Pinellas County's health care system for the very poor is distinguished by two characteristics, neither of them good.
First, it's expensive. And officials know that tax dollars will be scarce in coming years.
Second, high cost hasn't bought good health care.
"There is no case management in that system," said Dr. Claude Dharamraj, director of the state Health Department in Pinellas. "I don't know why we call it managed care."
Now, officials think they can pull off a public service coup: offer better care; boost the number of people served by 40 percent; and save taxpayers $5-million next year.
In September, the county will let its contract with Tampa's WellCare Health Plans lapse. The problem with the WellCare program, officials say, is that too many clients get referred after showing up at hospital emergency rooms seriously ill or after a catastrophic event like a heart attack.
It's not WellCare's fault, officials insist. That's just the way things work in the current model.
"They come to us in that hour of greatest need," said county health care administrator Lynn Kiehne. "We often lovingly refer to them as train wrecks."
To replace WellCare, the county will create a system of local clinics managed in conjunction with nonprofit groups and the state Health Department.
Unlike the current model, the new system will attempt to address the full spectrum of a client's health needs. This, officials hope, will lead to earlier intervention, better outcomes and lower cost. It's cheaper, for instance, to prescribe blood pressure medication than to treat heart attacks.
The clinic model will provide "medical homes" for clients at eight locations. Three will be associated with Dharamraj's state Health Department. Five will be housed at nonprofit Community Health Centers of Pinellas Inc. locations.
The three Health Department clinics will open Aug. 1. All eight are to be open by Oct. 1.
The theme of the effort is "No Wrong Door." It's hoped that emergency rooms, government financial service offices and other spots where poor people congregate will direct potential patients to the clinic system.
Once enrolled, clients will be given case managers to oversee their care. The goal is to get those who are largely unfamiliar with any health care routine yearly physicals, followup visits and medication guidance.
To be eligible, clients must have incomes at or below the federal poverty level. For a single person, the level is $10,400 a year; for a family of four, $21,200. Under the current plan, people with assets greater than $2,000 can't enroll. There's no such asset restriction in the new program.
The WellCare program serves about 7,000 Pinellas residents a year, at an average annual cost per patient of $3,000.
But it's estimated that there are 140,000 without health insurance who are under the age of 65, meaning they're ineligible for Medicare. Of those, officials think there are 20,000 eligible for the new clinic program.
If everyone who is eligible were to take part and require more than simple primary care, the funds for the new program would be maxed out. However, officials say not everyone who is eligible is in need of care. They also don't expect all to step forward and enroll.
The goal, officials said, is to reach 10,000 of those eligible in the county.
It's expected that by ending the WellCare contract, the county will be able to reduce its health services program costs from $27-million this year to $22-million in 2009.
It's a worthy effort, said County Commissioner Karen Seel, as long as it works.
"It makes me nervous if we still continue to get the sickest people and we haven't changed their health care patterns and we run out of money," Seel said.
Dharamraj said getting the needy into the clinic program won't be hard. People come to her door everyday looking for help, she said, but there's no place to direct them.
"You don't need a marketing campaign and a big grand opening," Dharamraj said. "They know where we are."
Law enforcement agents raided WellCare's headquarters in October looking for evidence of wrongdoing in its management of government health programs. No charges have been brought and county officials say the ongoing federal investigation is unrelated to the decision to abandon the contract.
Will Van Sant can be reached at firstname.lastname@example.org or (727) 445-4166.