Joined In Action
PMB 212, 1910 E. 4th Avenue
Olympia, WA 98506-4632
Size: Approx. 21,000
1996, just after the federal government gave up on
ambitious plans to provide health care insurance to all
Americans, a small group of physicians in rural Emanuel
County set out to create a program where no one fell
through the cracks in a disjointed health care delivery
system. Four years and many meetings later, a task force
led by Dr. Timothy Palmer created a plan called Access
Emanuel, to ensure that all county residents have access
to quality health care. Rather than depending on
traditional insurance, providers accept payment from
patients on a sliding scale based on income. The
collaborative project provides access to primary care,
limited specialty care, and prescriptions -- along with
case management for chronically ill patients, which
already has resulted in significant per-patient Medicaid
savings. A key focus is making access and enrollment as
easy as possible, utilizing streamlined applications
available at numerous sites. The program is administered
by a non-profit board composed of public and private
partners, including providers and social service
agencies. In 2001, the program was expanded to
neighboring Jenkins County.
application and referral process allows universal
screening for all available health care and social
services programs, increasing enrollment among eligible
adults and children.
16 primary and 6 specialist physicians in Emanuel County
are participating in the program, seeing patients based
on an equitable distribution of patient visits.
area pharmacies provide $7 prescriptions based on a
formulary developed and adopted by pharmacists who also
waive their dispensing fee.
a database that tracks patient information and
prescription history, a staff person coordinates patient
applications for prescription assistance programs
through pharmaceutical companies.
ill patients referred by providers are enrolled in an
intensive disease state monitoring program that includes
regular contact with RN case managers, regular clinical
screenings, health education and counseling.
transportation to and from appointments is provided to
patients in need.
(March 2000-June 2001):
of targeted uninsured population (approx. 1650 of 4,000
total) now has access to primary care and a “health
hospital indigent care costs 75% in one year by
identifying and case-managing high-risk patients
utilizing the emergency room.
$2 million in care donated to date by primary care
doctors, the county medical center and pharmacies.
case management for 22 chronically ill Medicaid patients
produced $311,892 in savings, by reducing emergency room
visits and the need for inpatient/outpatient services
(FY99 vs. FY 2000 data).
415 applications for other health care coverage programs
through a streamlined application and referral process
and new partnerships.
PeachCare (CHIP) enrollments from 217 to 602 by
assisting applicants and screening Access Emanuel
applications for uninsured children.
individuals with incomes up to 200% of the federal
poverty level are eligible. More than 1650 of the
estimated 4,000 uninsured county residents have been
primary care doctors, specialists, pharmacies and
hospitals donate a portion of their services. The
Georgia Department of Community Health funds two
administrative staff positions, while supporting this
effort as a demonstration project for caring for the
uninsured. The County supplies office space and
utilities for staff. Emanuel Medical Center and Emanuel
County Health Department jointly support the case
management component of the project: the Health
Department provides office space and a portion of
salaries, while the hospital provides salary, benefits
and a van for patient transportation.
already exist within your community to begin caring for
the uninsured more effectively – without major grant
funding. The positive results from the sharing of
resources tends to have a “snowball effect” when
partners begin to feel the accomplishment of helping
more people, more effectively.
communications lines open and strong will encourage an
open exchange of ideas and resource-sharing, providing
an enormous opportunity for system improvement.
procedures and applications to increase access and
expedite services to customers.
support of local and state officials and health agency
administrators by communicating a vision for change that
provides invaluable opportunities.
are no “rules” in developing innovative systems. If
you’re committed to making a difference, you must have
the courage and the flexibility to begin, even if you
don’t have all the answers (you never will), and to
continue amending and improving as you move forward
while determining what works best.
North Main St., 3rd Floor