MODELS FOR PRACTICE
FOCUS
AREA: ACCESS (PRIMARY CARE)
Program Name: Rural Health Network of
Location:
Healthy People 2010 Objective: 1-4, 1-5, 1-6
Web Address: http://www.ruralhealth-floridakeys.org
The
Lifelines Project is a project of the Rural Health Network of Monroe County
(RHNMC) (
Blueprint: Beginning in August 1999, RHNMC, a coalition of 36
agencies and individuals who govern the Lifelines Project and all functions of
the network, has provided primary health care to persons in need in the Florida
Keys regardless of ability to pay. Lifelines is marketed to the uninsured,
underinsured, working poor, and homeless. Income levels of clients usually fall
below 200 percent of the federal poverty level (FPL), with a majority of
clients with incomes at or below $15,000 per year. Lifelines provides
outpatient, primary health care that includes such elements as pharmaceutical
assistance, discounted laboratory costs, health education, women’s health
exams, and referrals. All clients are asked to pay a $10 co-pay if they are
able. RHNMC has two mobile unit vans, staffed by two teams of medical
practitioners that include two paid registered nurses and advanced registered
nurse practitioners. The project also employs health educators, a health
services director, and a medical director. The vans travel the islands of the
Florida Keys and are scheduled to be in the same specific locations each day of
the week. In addition to the mobile vans, RHNMC provides outpatient primary
health care services five days a week at the Ruth Ivins Center in Marathon.
Monroe
County is a unique area in the continental United States with health care access
difficulties. It covers 45,000 square miles, but 95 percent of the county is
part of the Big Cypress Preserve and the Florida Everglades on the Florida
mainland and is uninhabited and non-taxable. The inhabited portion, known as
the Florida Keys, is populated by about 78,000 people and is a group of over
300 islands, of which only 43 are connected by 42 bridges over a two-lane
highway. Key West, the county seat and largest population center, is located
150 miles from Miami, the largest proximal city to the Keys. Many residents of
Monroe County experience difficulties in accessing housing and medical care
since it has had the highest cost of living in the state for 20 years, and many
residents are low-income service personnel serving the tourism industry. For
this reason, the Lifelines Project is crucial for many inhabitants of the
Florida Keys.
Making a Difference: The Lifelines Project
provides health care to the uninsured with a level of service that historically
was not available in Monroe County before 1999. About 3,200 services are
provided each year. Sixty clients were randomly selected from the multiple
service sites to complete a service satisfaction survey. All 60 clients
responded positively to overall satisfaction with the services. The health
services director reports that 100 percent of the time, responses to inquiries
for appointments occur within 24 hours. The project has also reduced the number
of visits to the local emergency room, therefore reducing emergency room costs
for patients and providers. RHNMC has been successful in securing interim
funding from the Health Foundation of South Florida and Catholic Charities. It
also received sustaining funding for the first time in the project’s history
from the Monroe County government in August 2001. RHNMC was asked by Catholic
Charities to continue making a difference by building a new clinic in Key West
to treat the homeless under a Rural Health Outreach Grant from the Health
Resources and Services Administration (HRSA). RHNMC also developed a dental
program for the uninsured that was projected to begin June 1, 2002.
Beginnings:
The Lifelines Project was created as the result of a
reduction in health care services offered by the local health department. In
1998, the director of the county health department notified the RHNMC executive
director that the residual services provided by the health department in Key
West would be reduced and that total elimination of services was anticipated.
In response, the RHNMC executive director and the RHNMC board developed a plan
of action to provide countywide primary health care services through the use of
medically equipped mobile vans. The program was fully implemented on August 31,
1999, and the Ruth Ivins Center began providing services on May 1, 2001. The
Monroe County government, University of Miami School of Medicine, and U.S.
Department of Housing and Urban Development (HUD) provided start-up funding for
the Lifelines Project.
Challenges and Solutions: The University of Miami, one of the original
funders, continues to support the project with the placement of third year
medical students, but their funding support has come to an end. Monroe County
government and HUD continue to financially support the Lifelines Project. After
completion of its first year, the project was awarded a three-year grant from
HRSA and a one-year grant-in-aid from Catholic Charities of the Archdiocese of
Miami. The Catholic Charities grant-in-aid was renewed in 2001. In May 2001,
the project was awarded a one-year grant from the Health Foundation of Southern
Florida. The project is currently seeking sustaining funding from the State of
Florida to match that of the Monroe County government. Client co-pays only
generate about 10 percent of the project’s costs, and the Medicare and Medicaid
incomes are negligible.
The
Lifelines Project advertises to prospective clients through advertisements on
local access television, newsletters, brochures, and radio public service
announcements. Changes in service location are placed in printed media ads, and
brochures are distributed in neighborhoods of target populations. Additionally,
the Lifelines Project markets to the community at large via the RHNMC website.
Mark
Szurek, Ph.D.
Rural
Health Network of Monroe County, Florida - Lifelines Project
P.O.
Box 4966
Key
West, FL 33041
Phone:
(305) 293-7570