Medical Access Program (MAP): Organizing and coordinating care for the uninsured through community collaboration

Care for the uninsured is often fragmented, uncoordinated and expensive. Healthcare reform proposals have discussed expansion of coverage through savings in expensive hospital care and improved preventive and chronic disease management programs; however, real world tests of this hypothesis are lacking.

In Oregon, an estimated 16% of residents are uninsured; in Lane County, estimates approach 20%. The Lane County 100% Access Healthcare Initiative has developed the partnerships required to address healthcare access issues from a local perspective. The collaborative includes the CEO from every major healthcare institution, provider groups, and leadership from local business, government and non-profit agencies. In December 2007, the Initiative's Medical Access Program (MAP) began piloting a community program that aims to organize and coordinate services for the uninsured. For the pilot, 100% of the medical providers in Lane County, including specialty and ancillary service providers, agreed to provide gratis care.

The MAP pilot consists of 100 enrollees that do not qualify for government-sponsored health insurance programs and cannot afford commercial insurance. United States citizenship is not required. Enrollees work with a central care coordination office to select a primary care medical home and organize medical, dental, mental health and social service needs. A custom web-based system that is accessible through provider offices supports care coordination.

The pilot will provide the data needed to create a sustainable and scalable community healthcare access solution. Traditional medical claims are captured on enrollees to quantify the scope of services required by uninsured enrollees. A comprehensive program evaluation will be performed.