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In Illinois, counties have many permissions,
almost no mandates
Six nonprofit general hospitals, no public
hospital
Historically affluent, suburban area
Rapidly becoming more diverse, less affluent
International immigration accounts for all
population growth since 2000
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The DuPage County Health Safety Net system
will be a model for others to follow in
managing the health of a defined low-income
population effectively and efficiently across
the entire continuum of care.
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Low-income persons – i.e.
◦ those enrolled in or eligible for Medicaid
(>104,000)
◦ those medically uninsured adults with household
incomes under 200% of the Federal Poverty Level.
(>38,000)
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1989
DuPage Community Clinic Founded
Late 1990’s DCC reaches capacity of its model
2001
Access DuPage Founded
2003
FQHC #1 Established
2003
Medical Access Plan developed
2005
FQHC #2 Established
2007
FQHC #3 Established; Oral Health Plan
Mental Health Plan
2010
Southeast DuPage Health Initiative
Every person within the target population who identifies
him/herself will:
 Be enrolled in every public benefit plan or access program
for which he/she is eligible;
 Have access to regular primary care;
 Have access to the diagnostic services, specialty care,
hospital services, and prescription medications that
he/she requires;
 Have access to essential mental health and oral health
services;
 Have access to those services required to manage many
chronic diseases; and
 Have access to medical care that is delivered in an
increasingly linguistically and culturally competent
manner.
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Includes all organizations whose missions
compel them to be involved in the issue:
hospitals, health department, County, etc
Able to clearly demonstrate effectiveness,
efficiency, and a solid return on investment
on all resources used to develop and maintain
the Health Safety Net; and
Have the necessary political support and
financial backing to fully implement this Plan.
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Collaboration
Asset Focus
Fair Share (no blank check)
Mosaic Approach
System Focus
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Goal 1: Every individual within the target
population who is eligible for
◦ public health insurance coverage and/or a
◦ health care program providing access to care
is properly enrolled in that program in a timely
fashion.
◦ DuPage County Health Department has taken
responsibility to get people enrolled
◦ 28 community agencies are enrollment sites
◦ New SOAR Capability lets us get people who are
diagnosed with qualifying conditions onto
Medicaid or Medicare.
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Goal 2: Every individual within the target
population has a primary care “medical home”
from which to receive regular primary
medical care.
Federally Qualified Health Center
Private Doctors
Free Clinic
Three Federally Qualified Health Centers have been
opened; We’re working on a fourth
◦ Second site of Free Clinic has opened
◦ 1/3 of the doctors in the County participate
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Goal 3: Every individual within the target
population has access to the medical
specialists required to maintain good health.
◦ Weak Spot in the plan
◦ Specialists are asked to donate services without
charge.
◦ For some, this is a lot to ask
◦ Not enough participating specialists
◦ Working on getting specialty clinics in FQHC’s, etc.
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Goal 4: Every individual within the target
population has access to the diagnostic
services required to maintain good health.
◦ All the hospitals, pathologists donate labs,
◦ Radiologists donate imaging
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Goal 5: Every individual within the target
population has access to the hospital services
required to maintain good health in a timely
manner.
◦ All the hospitals treat Access DuPage patients under
their charity care policies
◦ Federation is working with hospitals on Frequent
User initiative
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Goal 6: Every individual within the target
population has reasonable access to those
prescription medications that are required to
maintain good health, and especially those
medications that will keep medical conditions
from worsening.
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Samples
Manufacturer’s Free Drug Programs
97% Generic Efficiency
Other Strategies
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Goal 7: An array of essential mental health
services is available for those within the
target population who need such services.
◦ Circuit Riding Psychiatrist spends time at nonprofit
MH agencies, substance abuse agency
◦ FQHC’s – Spanish Speaking MH providers
◦ Interns and Externs at Free Clinic, supervised by
large, reputable mental health provider
◦ More to be done
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Goal 8: Every individual within the target
population has reasonable access to the oral
health services that are required to maintain
good health
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Health Department in the lead
Expanded its crisis clinic to include Medicaid
Other strategies for elderly and disabled persons
Newly developed Dental School to open clinic
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Goal 9: Persons within the target population
with certain chronic diseases are enrolled in
Disease Management programs and making
progress in managing those diseases
◦ Access DuPage has NIH funded navigator program
for breast and cervical cancer
◦ Exploring wider use of navigators for Frequent
Users
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Goal 10:
All health services described in
this Health Safety Net Plan are provided in a
manner that is linguistically and culturally
competent to patients with limited English
proficiency (LEP).
◦ Language Access Resource Center trains
interpreters, provides interpreters to health and
human services agencies
◦ 7 Executive Directors doing plan for their agencies
on CLAS
◦ 250 Interpreters trained
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Goal 11: The effectiveness and efficiency of
the entire Health Safety Net is demonstrated
by means of a robust system of information
retrieval, analysis, and evaluation.
◦ SF-12 Data tracked for many years shows
improvement in mental health, stable physical
health
◦ Utilization data shows efficient use of system that is
low where it should be low (ED use), high where it
should be high (Primary care)
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Goal 12 The coalition of organizations taking
accountability for this Health Safety Net Plan
is organized and structured in a manner that
allows the Health Safety Net Plan to be most
successfully implemented
◦ Coalition formed in 2001 stronger than ever
◦ New collaborative efforts forming every year.
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Goal 13 Obtain all necessary political support
to insure the success of the DuPage Health
Safety Net Plan
Goal 14 The DuPage Health Safety Net Plan is
marketed in a way that insures optimal
participation from Coalition partners, and
optimal support from key external parties.
◦ Need to continually work on this.
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Goal 15 The DuPage Health Safety Net Plan is
sufficiently well funded to effectively
implement all components of the Plan.
◦ FY 2010 Donated Services worth $80 million
◦ 11,000+ persons enrolled
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Legal Residents < 130% FPL to Medicaid
Categorical restriction for Medicaid removed
Some employed low wage earners will get
coverage at Exchanges
Net effect: Enrollment in Access DuPage will
drop somewhat but the need for the program
will not go away.