DETROIT — The leaders of health systems serving Wayne County have agreed to pursue initiatives that will help contain uncompensated care which has been an increasing fiscal burden and create systems that will more appropriately and cost-effectively meet the health and social needs of uninsured and underinsured people.

Chaired by Nancy Schlichting, president and CEO of Henry Ford Health System, the Uncompensated Care Committee of the Detroit Wayne County Health Authority focused its work in three areas:

• Federally Qualified Health Center (FQHC)-Hospital Workgroup: Chaired by Jesse Thomas, president of Molina Healthcare of Michigan, this workgroup was specifically charged with creating more appropriate emergency department use and promote referrals to urgent care centers and community health centers. The workgroup was inclusive of emergency department physicians. A primary goal of the workgroup was to co-locate an FQHC and a hospital emergency department. The group also recognized that existing relationships between hospitals and FQHCs must be strengthened before this can occur.
• Physician Workgroup: Chaired by Ken Matzick, president and CEO of Beaumont Hospitals, this workgroup was charged with examining ways of working with physicians to improve quality, cost, and access for safety net services. The primary goal of the workgroup was to improve access to specialty care for uninsured and underinsured patients. Essentially, under this model, several specialty physicians agree to treat uninsured patients on a limited basis throughout the year.
• Finance Workgroup: Chaired by Jay Rising, executive vice president, Detroit Medical Center, this group was charged with estimating the uncompensated care burden experienced by health systems, assess coverage expansion options and alternate methods of leveraging federal matching funds; assess opportunities and current limitations on funding; and review federal requirements for funding and coverage expansion.

I am pleased to have had an opportunity to chair this effort, primarily because the problem of uncompensated care is so acute in our community, said Schlichting. Health systems in Southeast Michigan provided more than $600 million in uncompensated care in 2008. Clearly, there is a responsibility for providers to innovate in this area to think differently about the challenges we all have for providing care for the uninsured and under insured. This has created a sense of urgency to really make a difference.

Health systems represent a major component of the safety net. This initiative has shown how creativity and commitment by the provider community can result in innovative solutions, said Chris Allen, CEO of the Detroit Wayne County Health Authority. Under the leadership of Nancy Schlichting and the collaboration of regional health systems, we have forged a plan that will ensure that many uninsured and underinsured people with urgent health problems have a medical home to treat them in a timely, appropriate manner. At the same time, emergency department volume will decrease, allowing providers to care for truly emergent patients and reduce uncompensated care costs for hospitals.

The Uncompensated Care Committee will be reorganized to implement these recommendations during 2010. Members of the committee include Dennis Herrick, senior vice-president & CEO, Beaumont Hospitals; Kevin Seitz, executive vice-president, Health Care Value Enhancement, Blue Cross Blue Shield of Michigan; Dr. Paul LaCasse, president & CEO, Botsford Hospital; Michael Duggan, president & CEO, Detroit Medical Center; Jay Rising, executive vice president & CFO, Detroit Medical Center; Gary Ley, president & CEO, Garden City Hospital; James Connelly, senior vice president & CFO, Henry Ford Health System; Spencer Johnson, president, Michigan Health and Hospital Association; David Seaman, executive vice president, Michigan Health and Hospital Association; Peter Schonfeld, senior vice president, Policy & Data Services, Michigan Health and Hospital Association; Denise Holmes, associate dean for Government Relations and Outreach, Michigan State University Institute of Health Studies; Brian Connolly, president & CEO, Oakwood Health; Doug Welday, chief financial officer, Oakwood Health; Bob Hobin, chief strategy officer, St. John Health; Patrick McGuire, chief financial officer, St. John Health; Stephen Fitton, acting bureau director, State of Michigan Medicaid Services Administration; Garry Faja, president of St. Joseph Health System, Trinity Health; Adam Jablonowski, executive director, Wayne County Medical Society; Robert Frank, M.D., executive vice dean, Wayne State University School of Medicine. Chris Allen, executive director & CEO, Detroit Wayne County Health Authority; Janette Davis, chief financial officer, Detroit Wayne County Health Authority; Dick Bohrer, co-chair of the Health Authoritys primary Care Network Council and former U.S. Assistant Surgeon General; Neal Colburn, consultant, Michigan Primary Care Association; Joslyn Pettway, director of Primary Care Initiatives, Detroit Wayne County Health Authority.

Specific recommendations of the Uncompensated Committee include:

• Hospital-FQHC Workgroup: Develop and distribute a contact list and access information about all FQHCs to appropriate hospital staff; integrate point of care counseling in emergency departments to support referrals; collaborate with existing FQHCs to help address existing capacity and system issues; and create a pilot co-location of a hospital emergency department and FQHC.
• Physician Workgroup: Create a voluntary network of specialty physicians who agree to serve the uninsured; coordinate specialty outpatient clinics to provide physicians with an alternate practice site; create a network of physician consultants to help in the secondary care of the uninsured.
• Finance Workgroup: Pursue approach to Medicaid coverage expansion in compliance with any early adopter providers in federal health reform; substantiate the rationale of private employers benefit from Medicaid coverage expansion; and refine benefit costs and develop funding and management systems to support Medicaid coverage expansion.

For more information on the Uncompensated Care Committee and other initiatives of the Health Authority, contact Chris Allen, executive director & CEO, at 313-871-3751.