VCU Health System offers valuable lessons in managing health care for uninsured

By Malorie Burkett

Virginia Commonwealth University Health System’s program to better manage health services for the uninsured has been recognized as one of the nation’s success stories in providing indigent patient care.

“The VCU Health System has had a traditional commitment of providing care to the uninsured and underinsured,” said Sheryl Garland, vice president for the Department of Community Outreach for the VCU Health System.

The practices of the VCU Health System and four other public hospitals and health systems in the United States were profiled in a report on managing care for the uninsured conducted by the National Association of Public Hospitals and Health Systems.

The other four were Boston Medical Center; the Health and Hospital Corporation of Marion County, Indianapolis, Ind.; Jackson Memorial Hospital/Jackson Health System, Miami; and Parkland Health & Hospital System, Dallas.

Through telephone and on-site interviews during the summer of 2004, NAPH asked about a wide range of program components, including eligibility, enrollment services and care management.

The report gave an overview of each of the five managed care programs, including VCU Health System’s Virginia Coordinated Care for the Uninsured program, VCC, which uses managed care principles to provide care to a subset of the uninsured population served by the hospital.

According to Garland, the VCC program’s goals include establishing physician-centered primary care for uninsured patients; reducing the overall cost per unit-of-service for uninsured patients; educating uninsured patients regarding appropriate care-seeking; and improving the health status and outcomes of the uninsured population.

“The VCC program is built upon the concept of providing a medical home for patients,” said Garland. “This medical home is provided through partnerships between the VCU Health System and community providers to ensure that there is availability of primary care services.”

VCC is funded by the state indigent care program, and provides access to inpatient and outpatient services, primary and specialty care visits, ancillary and diagnostic services, family planning and prescription drugs. The program is coordinated with Virginia Premier, a Medicaid health maintenance organization owned by VCU Health System, to ensure continuity of care regardless of insurance status.

The report also mentioned key findings among all five institution’s programs, including:

• Managed care programs for the uninsured were structured differently to meet the needs of the uninsured patients in a specific community.
• Implementation of the programs profiled in the study did not require system-wide overhauls—in most cases, the hospitals already had existing information. systems, provider networks and care management strategies in place.
• Leadership was an important element in developing and operating the programs. This included commitment from the board, executive management and senior clinical staff.

“The VCU Health System uses many of the same principles as the other programs in the study to coordinate services for the patient populations,” Garland said. “All programs are focused on providing a medical home for patients and using managed care principles to assist in achieving their goals.”

The VCU Health System is a 779-bed teaching hospital with a Level I trauma center. It provides over 31,000 inpatient admissions, nearly 80,000 emergency department visits and more than 500,000 outpatient visits annually. The VCU Health System is a provider of care to the uninsured throughout Virginia, but most services are provided to those living in the city of Richmond or surrounding counties.

The NAPH represents more than 100 hospitals and health systems in the United States. NAPH educates federal, state and local decision makers about the unique needs and challenges faced by member hospitals and the nation’s most vulnerable populations.

For more information, visit http://www.naph.org/.