In the Pursuit of a Seamless Network of Care

Since the implementation of the Affordable Care Act (ACA), the number of insured people in the United States has increased; however, 12.2% (Q4 2017) remain without insurance in many communities. Healthcare safety nets continue to provide essential, community-based services to the remaining underinsured and uninsured people. Some of these individuals lack employee-sponsored coverage and their income is too high for Medicaid, some might be recent immigrants or seasonal workers, some might hold multiple jobs and still cannot afford marketplace coverage, and some might just have too low of a health status, are unemployed, and still are not Medicaid-eligible. Just navigating the complex system of government and local agencies takes a toll in the health of individuals and their families. The greatest issues still remain: access to care, affordability of care, and delivery of care.

According to the Small Area Health Insurance Estimates (2015), there are approximately 23, 317 uninsured adults between ages 18 – 64 in Cabarrus County, of which 42.1 % are below or at 135% of the Federal Poverty Level. More than one in seven (15.7%) adults report being unable to see a doctor in the past year due to cost (County Health Rankings, RWJF, 2015). I have been a Fellow at the Community Free Clinic since June of last year. To give you some context, we serve chronic working-age adult patients at 125% or below the Federal Poverty Level, with an annual re-certification process. As a central hub for HealthNet Cabarrus and the Pink Card Program, we provide access to on-site primary care, laboratory, behavioral, and pharmaceutical services, as well as specialty, diagnostics, and medical referrals. We have been serving the unmeet health needs of the county and its uninsured residents since our foundation in 1994. Currently, the Clinic has full time and part time staff, hundreds of volunteers including physicians, nurses, pharmacists, lab technicians, and many more. Our funding has come from several sources over our years of service: United Way of Central Carolinas, The Cannon Foundation, The Kate B. Reynolds Trust, Office of Rural Health Community Health Grants, The Leon Levine Foundation, Atrium Health/Carolinas HealthCare System – NorthEast, and private donations.

I have been involved in a series of meetings in order to develop a pathway for community members to more easily navigate our local system of care. The HealthNet task force has met for 18 working sessions, logging over 720-person hours to date to create a seamless system that serves the uninsured within Cabarrus County. Various health care and community organizations are involved in this endeavor: the Community Free Clinic, the Rowan Cabarrus Community Health Centers, Community Care of Southern Piedmont, Atrium Health/Carolinas HealthCare System – NorthEast, Carolinas HealthCare System – NorthEast Physicians Network, Cabarrus Health Alliance, Daymark Recovery Services, Cooperative Christian Ministry, and Cabarrus County Department of Human Services. All of us have the same goal in mind: to strengthen and revitalize the current health safety net for the uninsured population.

In a partnership with a team of consultants from Care Share Health Alliance, an organization that provides strategic support to other organizations forming coalition and safety nets in counties of North and South Carolina, we have strengthened our referral and enrollment system by implementing a web-based software, FHASES, to include multiple referral points and common data elements across partner agencies. Our principal goal is to increase the patient population accessing our services by 1000 within the next 12 months. With that in mind, we also want to increase individual trackability of referrals and appointments to make sure they do not get lost in the “black hole”. The collaborative has also focused in tracking population and individual data on social determinants of health. However, we will not only assess for SDOH, but also make the necessary referrals to local partners ranging from temporary housing to food pantries. This will be done using the Community Resource Hub, a platform established by Atrium Health using Aunt Bertha, that provides referral specialists the ability to close the loop.

Perhaps one of the most impactful experience has been working with these local, community leaders in the efforts to strategize and continue to meet the unmet needs of the Cabarrus community. The health care environment has shifted in the last 10 years with funding and policy becoming unstable and highly politicized. It has been fantastic to see the synergy among these organizations and leaders that continue to provide the necessary services to the community, and it has been a privilege being able to support them in this effort.