COD E R E D

with more coordinated services that promote preventive care and reduce inappropriateutilization of emergency and inpatient services. Others are concentrating more on extendingcoverage to gap populations by working with various partners to expand the availability ofand/or directly provide low-cost insurance products for the uninsured. The purpose of this paperis to review local initiatives to determine what approaches are being used to effectively expandthe safety net and/or reduce the number of uninsured, with the goal of identifying successfulmodels for replication in other communities and to inform state and local policymakers.II. Profiles of Local Models for Expanding AccessOne major strategy being followed involves expanding safety net care by developingbetter-organized and coordinated systems of comprehensive care. This strategy has importantfeatures designed to provide enrollees with a medical home, offer some form of casemanagement that enhances early detection of problems and promotes appropriate treatment,produce patient information that can be shared among providers working within the system, giveproviders some incentives to serve low-income patients, and promote the dignity of enrollees.Selected models illustrating this strategy are profiled in Section IIa below. Their features aresummarized in Table 1 at the end of the paper.A second common strategy is to develop low-cost insurance products that extend publicand private coverage to larger portions of the population. This can be accomplished bydeveloping and offering private plans to small businesses and individuals; mandating smallbusiness coverage; or developing cooperatives that allow small employers to join largeremployers. With this strategy, some of the issues that must be addressed include financing,marketing, benefit design, target population, provider choice, program duration and transitionpopulations of individuals between jobs. Models of this strategy are profiled below in SectionIIb, and summarized in Table 2 at the end of the paper.IIa. Models for Expanding CareGeneral Assistance Medical ProgramMilwaukee County(Milwaukee, Wisconsin)Start Date: 1998OverviewMilwaukee County created a program to shift care from a primary public hospital toprivate primary care clinics. The program formed a provider network, such that each primaryclinic is affiliated with a hospital, specialty provider and pharmacy. The county shifted frombeing a provider to purchasing care from private providers, and developed an integrated patientrecord system with primary care assignment. As a result the county was able to provide a morecontinuous care system over a larger area.D-2