Community Health Care Reform: Introducing the 100%/0 Campaign
Folta, Jennifer, Scanlon, John, Public Management
Communities can provide full health coverage to every uninsured citizen, as well as eliminate the multitude of health disparities experienced by lower-income populations. This is the remarkable defining assertion behind the national "100% Access/0 Health Disparities" Campaign.
In 1998, managers from the federal Bureau of Primary Health Care, U.S. Department of Health and Human Services, launched what became the 100%/0 campaign. In managing federal grants for community health centers, they had encountered innovative and successful community efforts to transform local health care safety nets.
The bureau team believed that, through sharing these "models that work," the bureau could help all 3,000 communities across the United States achieve 100 percent access to integrated health systems. Today, many local government managers and staffs are using these goals and lessons to improve health care access programs in their communities.
The story of the campaign was recently related in a report published by the IBM Center for the Business of Government (see box on page 27). It is really two stories. One tells how managers can deliver results on a mission that goes beyond the reach of the programs they are responsible for. The other is about the different approaches that community leaders follow to accomplish 100 percent access to health care systems. Both stories involve the art of leadership in creating coalitions, collaborations, and partnerships.
The bureau manages a $1 billion grant program that supports 650 community health centers and serves 9 million people annually. Its mission is to assure that vulnerable populations have access to primary and preventative health care. It is estimated that the programs meet 10 to 20 percent of the need; the reach falls far short of the mission. For this reason, a small group of managers in the bureau came together as the 100%/0 team to extend their reach. They did it by forming partnerships with national networks and with communities in action.
The team sought out potential national partners who had links to community leaders and who, for whatever reason, were interested in seeing communities achieve 100%/0. Each national partner could turn on a point of influence in a community or a local champion. With so many stakeholders in any local health care system, hundreds of possible local champions could be engaged.
The team formed "performance partnerships" with a number of organizations, including ICMA, United Way of America, the National Association of Counties, and the American Academy of Pediatrics. Each organization agreed to enroll a certain number of communities in the campaign through its membership.
The campaign is communities aggressively transforming their own health care systems. It is a way for communities to support each other, as each community goes through a formal process with these four stages:
Commit: Develop political will
Build: Restructure community assets
Perform: Deliver care, improve health
Success: Serve as benchmark for 100%/0 achieved
The bureau team, with its national partners, used national, state, and local events called "pacing events" to help find and enroll community champions and to present community benchmarks of success. "Models that work" were benchmark communities that had achieved their versions of 100 percent access. The local leaders would tell the story of how their communities came together to move through the four stages. Their stories both inspired and instructed.
It turns out that there is an exciting variety in the approaches and sources of leadership that mark the "models that work." Ultimately, the solution is a new partnership among local government, multiple health-system providers, the faith community, and the philanthropic and business sectors. The way to this solution and its final form, however, is unique to a given community. …