Department of Health LIP Request

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Presentation transcript:

2009-10 Department of Health LIP Request Florida Department of Health Low Income Pool Primary Care/Hospital Diversion Projects Florida Hospital Association Readmission Webinar February 18, 2010

2009-10 Department of Health LIP Request Low Income Pool $1 billion Medicaid Reform program 94% of pool distributed to hospitals

2009-10 Department of Health LIP Request LIP Council 24 members Provides pool $ distribution recommendations to Legislature

2009-10 Department of Health LIP Request LIP “Non-hospital Projects” $51.3 million for current state fiscal year $3.2 mil – Poison Control $18.3 mil – FQHCs $16.1 mil – Premium Assistance $1.2 mil – ER Diversion $3.0 mil – Hospital Primary Care $9.5 mil – DOH Primary Care/Diversion

2009-10 Department of Health LIP Request LIP Primary Care Funding History SFY 2006-07 - $2.0 mil 6 projects SFY 2007-08 - $3.0 mil 7 projects SFY 2008-09 - $6.5 mil 11 projects SFY 2009-10 - $9.5 mil 13 projects

2009-10 Department of Health LIP Request

2009-10 Department of Health LIP Request Project Goals ED Diversion Primary Care Medical Home Chronic Disease Management Services Link uninsured persons to health coverage

2009-10 Department of Health LIP Request Project Components Hospital based navigators or formal referral arrangements with hospitals Expanded primary care clinic capacity and operating hours Trained chronic disease management case managers and educators

2009-10 Department of Health LIP Request Project Components Pharmacy assistance services Linkages to specialists through We Care Networks or other volunteer provider organizations Eligibility assistance staff

2009-10 Department of Health LIP Request Project Statewide Summary Statistics January 1, 2009 through June 30, 2009 Emergency Room Diversions 5,683 Emergency Room and Hospital Referrals 5,593 LIP Patients Provided with a Medical Home 11,415 LIP Patients Enrolled in Disease Management Programs 2,259

2009-10 Department of Health LIP Request Key Project Successes High proportion of LIP project referrals are enrolled in a primary care medical home and return for subsequent health care services Patients have much improved access to needed and appropriate health care services Significant expansion of disease management capacity and improved health status of enrollees Excellent utilization of pharmacy assistance programs that help reduce hospital re-admissions

2009-10 Department of Health LIP Request Project Challenges Meeting the need for basic clinical primary care – demand is greatly challenging supply Providing timely access to specialty services Complexity of the chronic disease clients Transient nature of the targeted population

2009-10 Department of Health LIP Request Project Challenges Educating the target population on the concept of a primary care medical home Hiring physicians and nurses at state pay scales Partnerships can be a double-edged sword – usually a great asset but sometimes a liability

2009-10 Department of Health LIP Request To Where from Here? Recommend expansion of primary care/disease management projects Develop more direct partnerships with hospitals Use primary care/chronic disease management programs to help reduce hospital readmissions

2009-10 Department of Health LIP Request Questions?