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:		The Leo Center
Name of Program for Which Funding is Requested:			Heartland Medical Clinic Primary Medical Care
Primary Contact Person:		Renee Caldwell
Address:	One Riverfront Plaza, Suite 100 ; Lawrence, KS 66044
Telephone:	785-841-7297		Fax:	785-856-0375
Email:	renee@leocenter.org

Section 2. Request Information

A.	Amount of funds requested from the City for this program for calendar year 2008:	$ 36,000
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: Continued support is anticipated. These funds will allow Leo Center to hire a nurse practitioner, which in turn would allow the patient wait to decrease and provide a walk-in availability for acute illness.
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.): No. The growing need for medical care for uninsured and underinsured in Lawrence has increased need for service hours and the number of providers simultaneously able to serve. A nurse practitioner will serve 1100 more visits a year.
E.	If you are requesting an increase in funding over 2007, please explain exactly how the additional funds will be used: N/A. We have not requested funding in previous years, however the number of patients seeking treatment has increased, as has overall need in our community.

Section 3. Agency and Program Budget information

A.	How many paid full time employees work for your agency?	4.25 FTE	Volunteers?			11.4 FTE

B.	What percent of your total 2007 budget goes to employee salaries and benefits?				52%

C.	What percent of your total 2007 budget is used for operating expenses?			48%

D.	What is the total estimated cost to provide the program in 2008?			$394,000

E.	What percent of 2008 program costs are being requested from the City?			9%

F.	List other anticipated sources of funding and funding amount for this program in 2008:
	Anticipated Funding Source				Dollar Amount
	Contributions				$201,000
	Grants- Restricted
	KDHE-Diabetes Quality of Care Project				10,000
	KAMU-Prescription Assistance Program				2,750
	Douglas County Community Foundation-Diabetes Program				7,500
	City of Lawrence				36,000
	Programs and Patient Fees				124,000
	Other Fundraisers				5,750
	Rental Income				6,000
	Interest, Other Income				1,000



	TOTAL 2008 PROGRAM BUDGET				$394,000

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 City of Lawrence has an estimated 14,000 uninsured and most accounts agree at least that number have limited access to health care, such as very minimal ‘catastrophic’ coverage with no prescription coverage. The underinsured and uninsured have limited choices for medical care, and The Leo Center’s Heartland Medical Clinic (HMC), a Kansas Safety-Net Primary Care Clinic and part of the Kansas Diabetes Quality of Care Program, provides medical and prescription assistance on a sliding fee scale to those in need. This increases productivity and quality of life for those served in our clinic and diminishes the impact of primary care medical treatments sought at the local emergency department, often without payment.

HMC provided more than 4200 primary care visits to more than 2700 patients in 2006, 11.6% of whom were children. Early Detection Works, a KDHE women’s health program, offers free screenings for women’s care, and all subsequent treatments after a diagnosis are cost-free to the patient. Our Medication Assistance Program provided an estimate $2+ million in drugs at little or no patient cost in 2006.

The Leo Center (TLC) also provides services to the community through a food pantry- since opening its door in 2004, our food pantry has provided more than 1840 households (containing 5550 members) groceries for 38,450 meals. Our benevolence office has also provided household goods, furniture and financial support, such as rent and utilities to more than 2000 people in more than 700 households. This emergency cash assistance keeps households whole and to retains utilities. This emergency financial support keeps families housed and prevents the cascading effect of employment loss, education interruption, and health implications that follows loss of permanent shelter. The Leo Center also offers life-skills and financial training to provide a foundation for a more stable future.

In-kind donations of medical equipment and supplies; donated medical and other services; medications, rent and financial support totaled approximately $2 million in 2006. For every dollar donated, at least $10 in care is provided to our visitors; community members and churches donated $201,000 in 2006.

This is the first year we have applied to the City for this funding, having sustained our program with the contributions of local community members and congregations. The impact of soaring uninsured numbers coupled with the increased costs for medical care have brought many new patients to our doors, so we are looking for assistance for the services we provide. Our sustainability is good, and we expect to improve as we work on capacity-building activities, such as highly visible fundraisers and grant applications.

Community commitment to our organization is tremendous, and we expect it will remain so. Despite that, we have a need for some outside support and hope the City recognizes the value of preventative and primary care, also recognizing that we offer services that improve the quality of life for many in Lawrence, which in turn increases the community productivity and economy.

B. How was the need for this program determined?

Our 2007 annual budget is focused on the ability to provide care to more people seeking medical assistance, as our wait to see a doctor has lengthened this year due to increased demand for appointment times. This is an understandable change, as increased numbers of uninsured patients in Douglas County have been reported. Currently, if a patient with an acute illness cannot be seen in a timely manner, there are few options to avoid emergent medical care.

With the assistance of the City funding, HMC can fund the salary of a nurse practitioner (ARNP) for one eight-hour day each week, allowing 15 more patient visits weekly. This increase in patient fees would then provide self-sustaining revenue to retain the services of said ARNP after this funding period. The Leo Center also seeks funds to continue the medication assistance (Meds-by-Mail, or MBM) services it provides, as the increase in patient visits for chronic conditions in 2006 is expected to continue in future years. HMC provided more than 2000 prescriptions to patients last year, and distributed more than an estimate $2.2 million in prescription medications through our assistance program, many for ongoing treatment of chronic diseases, such as diabetes and hypertension. While the coordinator of this program has been provided through a KAMU/Americorps partnership in the past two years, KAMU can no longer offer an Americorps member to us, but has provided a small grant to assist in FY2007. We must continue to provide these services to our patients, therefore we seek City funding to assist in funding the coordination position for MBM.

Using first-quarter actual expenses and income figures, the 2008 projected budget shows a need for an additional $18,000 as salary for one eight-hour day per week nurse practitioner, as well as $18,000 to continue providing the medication assistance program.

