Statement of Problem/Need Being Addressed

City of Lawrence

Outside Agency Funding

APPLICATION

General Information: Each year, the City Commission considers requests for the allocation of dollars to a number of agencies that provide services benefiting the Lawrence community. The decision on funding a request will be made during the City’s annual budgeting process. The decision will be based upon the availability of funds, the need demonstrated through the agency’s application, the stated objectives of the applicant’s program, past performance by the agency in adhering to funding guidelines (as appropriate), and the ability to measure progress toward the program objectives.

Instructions: Applications for 2008 funding must be complete and submitted electronically to the City Manager’s Office at cliebst@ci.lawrence.ks.us by the deadline of 5:00 pm on Wednesday, May 2, 2007.

Questions? Contact Casey Liebst, Budget Manager at cliebst@ci.lawrence.ks.us or at 785-832-3409.

Section I. Applicant Information

Legal Name of Agency:		Health Care Access, Inc.
Name of Program for Which Funding is Requested:			Clinical Program
Primary Contact Person:		Nikki King, Executive Director
Address:	1920 Moodie Road Lawrence, KS 66046
Telephone:	785-841-5760		Fax:	841-5779
Email:	director@healthcareaccess.org

Section 2. Request Information

A.	Amount of funds requested from the City for this program for calendar year 2008:	$28,840
B.	Will these funds be used for capital outlay (equipment or facilities) in 2008? If so, please describe: No
C.	Will these funds be used to leverage other funds in 2008? If so, how: No
D.	Did you receive City funding for this program in 2007? If so, list the amount and source for funding (i.e. General Fund, Alcohol Fund, etc.): Yes. $28,000. General Fund.
E.	If you are requesting an increase in funding over 2007, please explain exactly how the additional funds will be used: Only inflation amount requested - no new program expansion being requested.

Section 3. Agency and Program Budget information

A.	How many paid full time employees work for your agency?	6.5	Volunteers?			140 (est.)

B.	What percent of your total 2007 budget goes to employee salaries and benefits?				7.2% (includes in-kind values) 59% (actual dollars)

C.	What percent of your total 2007 budget is used for operating expenses?			18%

D.	What is the total estimated cost to provide the program in 2008?			$418,560 (actual dollars)

E.	What percent of 2008 program costs are being requested from the City?			6.8%

F.	List other anticipated sources of funding and funding amount for this program in 2008:
Anticipated Funding Source				Dollar Amount
				$
Douglas County Government				24,720
United Way				60,000
Fundraisers, contributions				115,000
KDHE primary care clinic grant				70,000
Patient fees				20,000
Grants				80,000 20,000
Early Detection Works, misc income TOTAL 2008 PROGRAM BUDGET				$418,560

Section 4. Statement of Problem/Need to Be Addressed By Program

A. Provide a brief statement of the problem or need your agency proposes to address with the requested funding and/or the impact of not funding this program. The statement should include characteristics of the client population that will be served by this program. If possible, include statistical data to document this need.

The Health Care Access Clinic provides medical and prescription assistance to those who are without medical coverage and have limited financial means. The U.S. Census Bureau estimates released in July 2005 state 12% of Douglas County residents are uninsured. The 2005 Census data also shows over 15% of Douglas County residents have incomes below the poverty line (approx. 75% of Health Care Access patients have incomes below the poverty line).

The capability to treat an illness is as important as a diagnosis from our staff or volunteer health professionals. Treating a condition at the least costly level prevents uncompensated visits in the locally-owned hospital’s emergency room. The Clinical Program provides appointments on-site with staff and volunteer providers through scheduled appointments. Referrals are also available to volunteer medical professionals in the community for any specialty.

The Clinic received donated in-kind services, medication, space, and materials valued over $3.2 million in 2006. This number includes 6,252 prescriptions to treat our patients’ conditions through 16% more on-site visits (3,296); the City-owned facility, and 828 referrals to volunteer medical professionals. For every $1 invested in our services, our program generates another $9 worth of care for our patients. The clinic only requests a $10 optional fee for service from patients due to their low-income status, with only about 60% collected. Our City allocations, including the police and medical costs waiving for the 2007 Lawrence Half Marathon from which we benefit, have helped build our capacity to meet more demand every year. Continued support will enable us to ensure quality medical care and medication provision to this population to return them to health and productivity in school or at work in our community.

B. How was the need for this program determined?

The Clinic was started in 1988 to address the gap in the health care system between those who qualify for government health programs and private health insurance (see also Section 4 A statistics). The Lawrence-Douglas County Health Department does not provide primary care (illness treatment) as some health departments do, thus the Health Care Access Clinic was created to provide a medical home to the uninsured rather than exclusive reliance on the hospital emergency department. Over the nearly 20 year history of the clinic, more than 13,000 individuals have utilized our services.

C. Why should this problem/need be addressed by the City?

92.1% of Clinic patients in 2006 were residents of Lawrence, Kansas and over 79% of Clinic patients are employed. The mix of patients’ employers represents all sectors (see attached graph) which also demonstrates businesses struggling in our community to provide health benefits for their employees. Keeping these employees healthy and productive leads to better bottom lines for the businesses, provides opportunities for advancement for the employees for better income and for a better chance at securing health coverage for him/herself and family.

