Community-Based Case Study: MEDNET © A Collaborative Approach to Prescription Drug Access National Congress on the Uninsured Elizabeth Rugg, Executive Director, The Health Councils, Inc. Karen van Caulil, Executive Director, Health Council of East Central Florida, Inc. Steve Lesky, Regional Vice President, Allegany Franciscan Ministries

Chronically Ill Adults Bridges Gap Between Prescription Drug Needs and Prescription Drug Access MEDNET © Prescription Drug Access

Origin: 2003 Health Systems Plan Multi-tiered approach to identify health needs Step 1: Data Analysis Population Demographics Population Demographics Mortality/Morbidity Indicators Mortality/Morbidity Indicators Health Care Access (Resource Analysis) Health Care Access (Resource Analysis) Health Care Coverage Options Health Care Coverage Options Step 2: Community Survey (web-based & in-person) Step 3: Focus Group Discussions Step 4: Issue Summary & Priorities Step 5: Action Planning

Finding: Aging population will increase need for care Source: 2003 Health Systems Plan AgeNumberPercent , % ,8169.6% , % , % > , % Adult Population, 2000Composition of Seniors, 2000NumberPercent , % > , % 45 – 64 > ,335207, ,697281,390 % Growth 31.0%36.3% Growth in Seniors & Near-Seniors,

Finding: Income will limit access to care PinellasFlorida $33,765$37,307 < ,452 # Uninsured 91,999 % Uninsured 13.6% Source: 2003 Health Systems Plan Uninsured Non-Elderly, 2000 Commercial Premium Costs, Household Income, % Increase

Finding: Lack of care will increase cost of care Source: 2003 Health Systems Plan Health Care Expenditures – 2001 (Florida) 72% increase % increase

Greatest Health System Impact: Medication Access #1 Health Issue in Pinellas County #1 Health Issue in Pinellas County Circle of Influence Circle of Influence 45% - Issue to Self or Family45% - Issue to Self or Family 85% - Issue to Entire Community85% - Issue to Entire Community Barriers to Prescription Drug Access include: Barriers to Prescription Drug Access include: Lack of Health Coverage for Prescription DrugsLack of Health Coverage for Prescription Drugs Cost of Prescription DrugsCost of Prescription Drugs Lack of Awareness about Alternate Resources for Prescription Drug AccessLack of Awareness about Alternate Resources for Prescription Drug Access Source: 2003 Health Systems Plan (Pinellas County)

Community Solution: MEDNET © Four Essential Program Components: Patient Advocates – deployed strategically at the community level to work one-on-one with chronically ill adults, either in a clinic setting or at a one-stop service center Patient Advocates – deployed strategically at the community level to work one-on-one with chronically ill adults, either in a clinic setting or at a one-stop service center Program Software – to coordinate client intake, forms processing, and service delivery Program Software – to coordinate client intake, forms processing, and service delivery Pharmacy Vouchers – to provide short-term support to at-risk clients accessing free long- term use through compassionate use Pharmacy Vouchers – to provide short-term support to at-risk clients accessing free long- term use through compassionate use Health Literacy – to teach frontline care givers and able-bodied adults to access free medications on their own using web-based resources Health Literacy – to teach frontline care givers and able-bodied adults to access free medications on their own using web-based resources

Patient Advocates (MedNet Navigators) Receive referrals from local physicians and clinics Receive referrals from local physicians and clinics Record prescription drug needs Record prescription drug needs Determine eligibility for free use of prescription medications Determine eligibility for free use of prescription medications Download and complete application forms – request vouchers, if appropriate Download and complete application forms – request vouchers, if appropriate Coordinate physician, client, and manufacturer relations Coordinate physician, client, and manufacturer relations Initiate and complete refill requests Initiate and complete refill requests Advocate for patient needs Advocate for patient needs Confirm receipt of free medications Confirm receipt of free medications Program Locations Free Clinic Federally Qualified Community Health Center Sliding Fee Residency Clinic Public Health Department Local Hospital 8 FTE Total

