Software Solutions Web-based solutions for sharing information in community collaborations.
Multi-Share Health Coverage Building community based health coverage plans based on the multi-share concept pioneered in Muskegon Michigan through its Access Health program.
Access Health of Muskegon was developed in 1999 to provide access to health care for two distinct populations: the working uninsured and Muskegon County's indigent population. The Muskegon community developed its own benefit plan for the working uninsured and the State of Michigan mandated the benefit plan for those classified as indigent. To manage two distinct community collaborative plans, Access Health and the Muskegon Community Health Project developed case management software through a grant from the U.S. Department of Commerce. The software, known as i-Net was developed to case manage and integrate claims payment processing, thereby reducing the third party cost for claims processing.
Muskegon may be unique in its operation of both case management and claims payment. This web-based tool enabled Access Health to integrate the information from claims data into its case management records and provide a limited electronic medical record for providers. Through the i-Net software, providers were no longer limited to their own internal information on these patients. An ER in one health system can now see the treatment or prescription data provided by the ER from a second health system or from a community clinic. The claims data also enabled Access Health to better identify plan members with chronic disease diagnosis and trigger intensive case management interventions to reduce the high cost of episodic sick care.
Access Health began the implementation of i-Net with its indigent population, as required by the grant, and has since expanded the application's use with the working uninsured population.
To better understand the potential of i-Net for community based health plans, it is helpful to take a closer look at the use of i-Net with Muskegon Care, the community's indigent plan. Of the two groups, Muskegon Care presents the most serious challenges to a community. By comparison, it is significantly more difficult to manage the cost and health care needs of the indigent population, who are generally more chronically ill and have fewer resources. Access Health has demonstrated that the community infrastructure for indigent care programs can be enhanced, with the right collaborative tools, to expand coverage to the working uninsured and still meet the distinct health needs of the two groups.
While Muskegon Care provides the same benefits as all other indigent care plans in Michigan, its monthly member costs are dramatically lower than other county health plans for the indigent populations. According to actuarial data, the monthly member cost dropped from $110 in 2002 to $68 in 2004. Part of this can be attributed to an increase in the number of plan members (from a monthly average of 1,700 in 2002 to 2,200 in 2004). However, this reduction was more than offset by increases resulting from the State mandate for a 15% increase in provider reimbursement and an average 15% increase for medical cost across the board, attributed to inflation over the same time period. Effectively, we saw 30% increases in the cost of services between 2002 and 2004. In addition, the 2004 cost includes charges for inpatient hospital services (not included in the 2002 plan benefits.) Despite all these increases, Muskegon Care has managed to lower its monthly member cost by 40%. When you adjust the reduction for inflation and reimbursement increases, the decrease in cost over these two years is even more dramatic.
The overall decrease in monthly member costs can be better understood by looking at the reductions in the component costs that are typically the high cost variables. These items include; ER visits, drug costs, and out patient hospital service charges. Across the board the costs for these services have decreased significantly due to Muskegon's use of data to case manage its population.
Muskegon may be unique in the manner in which it manages health resources due to its community-based operation. Muskegon provides case management of the high cost, chronically ill portion of the indigent population. Muskegon also has the data management software in house to enable the efficient management of the plan. The Muskegon i-Net software and the case management using this software are the primary reasons these savings were achieved.