Recorded presentation

Michael Doonan, PhD, Deborah Gurewich, PhD, and Jeffrey Prottas, PhD. Schneider Institute for Health Policy, Brandeis University, Heller School, 415 South Street/MS 035, Waltham, MA 02454, 781-736-4831, Doonan@brandeis.edu

Abstract: Local health care delivery systems offer little in the way of care continuity for low-income at-risk populations. A large portion of the fragmentation is due to a complex web of service sites, diverse funding mechanisms, and gaps in the safety net. Different organizations with their own missions, regulatory constraints, and revenue streams are responsible for portions of the care continuum. Traversing the boundaries that define provider organizations is challenging for clinicians and clients. In 2000, the Bureau of Primary Health Care at HRSA enacted the Community Access Program (CAP) to help providers coordinate safety-net services for uninsured and underinsured populations.

In this presentation, I share our experience with four communities that are participating in CAP with the focus on strategies for successful coordination. Shortell et al (2002) in an examination of Community Care Network (CCN) public private partnerships describe the critical role of a shared common vision, strong governance, and effective management to obtaining the goals of interogranizational collaboration. We use a similar model to analyses CAP programs and provide data on how these indicators impact successful coordination. Underscoring all CAP efforts is the belief that improved coordination will not only improve access to care, but generate efficiencies as well. The goal is that these programs will be self-sustaining while enabling more users to be served for less money. We conclude that overcoming system fragmentation is a challenging but worthwhile goal, though one that requires ongoing and dedicated resources to be maintained.

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