Finally, momentum toward a solution on health care for Manatee County's working poor

A novel strategy to address the costly and excessive use of hospital emergency rooms by the poor for primary care is at hand. A community paramedic program would address that critical issue in health care here.

By steering Manatee County's medically needy population and underserved residents away from needless ambulance calls and emergency departments and into the paramedic program, the health care community and the county should save not only money but improve outcomes.

This looks like one piece of a complex puzzle that remains a work in progress. As is well known, the county and community have been struggling for years to find solutions to the indigent health care predicament.

The issue compelled county commissioners to approve spending reserve funds this fiscal year on one-year contracts to reimburse Manatee Memorial Hospital, Blake Medical Center and various physicians, specialists and others for treating impoverished residents. That commission approval of $5.3 million came very late, in December, well into the fiscal year.

During two years trying to find alternatives to spending reserves on indigent care, the county conceded -- showing how desperate the situation has become.

As is also widely known, the county and community saw this day coming. The trust fund established decades ago with money from the sale of the then county-owned Manatee Memorial Hospital to private enterprise dwindled year after year until reaching next to nothing today as medical costs rose and investment income fell during the recession.

Positive moves forward

After years and years of fretting about the lack of a comprehensive countywide health care plan while dawdling on actually working to create one, there's encouraging movement on three fronts.

The community paramedic program, proposed by county health officials, serves as a fresh, innovative beginning toward a comprehensive plan.

The recently created Manatee County Healthcare Advisory Board, representing a broad spectrum of health care providers as well as higher education and the business community, is charged with evaluating and monitoring the county's healthcare system; reviewing evidence-based practices and programs; developing ideas on serving the medically needy and then advising the commission.

The toughest task, though, could be recommending a new and sustainable source of funding for these health services.

In February, the county contracted with a Michigan consulting firm, Health Management Associates, to develop a health care plan and define best practices to help the uninsured and underinsured with their medical care and outcomes.

These efforts also increase community transparency and accountability.

Reckoning day coming

This concrete forward momentum comes none too soon as the stubborn situation becomes even more urgent with each passing month. The county's one-year contracts with medical providers do hold a provision for another year's extension.

Plus, the county is confronting a possible deficit in 2018 when the general part of the budget stabilization reserve fund is expected to be spent. With the trust fund depleted and the reserve fund in jeopardy, then what? How will the county pay for health care for the uninsured and underinsured? The pressure is palpable.

A community paramedic program, which could become operational June 1 under the county plan, is an promising start to a long-term, multi-faceted resolution to this crisis.

The soaring number of 911 calls alone prove the value of this program. Only 5 percent of all those calls in 2015 ended with a lights-and-siren ambulance transport to a hospital. The county has logged a 37 percent increase in 911 calls since 2008, but the growth in population comes nowhere close to that percentage.

The program will focus on primary care conditions such as diabetes, falls, congestive heart failure, chronic respiratory problems as

well as mental health and substance abuse. Residents will also be directed to appropriate services to meet their needs. In all, a dramatic decrease in emergency room visits is anticipated.

The pivotal goal in all this is to connect the county's physical and mental health care assets into a cohesive system.

"I believe we are resource rich in Manatee but we need to link our resources," Dr. Jennifer Bencie, administrator of the Florida Department of Health in Manatee, told the Manatee Healthcare Advisory Board during its fourth meeting 10 days ago. "The paramedic program is a great example. You have people who use the emergency room for many reasons, and we are trying to find a way to link them into more appropriate resources, and we have them, but it's linking them that is needed."

Indeed, there's the challenge. With Health Management Associates collaborating with the Manatee Healthcare Advisory Board, that looks very achievable.

Given the pressure to come up with a comprehensive plan in short order, the consulting firm plans to work on a fast track: Complete interviews with health providers and others in April; forge a working model in May and a final draft in June, finishing the project in July.

One has to wonder why this broad-based strategy didn't come years ago given the obvious lack of collaboration and coordination among health care assets. But here we are, at the cusp of solid progress on a dynamic health care system.

The volunteer advisory board's assignment about funding will no doubt find assistance from the Manatee County Citizens Financial Structure Advisory Board, also a fairly new entity. Charged with diversifying county revenue streams, the financial committee is considering six revenue alternatives to address county government's budget constraints, largely dependent on property taxes. An infrastructure sales tax of an extra half cent and franchise fees are the leading contenders.

One way or another, Manatee County must identify a new funding source for indigent care, as is the plan. This has not been an issue in other counties, which use sales or property taxes, or a combination of both.

All this action bodes well for finally ending the community anst over indigent care. The county deserves credit for establishing a citizen-driven approach to solving this crucial issue.

This story was originally published April 3, 2016 at 12:00 AM with the headline "Finally, momentum toward a solution on health care for Manatee County's working poor ."