A Model of Care for the Uninsured Population in Southeastern North Carolina

Rhyne JA, Livsey KR, Becker AE
Source: N C Med J
Publication Year: 2015
Patient Need Addressed: Behavioral health, Care Coordination/Management, Chronic Conditions
Population Focus: Low income, Uninsured, Vulnerable/disadvantaged
Demographic Group: Racial and ethnic minority groups, Rural
Intervention Type: Service redesign
Study Design: Other Study Design
Type of Literature: White

Cape Fear HealthNet is a unique collaborative model that was established to address coordination of care for low-income, uninsured individuals in the Lower Cape Fear Region of North Carolina. This model involves a centralized referral network to direct uninsured clients to medical homes among safety-net providers, a system for specialty referrals, and a short-term episodic or urgent care clinic (HealthNet Clinic) to address immediate or urgent health needs.

We provide a descriptive analysis of patients seen in the episodic care clinic during the period August 2010 through July 2012.

Our data suggests that, compared to county population estimates, the HealthNet Clinic patients were more likely to be people of color, and a higher %age of clinic patients had chronic diseases or lifestyle determinants of chronic diseases, such as diabetes, obesity, or smoking. Almost half of clinic patients (43.7%) required some type of laboratory or diagnostic service; less than 10% of clinic patients were referred to a specialty provider. Findings from this study can inform community collaborative efforts and planning by other safety-net providers to help leverage limited resources and increase access to care among uninsured individuals in North Carolina.

Patient characteristics cannot be generalized to all uninsured individuals in the region, as there are other safety-net providers in the Lower Cape Fear region, and their clinical data were not included in this analysis. CONCLUSIONS The Cape Fear HealthNet collaborative model is successful in directing patients, many of whom have significant chronic illness burdens, to a medical home in the community safety net.

Insights Results

Overview of article

  • The goals of Cape Fear HealthNet (CFHN) are to direct clients to medical homes, create a centralized system for eligibility and referrals, and provide affordable pharmacy options and case management for uninsured individuals with chronic diseases. In response to identified gaps in care, CFHN in August 2010 started an episodic care clinic, the HealthNet Clinic, to provide short term assessment, diagnostic and medical treatment, and medication assistance for low-income, uninsured patients in the region. The HealthNet Clinic was designed to serve as an access point for patients with unmet medical needs and to refer them to a safety-net provider within the collaborative network that could serve as a medical home and provide ongoing primary care services
  • This paper describes this unique collaborative model and provides a snapshot of patients seen in the network’s episodic care clinic for the period August 2010 through July 2012
  • To be eligible for services at CFHN (including referral to a medical home in the safety net), individuals must be uninsured, have an income at or below 200% of the federal poverty guidelines, and live in one of the counties served by the agency (Brunswick, Columbus, New Hanover, or Pender)
  • When an individual calls to inquire about services, an algorithm triage sheet is used to determine whether the client is an appropriate candidate to be seen in the clinic
  • After being seen by the physician for an initial visit, each patient is asked to see a patient navigator. The role of the patient navigator is to determine the patient’s eligibility status to participate in CFHN; this evaluation is required for referral to other safety-net providers
  • HealthNet Clinic patients with chronic illnesses who are enrolled in CFHN are automatically referred to 1 of 3 case managers who provide telephonic case management and conduct home visits when necessary. The registered nurse case management component of the CFHN program is based on the success of the nationally recognized Community Care of North Carolina model


  • A total of 1,030 patients were seen at the clinic during the study period. During the study period, monthly visits ranged from 12 total completed visits in August 2010 to 90 visits in March 2011. The number of patients seen per month was influenced by seasonal trends, school holidays, and staffing. Initially, the clinic was only open for 16 hours per week, but it expanded to being open 36 hours per week
  • The number of eligible patients increased as the number of patient encounters in the clinic increased, but the authors also believe it is extremely beneficial to have enrollment services provided through a patient navigator who is co-located at the clinic. Nevertheless, many patients fail to bring the paperwork required for the patient navigation visit, and some patients do not meet eligibility requirements. Overall, this collaborative model is successful in directing patients to a medical home in the community safety net. However, close collaboration with hospital systems and other community health care providers is paramount to help promote coordination of care, especially as resources for the safety net remain limited

Key takeaways/implications

  • Broader community prevention efforts are also needed to help modify social determinants that may negatively influence health among low-income, uninsured individuals. The authors hope is that the findings from this study can inform community collaborative efforts and planning by other safety-net providers to help leverage limited resources and increase access to care among uninsured individuals in North Carolina