Piecing together the healthcare puzzle

The story of Humpty Dumpty might best describe Manatee County’s healthcare crisis.

Can a system broken into so many pieces be fixed?

As the county grapples with a shortfall of $9 million for indigent healthcare costs, previously funded through a now-empty healthcare trust fund, officials are trying to piece everything back together.

“We’ve got a lot of people looking for solutions,” said Andy Guyre, Manatee County human services division manager. “Hopefully, we’ll have a short-term solution and a long-term solution.” 

Manatee County residents such as Lori Dengler, a nurse for Tidewell Hospice and veteran of the healthcare industry, are committed to finding them.

The East County resident is part of the newly created healthcare advisory committee, tasked with researching and making recommendations for funding healthcare needs, which total about $20 million annually.

“We’re in a gathering phase at this point,” Dengler said. “There’s a lot to consider. The fixes I couldn’t even begin to propose at this point. We’re just one piece of the puzzle. I don’t know that you’ll ever get a one-size-fits-all (solution), but we’ll try to help.”

Manatee County’s healthcare program eligibility caps income at 200% of the federal poverty level, $48,500 for a family of four or $23,540 for a single adult. Many families may have health insurance, but can’t afford their deductibles so they go to the emergency room instead of their primary physician, Guyre said. 

Data from a United Way study, dubbed ALICE, revealed 45% of households in Florida struggle to afford basic necessities. Those families are called “Alice” and household incomes are in line with 200% of the federal poverty level, although not an exact match. In Manatee County, 43% of households are at Alice or poverty level. In Parrish, that figure is 27% and in Bradenton, it’s 51%.

Dengler has witnessed this need both as a nurse and, in November, as a volunteer during the Remote Area Medical clinic, which provided healthcare services to nearly 1,500 people at no charge.

“There are people out there who are underserved,” Dengler said. “People who can afford an eye exam, but not glasses. There are people who fall between the cracks.”

TRYING TO SOLVE A FUNDING CRISIS

Healthcare Advisory Committee

Manatee County instituted a healthcare advisory board Nov. 3, 2015 to evaluate, monitor and discuss the county’s healthcare system and make recommendations for funding healthcare services to citizens without adequate access to healthcare.

Business professionals, nonprofit leaders and others, like Dengler, hope the information they collect can result in tangible results over the long term. So far, the group has had three meetings and another is scheduled for March 23. On March 29, it will meet with a consultant hired by the county and Manatee County commissioners to discuss the future of healthcare. The county commission ultimately will guide the committee’s focus.

“The advisory board will be ongoing,” Guyre said. “ It will look at changes in the community and be making adjustments over time.”

Consultants

Manatee County has contracted with Michigan-based Health Management Associates to complete a comprehensive overview of the county’s health status and to create a short-term solution for addressing the community’s needs and healthcare budget problem.

It will create a “snapshot” of Manatee County’s needs, available resources and the best way to utilize them. That plan will be presented to the county commission in the fall. 

“We can get it ourselves, but they’re experts at gathering it quickly,” Guyre said. “By Oct. 1, they’ll have a plan presented to the board of county commissioners.”

A consultant provided a similar service in 2008, but Guyre said the data is no longer valid. With more than 50,000 additional residents, the demographics of patients and healthcare providers, alike, have changed.

“Everything is different now,” he said. “We don’t have the funding sources we had.” 

Transition plan

With a funding shortfall looming for indigent care, Manatee County's staff began exploring alternative options for care about two years ago. Although the county contracted with Universal Health Services (owner of Manatee Memorial Hospital and Lakewood Ranch Medical) and Blake Medical Center for indigent care services, it also realized hospitals emergency rooms are the most expensive type of care.

The staff developed a payment plan for physicians, called the “transition plan.”

“It creates a way for them to be seen by a doctor outside the emergency room,” Guyre said. 

Previously, uninsured patients would to to the hospital for initial treatment and be covered for up to three followup physician visits for that illness. Now, they don’t have to go to the hospital in the first place.

The plan is in its roll-out phase. It provides up to $1.25 million, in total, to participating providers through Sept. 30.

To qualify, individuals must be residents of Manatee County and have income levels below 200% of the federal poverty line, $48,500 for a family of four in 2016 or $23,540 for a one-person household. 

Government’s programs

Manatee County’s human services departments oversees more than 130 programs and contracts. Of those, about 15 are medical in nature. 

One program, available to all county residents, is the prescription drug discount program. On average, its saved participants 58.5% on medications off retail prices, a total of about $64,000. For each prescription, Manatee County earns $1.25, which it can use toward its programs.

It’s also working to develop a program that targets diabetes education, Guyre said.

“We already have programs in place to reduce costs,” Guyre said. “We’re always doing that.”

Community efforts

Aside from the county’s own initiative, healthcare providers and other organizations are working on their own solutions. For example, the Manatee Chamber of Commerce has made healthcare part of its legislative platform, encouraging the state to support solutions that will expand access to healthcare and reduce per-patient costs. And, it and the Sarasota Chamber of Commerce on March 9 and March 11, respectively, will launch Health Links, a community-based workplace health and safety program their members can utilize. 

The Manatee County Healthcare Alliance, Manatee County Health Department and organizations such as We Care Manatee, a medical nonprofit, all work independently, writing grants and creating new programs as needs arise, as well.

“There’s always going to be stuff going on we don’t know about,” Guyre said.

A team of concerned residents last year organized the area’s first Remote Area Medical event, at which just under 1,500 people received free medical, dental and eye care at Manatee Technical College. Organizer Dr. Richard Conrad said the 2016 event will be even larger — three days, instead of two, with one pre-event day reserved for pet care.

Paramedicine program

Manatee County Emergency Medical Services has created a new pilot community paramedicine program. In effect, it will allow specially-trained paramedics to serve as a sort of social worker who can followup with patients transported to the emergency room to help ensure those patients don’t unnecessarily return to the E.R.

The program is funded through this fiscal year, and organizers hope it can be continued next year in the county’s budgeting process.

“Anything to treat someone outside the ER for nonemergency issues is going to drive costs down,” Guyre said.