2009 Finalist
Orange County, Florida
Innovations in American Government Awards
Innovations in American Government Awards

Orange County, one of the largest counties in the state of Florida, had the highest percentage of uninsured residents in the state despite the fact that three-quarters of the uninsured were employed. In 1999, a local hospital abruptly closed its doors. Soon after, the emergency room at another area hospital shut down and a public health clinic also closed its doors. As a result, uninsured residents of a large, underserved area in Orange County had no alternative but to access healthcare services at the remaining hospital emergency rooms or the one freestanding county clinic. Healthcare leaders saw the urgent need to address this community crisis. The mayor convened a task force that led to the development of the Primary Care Access Network (PCAN).

PCAN is a creative governance model comprised of the community’s healthcare safety net providers, including area hospitals, Federally Qualified Health Centers, government entities, private foundations, volunteer agencies, and faith-based organizations. These agencies, which previously worked independently and sometimes competitively, joined forces with a common mission to build a cost-effective model of care. Their focus was on leveraging resources, tapping state, federal and philanthropic funding, and developing political and community support.

PCAN currently operates ten primary care clinics and one secondary care clinic. In addition, ten afterhours clinics, operated by a faith-based group, are staffed by volunteers to treat patients with acute non-urgent medical needs. PCAN’s initial goal was to provide primary healthcare access to 40,000 of the working poor. Services for the uninsured have increased from 5,000 patients to more than 100,000 in eight years. In addition, PCAN's volunteer component has grown to approximately 1,600 healthcare providers. The value of these donated services was estimated to be $5.8 million in 2008.

Several studies have measured the PCAN population’s health status. One significant study was conducted by the Florida Hospital Cardiovascular Institute's Congestive Heart Failure Clinic, which was established in 2006 to provide underserved patients with access to specialty care for chronic heart failure management. The 2005 readmission rate of 39 percent has been reduced to only 4 percent since the clinic was opened. A second study was conducted to determine the value of a care management program targeting uninsured diabetic patients in two PCAN clinic locations. The program was developed because of the prevalence of diabetes in the uninsured ethnic and racial minority groups. Program participants realized improved health, skills, and knowledge for managing their diabetes as evidenced by a 21 percent decrease in glycated hemoglobin A1c (a measure of diabetes management) for graduates of the program and a 10 percent decrease for the total managed program population.