In Miami-Dade County Florida, the local uninsured population has reached above 590,000 for those under age 65. In addition, among the over-65 residents in Miami-Dade County, one of the fastest growing segments of the population, 5% have no health coverage. Access to care is a problem for these uninsured individuals.
There are significant barriers to available care for those uninsured residents. One of those barriers is the complex enrollment process for public health coverage. Many of the local uninsured are immigrants and two-thirds of the population does not speak English at home. In addition, there are cultural views and traditions regarding health care which act as additional barriers.
Uninsured individuals put a high demand on safety net resources such as Emergency Departments and public hospitals. Those without insurance often delay treatment until their health condition worsens to the point of becoming an acute problem requiring more costly care.
One local organization is attempting to overcome these barriers to health care for the uninsured. Acting as an umbrella organization providing coordination services, CAP is working to better utilize existing public resources more efficiently and effectively to benefit the uninsured.
Led by the Jackson Memorial Foundation (JMF) the Community Access Program of Miami-Dade County Florida A Healthy New Start (CAP) attempts to collaborate with local safety net health care providers, advocates, government, higher education and community organizations to systematically address the issues of health care access, health education and chronic disease management for the uninsured. By coordinating the fragmented efforts of multiple community organizations, the CAP program hopes it can better address the needs of the uninsured.
Similar CAP programs successfully operate in about 45 communities throughout the country.
Joyce Nunez who just took over the reins as the Director of the Miami-Dade County CAP program in May commented on why she accepted her new position, “As a public servant for over 30 years primarily in the area of social service delivery, I have a longstanding commitment to the people in my community to make a difference in their overall wellness and to the improvement of their quality of life. As an immigrant and a minority, I know first hand how the issues of ethnicity, lack of legal documentation, economics and lack of health insurance can become a significant barrier to accessing the available health care.” She continued on how CAP can make a difference, “I foresee CAP building upon previous community momentum and broadening its health care access to the uninsured through its continued partnering efforts, efficient use of the Community Health Workers, and the Health Navigators component and its linkage with the Disease Case Managers component.”
The CAP program uses Community Health Workers to provide wellness education and attempts to link the uninsured to available community program services. It focuses on providing cost savings to CAP consortium members and to patients by leveraging Medicaid and other public funding, and by redirecting CAP patients to appropriate sources of health care based on their specific needs. Through disease management, CAP increases the quality and effectiveness of care for patients with CHF (congestive heart failure), Diabetes, and Behavioral Health issues.
Another tool used by the CAP program to assist uninsured residents to access and appropriately use health services is the use of culturally sensitive Health Navigators. The health navigators help guide the uninsured through the system. They assist residents through the eligibility assessment and enrollment process for public benefits and link them with program disease managers, community health workers and in finding a medical home for better coordination of care.
Talking about its success in reaching those people in the community it was designed to serve, Nunez says, “CAP has been very successful at reaching its target population and at increasing community awareness through effective use of culturally sensitive Community Health Workers (CHWs) who spread the word through personal client contact, the use of marketing educational materials, the development of a CAP website and other outreach efforts at community fairs, community based organizations and partners sites.”
Funding for the CAP program comes from the Health Resources and Services Administration (HRSA), and an in-kind match for support staff from JMH and other partnering organizations. Commenting on the long term plans for financing the CAP program, Nunez replied, “The collaborative partners have agreed to be vested to this project and further assist it to achieve ultimate operational independence and long term self sufficiency. As the program evolved it achieved cost avoidance and a return on investments to the community and providers. Now increased emphasis is being placed on CAPs sustainability through a broad base of community support.”
The success of the CAP program is measured through an evaluation process which is conducted by the University of Florida Department of Health Services, Research Management and Policy. The process measures how effectively the group is working, how many clients are being served and are taking advantage of the services. According to Nunez, “The most valuable evaluation tools of course are the success stories documented by the service providers and staff, including the number of clients enrolled in benefits and the number of patients enrolled in a medical home.”
Describing the success of the Miami-Dade CAP, Nunez said, “Yes, we believe the program has been very successful. A significant achievement has been the programs ability to provide cost savings to its collaborative members and patients through leverage of Medicaid SCHIP and other public benefit funding. Another significant milestone involves a direct benefit to the target population through the coordination of consistent care for high cost disease conditions. This is accomplished through intensive disease management, and by redirecting patients to appropriate sources of health care for their specific need.”
According to Nunez, while the CAP program has had a positive impact on the community it is only part of the solution. She said, “The persistent rise in the uninsured population has placed a high demand on the hospitals and safety net providers making it difficult for them to assist all residents in need of health care services. CAP combines the resources of Miami-Dades safety net providers and integrates the services they offer by aggressively promoting the availability of these services to uninsured and underinsured residents thereby improving access to public benefits and health care and decreasing Emergency Department utilization.”
She continued, “Although CAP has been successful, it continues to face numerous challenges due to the diverse population and large number of recent immigrants which continues to grow.”
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