A key committee of the Partnership is the Clinical Council, comprised of the chief medical officers of its private members, as well as representatives from the Medical Society of Milwaukee County, the Wisconsin Center for Nursing and the Free and Community Clinic Collaborative. In addition to its focus on improving access, clinical outcomes and utilization management for Medicaid patients, the council has also been working to address barriers to specialty care for the uninsured.
The most recent 2009 Census survey indicates that there were approximately 121,894 uninsured individuals in Milwaukee County at any point in time, and approximately 91,000 individuals who are uninsured all year long – about 10% of the population. Low income, uninsured adults often delay care or seek specialty care via emergency room visits. Even those uninsured patients who are established at a primary care home experience barriers to specialty care. Safety-net clinic primary care providers must often negotiate with individual specialists and hospitals to obtain specialty consults, tests and procedures; in some cases, resort to referring their patients directly to EDs to access needed inpatient or outpatient services.
Under the direction of the Clinical Council, the Partnership has conducted extensive financial, utilization and claims analysis to determine the best distributive model for an efficient and clinically effective system of specialty care for a cohort of low income uninsured individuals. The council identified 11 safety-net clinics that provide primary care, medication access, benefit counseling, enrollment assistance and other wrap around services, that also have the ability for provide post specialty care follow up. The low-income, uninsured population served by these safety-net clinics and the FQHCs is approximately 23,000 adults.
The Partnership is currently piloting a Specialty Access for the Uninsured Program (SAUP) that pairs FQHCs and other safety-net clinics with hospital/health system partners to facilitate access and care management for uninsured patients. In 2011 the SAUP pilot will enroll a limited number patients in the program for episodes of care, using a standard enrollment and charity care eligibility process across referring clinics and health systems.