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Strategic Investment

Case Study: Funding an Integrated System of Care for the Uninsured

Two Disproportionate Share Hospital (DSH) facilities in Orlando, FL donate $15 million in annual DSH dollars to help fund the Primary Care Access Network (PCAN) of Orange County (FL). This cost-avoidance strategy has created an affordable, integrated system of medical care built on a foundation of Federally Qualified Health Center (FGHC) medical homes. Non-urgent, self-pay ED vs. ER visits are down 25%.

In 1999 in Orange County, FL, two hospital EDs and a Health Department primary care clinic closed within weeks of each other – unleashing a flood of non-urgent, self-pay visits to the remaining hospital EDs. This county’s three hospital CEOs-including Florida Hospital/Adventist Health Systems-and the Health Department approached the Orange County Government’s Health Services Department for assistance. This group and a small FQHC formed a Work Group.

They found that Orange County had the state’s highest rate of uninsured people, but the lowest rate of Medicaid enrollment, and that many uninsured people could or would pay something for their health care-which resonated with the county’s Mayor and County Commission.

The Work Group convened all of the county’s safety net providers to form the Primary Care Access Network (PCAN) in 2001. Its goal: developing an affordable, integrated system of care for the county’s 200,000 uninsured, and leveraging disproportionate share dollars to reduce non-urgent ED vs. ER use, PCAN now includes 22 safety net providers: three hospital systems, FQHC entities, a Secondary Care clinic, free volunteer clinics, respite care, the Health Department, EMS, and others.