Section 4. Description of Program Services

A. Provide a brief description of the service you will provide and explain how it will respond to the need you identified in Section 3. The description should include how many clients will be served, and should describe as specifically as possible the interaction that will take place between the provider and the user of the service.

The Health Care Access’ Clinical Program provides comprehensive primary care to the uninsured, low-income of Douglas County through one mid-level staff provider and area general practitioners and specialists in its volunteer network both on and off site. A second mid-level provider will begin half-time this month to enhance the women’s health appointment capacity thanks to a 12-month grant. Clients are served through urgent and scheduled appointments weekdays from 8:30 a.m. to 4:30 p.m. Volunteer physician and nurse practitioner clinics contribute an additional two to six hours of services per week. Prevention and early intervention are emphasized to address a growing chronically ill population. To improve the quality of our managed care, the Clinic participates in efforts such as our ongoing Diabetes Outcomes studies and the implementation of the new Diabetes Education Management System (DEMS) to enhance diabetes monitoring. Referrals to area specialists are made to further increase access and decrease disparities. A vast and dedicated network of health care professionals in the Douglas County community donate care for Health Care Access Clinic patients, ranging from dermatology to assuming the care of individuals diagnosed with terminal illness. Lawrence Memorial Hospital donates all laboratory, radiology and auxiliary testing, with write-offs rapidly rising in response to the increasing presence of chronic conditions and terminal illness. Currently, the wait time for a scheduled appointment is five weeks. As demonstrated in a professional research study, the capacity of the clinic directly affects the usage of the emergency room. Projected visits for 2007 are 3,400 (up 4% from 2006). When factoring the new mid-level provider’s appointments, visits will be up 28% to approximately 4,530. Other Programs of the Clinic include Medication Assistance, Women’s Health Services, Health Education/Resource Referral/Outreach; School Linked Services for Uninsured Children; and Student practicum placement program.

B. Describe any efforts your agency has made to explore the community to determine if there are any other agencies providing similar types of services. What efforts have you made to coordination services?

The Health Care Access Clinic is the only agency in Douglas County providing comprehensive health care services exclusively to community members who are without a medical home (i.e. Indian Health Service, Veterans Administration, Student Health Services) or medical coverage (Medicare, Medicaid, health insurance). With a target audience of low-income individuals, only an optional $10 fee is requested. The Lawrence-Douglas County Health Department and the Heartland Medical Clinic / Leo Center also serve the low-income, uninsured of Douglas County.

Health Care Access does not duplicate services available at the Lawrence/Douglas County Health Department (immunizations, STD treatment, family planning, etc) as outlined in an annually signed Memorandum of Agreement, but there is constant collaboration in serving many of the same patients for different needs. Our illness care services range from treatment of colds and flu to chronic diseases such as diabetes and hypertension, and are available by same day or next day appointments for acute conditions, scheduled appointments, or by referral Monday through Friday.

The Heartland Medical Clinic initiated services to the uninsured about five years ago, but today includes services to individuals with coverage and charges a significant fee for services. Their offerings are more limited with a part-time D.O. as the provider and without the comprehensive offerings of a volunteer referral network, but are a useful resource for those seeking care for an acute condition when Health Care Access Clinic appointments are booked too far out for the caller. The Health Care Access Clinic only utilizes physicians who are board certified and have privileges at Lawrence Memorial Hospital and can therefore offer comprehensive care for any condition presented through its network of providers in Douglas County. Our system allows for treatment of virtually any case presented without the consequence of medical bills that typically prohibit people from seeking treatment thanks to the partnership with the Lawrence Memorial Hospital and nearly every medical provider in the county. In addition, the Clinic is a member of the Community Health Improvement Project’s Access to Health Care Task Force, comprised of more than 12 health entities in the community, that meet quarterly to foster collaboration of services. Its leadership group, of which we are also a member, monitors Healthy People 2010 related work in Douglas County.

Section 5. Program Objectives

Please provide three specific program objectives for 2008. Objectives should demonstrate the purpose of the program and measure the amount of service delivered or the effectiveness of the services delivered. A time frame and numerical goal should also be included. Examples include, “75% of clients receiving job training will retain their job one year after being hired,” “increased fundraising efforts will result in a 15% increase in donations in 2008,” “credit counseling services will be provided to 600 clients in 2008,” “new digital arts program will serve 275 students in 2008” etc. Applicants will be expected to report their progress toward meeting these objectives in their six month and annual reports to the City.

	Program Objectives

1.	Based on current capacity to serve and the number of current female patients over the age of 40, 60% of female patients over the age of 40 will have had an annual wellness exam (including a CBE, a pelvic exam, and a Pap test) and a mammogram within the year sampled, following guidelines proven to greatly reduce their risks for breast and cervical cancer.

2.	60% of Diabetic patients will have improved the management of their Diabetes, as evidenced by reduced Hemoglobin A1C levels, provided foot exams, referrals for eye exams, use of Medication Assistance Program, and use of education services or referrals.

3.	75% of Hypertensive patients will have improved the management of their Hypertension, as evidenced by reduced blood pressure levels, education received, and use of Medication Assistance Program.

Please return completed application electronically to cliebst@ci.lawrence.ks.us by

5:00 pm on Wednesday, May 2, 2007.

Office Use Only