COD E R E D

Coordination - When health care agencies develop arrangements for joint responsibilityof the delivery of services.Safety nets are extending care by developing integrated eligibility systems. Thesesystems include a defined screening, eligibility and enrollment process that limits eligibility,defines the eligibility period and service restrictions, and encourages stable participation.Outside funding is maximized by ensuring that persons meeting eligibility criteria for local, stateand federal programs become enrolled in those programs.Innovative safety nets are also using primary care assignment to expand capacity,improve continuity of care and reduce costs. In these systems patients are assigned to aspecific medical home where they have expanded access to primary care and through whichthey go for referrals to specialty care. Reimbursement methods for providers often include riskarrangements and incentives for performance but do not normally utilize “aggressive” paymentmethods.Specialty care is an important component of delivering an effective local health careinitiative. Meeting the costs involved in maintaining an adequate supply of specialty careproviders can be challenging. Local health care initiatives have involved specialty careproviders during the design and beginning phases of developing a local initiative and worktowards the development of adequate reimbursement rates and performance-based paymentmethods.Another common feature is the development of a structured referral network with adefined network of providers and procedures for coordinating care between ambulatory andhospital settings. It may involve structured protocols in clinics, hospitals and ERs for patientreferrals to the most appropriate and least expensive settings for care. Additional features mayinclude after-hours hot lines and navigators to assist patients in accessing services.Safety net initiatives also focus on the development of integrated patient record systems.Integrated eligibility and patient record systems (IPRS) link ambulatory, hospital and specialtycare sites in the system. An IPRS tracks eligibility, health history and movement of patients asthey obtain services. These systems are used for enrolling patients in third-party programs,improving access to and better coordination of services, and saving costs through reducedduplication.Innovative safety net models have invested resources in the development of qualityassurance programs with patient care guidelines and case management programs. Suchprograms require integrated eligibility and patient record systems that allow monitoring ofpatterns of care and outcomes. Resources from the community for quality assurance activities,measurement strategies and performance targets should be determined early in thedevelopment of new programs. Periodic evaluations that permit public accountability areimportant for the overall success of a program.Safety net programs rely completely on local funds or on a combination of local, stateand federal funds. They rarely have sufficient funds to adequately serve the target population.Those without a substantial portion of funds from a regular source such as Medicaid orcommercial insurance often have the most difficulty. A diversified funding stream enables localsafety nets to stabilize their budgets and protect themselves from unanticipated changes.D-28