Cost comparison of two models of primary care delivery in rural Palm Beach County, Florida

PROBLEM: Palm Beach County, FL consists of an eastern urban coastal area and a western rural inland area. The inland area comprises four towns that are collectively referred to as “the Glades.” The population of the Glades has a high rate of poverty with 2/3 of residents earning less than 200% of the Federal Poverty Level Guidelines. The rate of uninsured status is 28%, much higher than the overall county average of 18%. In 2005, the Health Care District did a needs analysis and identified a shortage of primary care providers in the Glades. The high rate of uninsured and high rate of poverty are reasons cited by primary care providers for not practicing in the community. Because of the lack of primary care providers and the difficulty in attracting new providers to the area because of the poor payor mix, the District provided funding for two established Federally Qualified Health Centers (FQHC) to open new access points in the community. In addition, The District operates a county-wide managed care program, Coordinated Care Option 2, which provides eligible members with outpatient clinic and pharmacy services at the network provider of their choice. There are network providers in the Glades area. This study compares the cost of care under these two models in the same community. METHODS: Utilization data were collected from the FQHC and from the Coordinated Care, Option 2 program. From the data, the per member per month cost was calculated for each model. RESULTS: The Coordinated Care Option 2 program had an average monthly membership of 4,200 members for the reporting period. The average per member per month cost at this time was $66. The FQHC served 271 unduplicated patients with 2301 encounters during the initial startup period. The average per member per month cost during this time was $145. CONCLUSIONS: Two models to provide primary care services in western Palm Beach County were examined. The clinic model was more expensive than the managed care network model. However, providing funding for the clinic model did result in the addition of primary care practitioners to the community.