A cross-departmental planning group consisting of the Health Department, San Mateo Medical Center, Human Services Agency and HPSM, has worked to develop an initiative that would be well positioned to seek funding through this RFA, and strengthen our community’s ability to meet the Board of Supervisors Blue Ribbon Task Force on Adult Health Care Coverage Expansion charge to develop a recommendation for coverage expansion by July 2007. This group researched and analyzed several options for focus, in anticipation of the release of this RFA, and is currently finalizing a proposal to apply for up to $20 million in federal matching funds.
The proposal, titled “The San Mateo Chronic Disease Initiative”, entails an innovative program to reach out and provide comprehensive health care to all uninsured diabetics in San Mateo County with income up to 400% of the federal poverty level and who meet all other eligibility requirements for the County’s WELL and Discounted Health Care financial assistance programs. Diabetes was targeted because of all chronic diseases, diabetes incurs the highest costs to our local safety net, and represents an area of significant health disparities. It is a leading cause of heart disease, kidney failure, blindness and amputation, and nationally accounts for $132 billion, according to the CDC, largely in treating late stage complications that could have been averted through early treatment. The focus on diabetes aligns with the Board of Supervisors’ Healthy Communities San Mateo Initiative, which has brought a wide range of community partners together to eliminate health disparities, including a Blueprint for Prevention of Childhood Obesity that represents a broad-based, primary prevention approach.
The program will consist of a state-of-the-art, radically redesigned primary care system that will focus on reducing both short-term and long-term hospitalizations and other late stage complications. It will accomplish these goals by integrating the following:
• the “chronic care model of care”, which focuses on patient self-management and life-style and behavior change, using non-physician health professionals
• “disease management” strategies that identify and aggressively case-manage patients pre-identified as having high risk of hospitalization
• Open-access and urgent care systems that will insure early access and intervention to prevent acute hospitalizations.
This program will accomplish coverage expansion in two ways:
• It will provide access to health care to all uninsured diabetics in San Mateo County, including those currently not eligible for the WELL program by virtue of having family income in the 200% - 400% FPL range.
• It will redirect existing diabetics in our clinic system into the diabetes project, creating additional system capacity that can be backfilled by the current queue of uninsured patients waiting to receive care in the clinic system.
Finally, this grant is intended to strengthen the entire safety net system, and Ravenswood Family Health Center, our Community Health Center partner in the South County, will be given the same status as County Clinics in terms of ability to refer their most difficult and expensive diabetic patients to the program.
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