Government plans to provide health care to the uninsured are being debated across the country. But in Fairfax County, the point is nearly moot. Local health officials hope to make it completely so with recently outlined plans for an ambitious expansion.
Through clinics in its Community Health care Network (HCN) the county provides health care directly to 12,000 people. Another 13,000 to 18,000 in the Fairfax/Falls Church area are covered through a patchwork of other health care providers, known collectively as the “safety net.”
The county estimates it has up to 40,000 residents who don’t have health insurance and can’t afford it. The safety net covers up to 30,000 of them. Chris Stevens, HCN’s program director, said many people have no idea how close the county has come to exempting itself from the national health care debate.
“[The health care program] is huge, and people just take it for granted,” she said. “There are very few jurisdictions that have anything like this ... Fairfax County has just seen the wisdom of providing basic care to those who are most in need.”
“Without basic health care, you can’t go to school, you can’t go to work.”
Stevens said the county has been able to confront the problem so comprehensively because it has a relatively low percentage of people without insurance. Statistics from the health department cite about 100,000 uninsured Fairfax County residents (out of about 1 million), up to 40,000 of whom earn less than less than 200 percent of the federal poverty level, the calculation the county uses to determine eligibility. That would be $19,600 a year for individuals, $33,200 for a family of three.
THE SOUTH COUNTY Government Center, on Richmond Highway, hosts one of HCN’s three clinics in the county. The others are in Reston and in Seven Corners in Falls Church. In 2005, the South County clinic alone served more than 6,000 patients. All met the safety net’s three criteria of being low-income, uninsured county residents. Most of the patients are between 18 and 64, Stevens said, because most poor children and senior citizens are covered by Medicare, Medicaid and other government programs. About 70 percent of patients are in families, and 30 percent are single.
Stevens said the clinics offer the same primary health care found in private doctor’s offices, including lab and x-ray services, prescriptions and referrals to a network of more than 300 specialists, whose cost (often donated) is also covered by HCN. The clinics also offer health counseling and health education. Pediatric, obstetric and maternity services are available through a partnership with Inova hospitals.
HCN has had three clinics for more than a decade. During most of this time, the clinics were operating at full capacity, with a waiting list to join the system. But several years ago, the Department of Family Services began training teams to advise people seeking health services on their best options within the overall safety net, not simply the county’s portion of it. This led more patients to take advantage of other free health care providers, such as the Herndon Free Clinic and Partnership for Healthier Kids, easing the strain on HCN. For the last year, Stevens said, HCN has been operating below capacity and looking for more patients.
Stevens said the HCN program costs the county $9 million a year. This is about $750 a patient. At a recent meeting of the Route 1 Task Force for Human Services, guest JoAnne Jorgenson, a deputy director at the Health Department, said the costs of the HCN program compare well with other attempts at providing health care. The county strives to maximize the program’s efficiency.
IN JANUARY, the county took a big step toward reinventing the HCN program. Years ago, health officials decided that in order maximize the program’s size and better integrate it with Inova and other partners, the county should create a non-profit entity that would oversee its provision of health care. This non-profit would have access to state, federal and private funds that county government cannot request. It would also be able to set long-term funding plans that suit the needs of a health system better than the annual budgets set by the Board of Supervisors.
But in order to create such a non-profit legally, the General Assembly had to pass a state law to allow it. This happened last year. The legislation mandated that the county establish a commission that would manage the non-profit corporation. On Jan. 8, the Board of Supervisors approved that commission — composed of five high-ranking county directors — which will now begin the process of exploring the nitty-gritty details of how the health care system will work.
All this was explained to the private and public providers of human services who meet once a month as the Route One Task Force. County officials said they hope the new system, envisioned as a partnership between the county and Inova, will allow them to coordinate services, pull in private providers and leverage more money to build one or two new clinics, thereby expanding coverage and improving accessibility.
“We are positioning ourselves to look comprehensively at access to health care for the uninsured,” said Verdia Haywood, who directs all human services for the county.
THE NEW PLAN has three primary goals. The first is to ease people’s access to health care by providing more clinics closer to home. Now, everyone in the county who needs maternity services must travel to Inova Fairfax Hospital in Falls Church, a ride that attendees at the meeting estimated would require three buses and about two hours, one way from Richmond Highway.
The second goal, according to Haywood, is to expand services to meet increasing demand without taking more money from the county budget. He said a non-profit corporation could use a business approach to seek more private and public sector funding and use the money more creatively. “If it is a government body it will not have the flexibility it really needs to help it grow the community safety net.”
The third goal is to create a computerized network that links all service providers, making it more likely that people will reduce expensive visits to the emergency room by seeking preventive care. Jorgenson said that patient education efforts have already had some success in this regard, but the major fix must be systemic. “We had a culture to change down in this area, and the culture was if you’re sick, go to the E.R.” She envisioned a system in which, when customers did need to visit the emergency room, they would walk out with an appointment in hand for a follow-up visit at a safety net clinic.
Barbara Doyle, the C.E.O. of Inova Mount Vernon Hospital, said Inova’s stake in the partnership rests on its desire to serve the community. County officials added that more access to primary health care means fewer visits to the emergency room. Hospitals are required to take emergency room patients whether or not they have health insurance. If they do not pay, hospitals eat the cost of the visit.
The county and Inova are currently the only two partners listed in the plan to create a non-profit organization. But Jorgenson said there is room for more. “We will allow any partners to the table, as long as they bring something with them.”
BUT THE COMPLEX SYSTEM of oversight mandated by the state left Supervisor Gerry Hyland (D-Mount Vernon) in doubt about the Board of Supervisors’ control over the decisions of the non-profit, because the corporation would be directly responsible only to the county’s health care commission. “Although your chart says ‘accountability.’ My question is how is that accountability going to happen?”
Haywood assured Hyland that the commission would report to the board, and the board would have power of the purse. “The board’s public dollar must be a part of this system or it won’t go anywhere … so you have that accountability. If you withdraw your funds it doesn’t exist.”
The response from Pam Michell, the director of New Hope Housing, one of the county’s largest non-profit social service providers, revealed the complicated, potentially conflicting, interests of a county-sponsored non-profit corporation created in partnership with a private hospital chain. Michell said that by definition non-profits’ over-riding accountability must be to the community, represented by their board of directors. “I have the opposite objection from you, Gerry,” she said. “I’m worried about too much government.”