to enhance the system of care for lower income persons in the area, to pursue broader safety net improvements (outreach, information systems, financial planning), to reduce the numbers of uninsured and underinsured, and to continue partnership and leadership development. Project Description. In the first trial, a continuum of services will be available to a target group of uninsured and underinsured in two communities – the Ogden community and rural Pottawatomie County. The system of care will consist of explicit linkages between hospital, public health, and primary care services, as well as strengthened ties to mental health and other social supports. Case managers and mid-level nurses will tie the elements together, while physicians will advise on developing appropriate care pathways. Workforce Initiatives: We will enhance regional nursing care using mid-level practitioners, a case management system for enrolled persons, and more unified eligibility determination. We will also coordinate the expansion of a small business health insurance purchasing program in the Manhattan area. Technology Initiatives: We will pilot use of uniform patient information forms and a coordinated approach to online data submission by participating physician groups, hospitals, and the health department. We will evaluate a case management system for information sharing and determine how to use telehealth to reach more consumers. We will make technical assistance and education available to providers using the Internet. Other Initiatives. We will develop and implement a financial plan and state and local legislative strategy to build program sustainability. This will include determining the feasibility of establishing an indigent care fund for the area. We will foster cooperation among providers and other social support groups to enhance multi-disciplinary work, help develop leaders, and enhance regional identity. Expected System Improvements and Related Benefits. This initiative will test the viability of a dual system change effort: workforce and technology. The changes involve integrating health services and support functions among a group of providers for a defined population -- crafting a care management system. Expected outcomes include: Reduced disparities as measured by Healthy People access and prevention indicators; Increased enrollment of eligible persons into available public programs; Better tracking and coordination of the health and social services used by uninsured; More predictability in the way that uninsured and underinsured persons enter the healthcare system and better balancing of the burden of care across providers; More information on the cost structure (both administrative and medical care costs) involved in maintaining a program of this nature. The feasibility of obtaining additional outside funding for health and related care will be determined; Improved working relations among providers, social services, and the community; Improvements in regional social cohesion with telehealth and related technologies. Timeframe. The first three months of the phase one 15-month trial will be used for detailed planning and care system design. Initial implementation and early start-up will take four months, followed by six months of full operation. The evaluation period and decision-making regarding continuity would occur during the final two months of the program. The subsequent nine months, phase two, of the two-year project will extend program activities and the evaluation into a three-county service area. Project Continuity: The successful achievement of proposed initiatives will provide a framework for expansion of the project to the entire seven-county region. Our region resembles hundreds of communities across the Midwest with significant numbers of elderly and working poor, out-migration, slow growth rural economies, and more problems with access and adequate health insurance coverage. We are anxious to contribute solutions to local providers and other communities in the same context as ours. Positive results from our work may be replicable in these other locations. [Back to Main Page] [Back to Executive Summaries]