BO: We’re looking to focus on the uninsured and underinsured population and to develop a standardized computer system which will enable us to enroll these clients who come through the emergency room into an insurance program, whether it be Medicaid, adultBasic or any other programs we can find that would enable them to get some kind of insurance. Once we get them into an insurance program, we also want to assign them a primary care physician so that they have a primary care home. If we’re unable to find any primary care home, we’ll also refer them to any kind of clinic service that they would be eligible for. Once they’re in the system, we also want to provide case management–we want to be sure that they go to necessary doctors’ appointments and visits. Although the primary focus is going to be medical services and we’re looking for the initial entry point to be emergency rooms, we are also looking to provide any services in the county that these people or families might need.

BO: Once we get insurance for a person in this program, we’ll refer them to a physician who is willing to take their insurance, based on the need of the client, to maximize the likelihood of that client to go to that physician. If the most important criterion for the client is proximity to the physician, then that’s what the referral choice will be based on. It may be language or any other type of criteria–we’re looking to refer them to someone who is going to make them feel like they have a primary care home. For those who do not qualify for any insurance, we’re hoping to have a referral bank of physicians who would say, "Yes, I’m willing to take X number of patients at no cost or low cost." We’ll also be looking at sources of funding to provide any kind of medicines that person might need, and also looking to get x-rays and tests reimbursed as well. It’s going to be a volunteer process and we’re going to be working with the Montgomery County Medical Society for assistance in recruiting and retaining volunteer physicians. We’re also looking also to see how we can get them reimbursed and how we can make it beneficial for them to belong to this program. Once we get it more clearly developed exactly what the program is and exactly what the benefits are going to be, it’s going to be a lot easier to recruit physicians.

BO: Hospitals do have protocols for dealing with individuals who come in demanding emergency room care who are not eligible because of insurance or because the ER is not the appropriate place to be. Those protocols still stay in place, but we will have case managers on site who would hopefully be able to identify exactly what the needs of that person might be, instead of hospital personnel having to use their time to do that. We do plan on doing quite a bit of PR around this program before it is enacted and get the program details out there for community residents and for physicians. It’s not mandatory to enroll in this program and people who need treatment will not be turned away.

BO: Case managers, who would be employees of the hospitals, would access a computer program that will be standardized throughout the participating hospitals and whatever other facilities we need to put this program into. The case managers will enroll the person in the program, identify the person’s eligibility for insurance, do a needs assessment to determine what services are appropriate, make the referral and follow up to make sure that appointments are being kept. The program will also have a transportation bank–a compilation of organizations that provide free or low-cost transportation—to make sure that people are physically able to get to their physician appointments.

BO: At this point we are focusing just on the Norristown to Pottstown region. We’re looking for as much participation as possible—at least one hundred physicians, either private or hospital-employed. That may be one of the program’s greatest challenges. The physician referral bank idea has been successful in at least ten other regions across the country. Pennsylvania may be different–we may have different challenges that other states didn’t have. We do plan on working with our medical society to overcome those questions and concerns.

BO: We’re looking to create a better delivery system for services, not just at the county office, but any social service agency within the county. The entry point will be the emergency rooms, because that’s where we find a lot of people who need services and don’t know where else to go. So, we’re looking to create a program that’s actually multi-agency, not simply medical-based or hospital-based–including referrals to mental health services, drug and alcohol services, aging and adult services. Frankly, it takes a lot of coordination and funding, and it would be tough for any single hospital to undertake something like that. The point of having a standardized computer system is so that, whether a person presents at one of the hospital ERs, or at the Health Department, we would be able to know if that individual was already in the program, if they were assigned a primary care physician, and refer them to their case manager for follow-up. The idea is that we are not duplicating services, because we do have people who do present at different emergency rooms. The Health Department will oversee the program and its funding, ensuring that the project is something that is best for the residents of this county. Even though the program is going to be in the hospitals and will benefit the hospitals greatly, it’s not simply a hospital program.

BO: We’re funded with a federal grant through the end of August and we would like to have something in operation by early summer. This is a one-year, HRSA-funded grant of $649,000. At the end of the funding, there is a possibility that there could be an extension, and we’re hoping that the program’s cost effectiveness and benefits will be demonstrated. We are also looking to possibly supplement it with other grant money. I believe the program can become self-funding through the savings that it accrues.

BO: No, not at this time, although they are putting in planning time and effort which is uncompensated. The case managers will be funded by the grant.

BO: Yes, we do want to demonstrate the benefits that could take it throughout the county, although it would take some modifications because Montgomery County is very large and has different needs and different resources. We would seek additional funding and approach other institutions after we have an exact operational model for this program before the end of the grant year.