History

History and Details

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     Nearly everyone in Milwaukee County is impacted by the changing health care environment and rising costs for care. Yet most of us are still able to see a nearby physician when we are seriously ill, need follow-up medication and care after surgery, want to see a specialist or have access to advanced equipment for special needs.

The General Assistance Medical Program (GAMP) makes these things possible even for uninsured and indigent individuals in our community.

     Milwaukee County developed a model a solution to serve those who have no other options for obtaining health care services. GAMP provides better access to care and lowers costs because it encourages early intervention and on-going management of health conditions. Primary care clinics are the cornerstone of GAMP. Recipients can go to primary care providers, clinics and hospitals right in their neighborhoods - instead of having to travel to one central location. The number of Emergency Room visits by patients in the program has decreased greatly and the cost per patient also has declined.

     To address community concerns and create a venue for provider dialogue regarding a new structure to address indigent health needs, the County Board of Supervisors and the County Executive established the Health Care Policy Task Force to review and coordinate the development of a system to provide primary care access. The Health Care Policy Task Force was to:

• Develop policy recommendations defining the role and participation of Milwaukee, other governmental entities, health care providers and community interests in planning, monitoring, administering and funding health care services for the medically indigent.
  
  
• Work with other involved entities in developing a community-wide plan for the delivery of health care services to the medically indigent, including how to inform the community of this availability.
  
  
• Address the future funding of the Regional Trauma Center (A role Doyne Hospital had served).
  
  
• Develop a partnership between governmental entities, health care providers and community interests to achieve these goals and directives.

     Over a period of 18 months, the Health Care Policy Task Force reviewed and discussed service delivery models. In 1997, the Health Care Policy Task Force approved a conceptual plan that made the primary care clinics within the County the cornerstone of a system of care. This model shifted the focus of care from hospital care to services in community settings by primary care physicians. The new system recognized the importance of continuity of care, regardless of the payer source. Using neighborhood clinics provides a higher likelihood that the client will continue to access services even when his/her economic condition improves. Primary care clinics provide or arrange for all the care that is needed by the patient utilizing existing relationships with specialists, home care agencies and pharmacies. The system creates a "mainstreaming" approach to care.

The primary goals of the General Assistance Medical Program system model are:

• Provide better health care to current and future GAMP clients.
  
  
• Emphasize preventive medicine for GAMP clients.
  
  
• Provide more efficient primary and preventive health care in order to decrease overall health care costs and therefore serve more uninsured residents of Milwaukee County.

     The new model of service became effective in April 1998. At that time, all of the hospitals within the County became partners in addressing the service needs of indigent individuals. Since its inception and implementation, the General Assistance Medical Program has become a true public/private partnership of medical providers to address the medical service needs of indigent county residents.

     The GAMP network includes all of the hospitals in the community as well as 15 independent, community-based clinics with 27 seperate service sites across the county, 240 specialty care providers and 25 pharmacies. Each provider brings unique qualities and services that contribute to the strength and diversity of the system.

     The GAMP system is based on the proven concept that it is less costly and better for individuals to provide primary medical care in order to prevent more serious and costly services and hospitalization in the future. To meet the health needs of people within their communities GAMP has contracted with a number of area providers.

     Community clinics and primary care providers are just one piece in the provision of medical care to residents. Due to accidents and unforeseen medical emergencies, the development of chronic medical conditions, surgeries or the requirement of advanced medical diagnostics, services from area hospitals are often required. When necessary, these services are coordinated by the primary care physicians to meet the specific needs of the client.

     Physicians treating today's medical conditions are heavily dependent upon pharmaceuticals. Recognizing the need for individuals to have easy access to obtain prescriptions, GAMP works with dozens of pharmacies around the County. The goal of widespread access is to make access for initial and refill prescriptions easy and convenient. By supporting local, widespread access to pharmacies, GAMP removes one of the barriers to obtaining proper medical care. For individuals with chronic conditions - heart ailments, diabetes or asthma - the ability to obtain refills of medications can mean the difference between healthy maintenance of the condition and more serious complications.

     Since the change in the program in 1998, GAMP has worked with more than 25 local pharmacies in filling prescriptions for community clinic patients. The annual cost for pharmaceuticals to GAMP in 2000 exceeded $7,000,000; yet the outcome of these costs will be reduced complications from diabetes, reduced heart attacks through the preventative treatment of hypertension and reduced number of emergency room visits and inpatient admissions from asthma attacks.

     Each of the community clinics and primary physicians in the General Assistance Medical Program brings a variety of strengths to the program, but sometimes the needs of an individual exceed the capabilities of these clinics and physicians. When necessary, the community clinics refer patients to a variety of specialty care providers for diagnostic services, treatment and follow-up. Each of the providers in the General Assitance Medical Program network is free to choose any provider with whom they have referral relationships to provide services. By encouraging and supporting the use of existing medical provider relationships developed by the community clinic, the General Assistance Medical Program streamlines services to indigent clients with those provided to other clients.

     Home health care, diagnostic services or durable medical equipment also may be required. Each of the primary care clinics working with GAMP may coordinate these services necessary for clients. From MRI radiology services, to crutches, to home care visits by registered nurses and therapists, the General Assistance Medical Program provides to these services for County residents in need.