Site Options, Program Needs & Cost Factors Site Options & Program Needs Staffed Site Staffed Site 1 FTE Patient Advocate1 FTE Patient Advocate Volunteer Site Volunteer Site 3-5 reliable volunteers3-5 reliable volunteers 1 FTE Volunteer Coordinator1 FTE Volunteer Coordinator Both Site Types Need: Both Site Types Need: Office SpaceOffice Space Computer w/Internet AccessComputer w/Internet Access Printer, Copier & Fax MachinePrinter, Copier & Fax Machine PostagePostage Office SuppliesOffice Supplies Locally-developed or commercially-produced client enrollment & services tracking databaseLocally-developed or commercially-produced client enrollment & services tracking database Cost Factors Salary & Fringe (1FTE OR volunteer coordinator) Salary & Fringe (1FTE OR volunteer coordinator) Cost to: Cost to: develop & maintain client enrollment & services tracking database ORdevelop & maintain client enrollment & services tracking database OR subscribe to commercial productsubscribe to commercial product

Prioritize chronic disease concerns Reason: Establish eligibility criteria for pharmacy voucher component (30 day supply of medications)Reason: Establish eligibility criteria for pharmacy voucher component (30 day supply of medications) Establish program policies Reason: Establish consistent program practices across multiple partner sites; e.g., policy requiring validation of secured medication against patient chart, etc.Reason: Establish consistent program practices across multiple partner sites; e.g., policy requiring validation of secured medication against patient chart, etc. Create targeted referral system Reason: Respond to specific health care needs; e.g., access to mental health medications Develop patient advocate training program Reason: Create well-educated network of community-based patient advocates Review client enrollment & service utilization Reason: Recognize emerging trends, assess community return on investment, and establish best practicesReason: Recognize emerging trends, assess community return on investment, and establish best practices Factor Critical to Success: Community Consensus

What to Expect: Return on Investment MEDICATIONS BY DRUG CLASS FREE CLINIC SITE 1/1/07 – 9/30/07 % OF ALL Arthritis$2, % Asthma/Allergy/Lung$46, % Diabetes/Endocrine$46, % Gastro-Intestinal$22, % Heart, Cholesterol & Stroke $124, % Mental Health $121, % Migraine/Other Pain $11, % Other, Including Seizure $19, % TOTAL MEDICATIONS (9-Month Return) $395, $10 : $1

Program Evaluation Reviewed MedNet database to identify potential data points for study Reviewed MedNet database to identify potential data points for study Qualitative analysis – observation, interviews Qualitative analysis – observation, interviews Convened evaluation team meetings to discuss implementation, outreach and processing efforts and challenges, lessons learned and “best practice” differences between clinic and community based sites Convened evaluation team meetings to discuss implementation, outreach and processing efforts and challenges, lessons learned and “best practice” differences between clinic and community based sites Developing client satisfaction survey instrument and process Developing client satisfaction survey instrument and process Continuing to review/analyze outcome data differences between program sites Continuing to review/analyze outcome data differences between program sites

Outcomes High level of satisfaction by the MedNet staff with the software and the technical support High level of satisfaction by the MedNet staff with the software and the technical support Ability to share “hot tips” and network across program sites is considered to be a major strength of MedNet Ability to share “hot tips” and network across program sites is considered to be a major strength of MedNet Clinic sites have an easier time securing needed paperwork from MDs…however, the community site continues to achieve a strong return to the community Clinic sites have an easier time securing needed paperwork from MDs…however, the community site continues to achieve a strong return to the community

Next Steps… Measure impact of MedNet Measure impact of MedNet Has it reduced the incidence and impact of “avoidable admissions” to local hospitals for the uninsured with chronic diseases? Has it reduced the incidence and impact of “avoidable admissions” to local hospitals for the uninsured with chronic diseases? Has the program reduced the cost of managing chronic disease for low- income residents? Has the program reduced the cost of managing chronic disease for low- income residents?

Program Design Elizabeth Rugg, Executive Director Program Evaluation Karen van Caulil, Executive Director Health Council of East Central Florida, Inc Program Funding Steve Lesky, Regional Vice President Allegany Franciscan Ministries