Problem Addressed: Access to Insurance

Healthy People 2010 Objective: 1-4, 1-6

Web Address: None

SNAPSHOT

The Lake Plains Community Care Network (LPCCN) is a not-for-profit corporation formed in 1997 from a network of employers, providers, and community service groups and organizations that have collaborated since 1993. The network addresses rising costs of health care and the dwindling choices of health care services in rural areas. The Lake Plains Community Care Initiative is one of several community-oriented programs under LPCCN.

THE MODEL

Blueprint: The Lake Plains Community Care Initiative is a local response strategy that targets growing concerns over access to and affordability of quality health care and health insurance coverage for the area residents. LPCCN exists as a three-county, rural health network located in upstate Western New York. It is a not-for-profit corporation comprised of representatives from three hospitals, three public health departments, area health practitioners, and community/governmental business representatives. The corporation has 13 governing board members with an approximate 25-member community advisory council. A part-time CEO, full-time associate director, full-time care management coordinator, and limited support personnel staff the project.

As a rural health network, LPCCN seeks to offer open-ended service support to all 150,000 individuals residing within the catchment area. Insurance efforts are directed toward offering support to uninsured and underinsured adults and their families. The targets are individuals who are typically self-employed or employed in small group environments (organizations with 50 employees or less). Many of these individuals are employed in agribusiness, retail, or the service industry. The Lake Plains Community Care Initiative seeks to better coordinate and strengthen the local health delivery system while at the same time promoting additional competitively priced health insurance options to the communities. This is accomplished by two methods. First, LPCCN established a three hospital, 160 physician, messenger model (a type of preferred provider organization [PPO] that was established by the Federal Trade Commission to allow physicians to negotiate reimbursements) to coordinate and strengthen the overall delivery system. Gradually, the PPO will be enhanced through the provision of local support features or functions such as local medical management, case management, community care management, and utilization review efforts. Second, LPCCN attempted to reach local self-insured organizations, employment-sector trusts, and a third party commercial carrier to contract with the PPO and actively take advantage of the enhancements being provided.

Making a Difference: The Lake Plains Community Care Initiative covers approximately 2,400 lives by servicing health insurance plans. The Initiative expects to add 1,000 more covered lives in 2002.

Beginnings: LPCCN was incorporated in 1997, and the first service contract took effect in July 2000. The problem was noticed beginning in the early 1990s when the provider system began losing market share and experienced increasing difficulties in meeting financial objectives and attracting new practitioners to the communities. The numerous insurance carriers decreased as well as the consumer responsiveness of those that remained. As Lake Plains gained in local prominence and stature, LPCCN commissioned a market analysis through the University of Buffalo, School of Medicine and Biomedical Sciences. The results of this study only put numbers to what was known and experienced on a day-to-day basis by businesses and health care consumers alike. It revealed that premiums were too high for the actual utilization, and fewer choices and less customer service was made available.

Challenges and Solutions: Lake Plains Community Care Initiative has experienced varied challenges over the past several years. All health insurance activities in New York State are complex and highly regulated. Finding locally controllable response options that are prudent and fiscally affordable have proven very difficult. The program leaders realize that one strategy is clearly not right for all. An array of strategies (such as self-funded insurance plans, specific trust plans, and an innovative partnership with a large commercial insurance carrier) is needed to effectively get the job done. Another major challenge is the continued pursuit for new options while also seeking to refine those already in place.

LPCCN has been funded as a New York State Rural Health Network since 1997 and has also benefited from a federal rural network development grant, Kellogg Foundation grant award, and member organization contributions. The organization anticipates becoming self-sufficient by 2004 as the revenue stream grows from increased utilization of PPO services within the community.

PROGRAM CONTACT INFORMATION

Kenneth L. Oakley, Ph.D., FACHE

Lake Plains Community Care Initiative

4156 West Main Street

Batavia, NY 14020

Phone: (585) 345-6110

Fax: (585) 345-7452