Let's say there's a man who needs a colonoscopy.
Both of his parents died of colon cancer. He's employed but uninsured. And he knows his bill will probably be more than $1,000.
What's he going to do?
“Put yourself in that place — you're making $10 an hour, you're 50 years old and you need a $1,000 test, what are you going to do? Nothing,” said Lou Carmichael, the CEO of Variety Care. “You're just going to wait, even though your doctor knows it's probably indicated because of your family history.”
Several Oklahoma County community health leaders have spent the past year drafting a master plan on how to better serve people like this hypothetical man.
The group, known as the Commission to Transform the Health Care Safety Net in Oklahoma County, has proposed the creation of a network that would serve as a “single robust system for receiving, managing and distributing requests for donated specialty care,” according to the commission's report.
Within the plan, specialty care services are defined as “not only consults with sub-specialist physicians, but also labs and other diagnostic tests (e.g. X-ray), inpatient and outpatient procedures (e.g. surgery), referrals to behavioral health agencies/professionals, and access to certain medically necessary equipment and supplies (e.g. prosthetics),” according to the report.
About 90,500 Oklahoma County residents — roughly 13 percent — are uninsured and have household incomes at or below 200 percent of the federal poverty level, according to the commission's report.
Oklahoma County is believed to have more community-based and faith-based health care safety net providers per square mile than any other major metropolitan county or region in the U.S., according to the report.
There are 12 federally qualified health centers and 19 charitable clinics in Oklahoma County.
One issue those clinics face is connecting people who are uninsured with specialty services that those clinics cannot provide.
Carmichael, a commission member, said hospitals or specialists will sometimes donate this care, but it isn't done so in an organized manner.
“We spend hundreds of dollars chasing phone calls and pieces of paper to ask somebody who knows somebody who might do this for free,” she said. “This is going to take all of that nonsense out of it, so when our patient needs something, we call the commission and the commission arranges the rest of it.”
Once the person receives the donated specialty care, he or she will return to his or her medical home for follow-up care. This is one of the key provisions in the commission's master plan.
“One of the frustrations of sub-specialist physicians taking referrals has been the lack of a primary care medical home to whom to return the patient for ongoing care that will assure good outcomes and not forfeit the value of the specialty care rendered,” the commission's report states.
To be eligible for network specialty care services, an uninsured patient must be at or below 200 percent of the federal poverty level and be a patient at one of the network's designated medical homes.
Carmichael said having a medical home with a primary care provider means having a doctor who understands your medical needs and history.
“Small changes in your blood work or your blood pressure, if you're just being seen one time, might not seem like a big deal, just because it seems like it's a little high, but if they're used to seeing you over time and something is different, it's really better to have a primary care provider who's looking out to catch things early and to take preventative (measures),” she said.
One of the next steps in creating the network is finding an organization to administer it. The commission has estimated that the network will cost $55,000 in startup costs and $896,500 in its first year of operation.
The commission anticipates financing the early stages of funding for the Oklahoma County Community Health Network through private foundations, hospitals and health systems, the Oklahoma City-County Health Department and also corporations, business and donations from residents.