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

With our participation in the Kansas Diabetes Quality of Care Program, HMC increased capacity for concerted treatment of diabetes, often treated incompletely in patients without coverage. We now offer testing and treatment supplies in addition to the medication assistance program. Coordinated treatment and support is to expand over the course of 2007-2008 as we will implement self-guided care and education programs to decrease the likelihood of complications and secondary illnesses such as hypertension and Metabolic Syndrome. Much attention has been focused nationally on the cost of these treatments becoming a social service burden, and our program is intended to address these needs.

Chronic illnesses require ongoing treatment, the expense of which prevents many patients from seeking care, often leading to acute, immediate illness and complications subsequently treated in the emergency department of the locally-owned hospital. These uncompensated visits are avoided by preventative treatment in programs such as offered by HMC. Further, support of TLC decreases other social service support requirements by the local government, as our agency provides multiple services to prevent dependency on local welfare resources. Support of TLC’s clinic increases options available to those in need of treatment for acute illness such as respiratory infection, keeping the patient out of the ER. Likewise, our benevolence services provide options to prevent loss of rental housing, utilities, and employment while making food, furniture, and medical care more accessible.

By supporting our community members in times of challenge, greater social costs are averted; each of these services individually strengthens our community by improving the security, health, productivity and self-sufficiency of The Leo Center’s visitors.

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.

To pursue the mission of providing necessary health care services to anyone in the community, Heartland Medical Clinic offers patients many services, including:

· Primary Care, Diagnosis and Treatment	· Medicaid Eligibility
· Pharmaceutical Drugs, wholesale and samples	· Complete Lab Services
· Manufacturers’ Indigent Drug Program (IDP)	· Immunizations
· Short-term Crisis Intervention	· Life Skills Training
· Homeless Services	· Food Pantry
· Advocate Pregnancy Services (an on-site partner)	· Benevolence Assistance
· X-Ray, with on-site reading	· Sonogram
· Diabetes Counseling and Support	· Diabetic Supplies
· Initial Cardiac Care, including stress test and labs	· Early Detection Works, a women’s care program

As a provider, our target population is any person who requires medical attention or other services to promote health.

At time of service, patients are screened for possible inclusion in our Medication Assistance Program, our diabetes program, Early Detection Works, and any other possible service needs. Appropriate referrals are made within our agency with patient permission, and services are coordinated with the patient at that time. Participation in any program is strictly voluntary, and services are offered with patient guidance.

HMC’s intended client base is anyone in the community seeking primary care, and unlike other local health care clinics in Lawrence, no patients are excluded due to income requirements. This unique aspect makes health care accessible to those who might only have catastrophic insurance, or those exceeding income guidelines elsewhere, but unable to afford the care for a costly chronic condition, the co-pays, or the deductibles. This gap in local accessible health care is only addressed at HMC, and our services are crucial to this population. Patient fees are automatically adjusted if the patient is uninsured, and no patient is refused care for inability to pay. For those without insurance coverage of office visits, a flat fee of $42 is charged for the first visit, and the subsequent visits are $30. If unable to afford these fees, a financial agreement is made with the patient based on need, down to no charge.

If prescribed medication, the patient will visit with the MBM coordinator to enroll in the assistance program, or medications may be offered from samples or our closed pharmacy. In this manner, medicines are made available that might be inaccessible to our patients, to the amount of over $2.2 million in 2006.

Patient visits totaled over 4200 in 2006, with more than 2700 active patients. Of these, over 160 received costly non-generic medications directly from the pharmaceutical companies through our MBM program, valued at over $1.06 million- ongoing care that could not have been provided without our assistance program. An increase in need has been reported in Douglas County, corresponding to increasing uninsured rates nationally. Outreach and increased awareness of services available at TLC has resulted in a 6% increase so far in 2007 of those seeking treatment, and our diabetes treatment program is expected to bring in at least 130 new chronic disease patients. Quarterly testing and continued testing supplies and medication support are necessary for these diabetic patients. The KAMU/Americorps provided coordinator for the Diabetes Care and Treatment Program will conduct regular communication to promote self-guided care and education opportunities for these participants.

HMC expects to see an increase of 6-10% in primary care visits in 2007-2008 to at least 4450 visits of 2862 patients.

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?

CEO, Joe Reitz, and PR/Development Director, Christian Moody, have met with Health Care Access(HCA) at their clinic to see how our programs differ. As HCA excludes patients with insurance, our support of those needing affordable care despite coverage does not overlap with their services. Likewise, we do not exclude based on income guidelines, so those who may exceed the guidelines set at HCA whose incomes still fall well below a living wage are able to receive health care without dramatic financial consequences. We also offer other non-medical services for whole support of our visitors, including crisis counseling, food pantry, Advocate Pregnancy Services, and financial benevolence services. While HMC does not accept Medicaid insurance, it does serve the Medicare population.

We are currently working toward seeking coordination with Douglas County Dental Health Clinic, and have agreements with several local dental providers to serve our patients in need of dental care.

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.	TLC will hire an ARNP to serve at least one 8-hour day per week in HMC, resulting in 15 more patients served each week. As the search for this new employee has already begun, we expect to apply an increased schedule within 8 weeks and decrease wait times from two weeks to one week or less.

2.	Increased awareness of programs and services available at TLC will provide an increase of patients seeking primary care here, resulting in an increase of 6-10%, for an increase of at least 250 patient visits in 2008 to 4450+ primary care visits of 2862 patients or more.

3.	TLC will hire a coordinator for the Medication Assistance Program, to replace the Americorps member provided through KAMU. This permanent position will continue to provide medications to patients consistent with our previous provisions of 2000+ prescriptions facilitated.

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

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

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