Over 500,000 people in Miami Dade County do not have health insurance, according to the latest Florida Health Insurance Survey of June 2003, conducted by the Public Health Trust. Many more end up at hospital emergency rooms because they have no access to primary and preventive healthcare. Uninsured people living with chronic diseases such as diabetes, heart disease, asthma, and mental illness, for example, are often forced to rely on hospital emergency rooms as their only source of healthcare services. Usually, they are repeatedly admitted to the hospital for physical conditions they could easily control with access to consistent primary care. In many cases, all they need is someone to help them navigate the healthcare system.

This is where case management and, more specifically, disease management can play a huge role in increasing access to care. Case management provides a mechanism for people to develop a relationship with a primary care center and allows them to have a medical home where they can be treated without having to go through the more costly emergency room. Disease management, a more narrow form of case management, is a process through which a person with a specific chronic disease is identified and a plan, which efficiently utilizes health care resources, is designed and implemented to achieve the optimum patient outcome in the most cost-effective manner.

Fortunately, the Health Resources and Services Administration (HRSA) acknowledged the benefits associated with case management, disease management and health navigators, a form of Community Health Workers. Since 1999 it has been providing Community Access Program (CAP) grants to communities that have begun to reorganize their health care delivery systems to provide better coordinated, more efficient care for uninsured residents.

Since then, CVM has helped lead the way in convening partners in Miami-Dade to receive a CAP grant. In 2001, the Healthy Communities Access Program (HCAP) was consolidated and given the first grant which allowed Jackson Memorial hospital system as well as the community health centers systems to provide disease management, health navigator services, community outreach and capacity building.

As the HCAP begins its third year of funding, CVM continues to play a role in determining how the community adapts the program. Having learned from the two previous years and having to sustain the program locally as federal dollars are reduced, the HCAP collaborative chose to expand its disease management program, maintain the health navigators and reduce or eliminate all other services.

The HCAP Collaborative has proven to be a strong model for community collaboration because of the substantial cost savings it generated and the increase in numbers of people accessing benefits. Due to the practices of data sharing, consistent communication and collaborative problem solving an estimated 100,000 eligible people enrolled in public benefit programs and gained access to healthcare.

Our hopes for the future are that these practices will become the norm for the providers involved, beyond the time of the grant, so that the local fragmented healthcare system becomes more coordinated and case and disease management become standard practice.

Now that the HCAP has been funded for a third year, there is an extended opportunity to showcase the accomplishments of the collaborative and support the implementation of other case and disease management programs in the county. Building on the previous two years with the HCAP Collaborative in Miami-Dade, CVM will continue to monitor the progress of the expanded disease management efforts through this grant. We will look to highlight the continued successes of this model as a best practice for Miami-Dade and educate stakeholders and policymakers through the Office of Healthcare Planning to ensure its replication across provider sites.

To share your ideas and get more information about case management, please contact Mikele Aboitiz Earle.