The County of Philadelphia (which shares boundaries with the City of Philadelphia) has a population of over 1.5 million more than half of which is made up of ethnic minority groups. 23 percent of the city’s population is below poverty, and approximately 94,000 Philadelphia residents lacked health insurance in 2000. Statewide, the level of uninsurance was 11 percent, a total of 1.38 million people.3 A total of 468,843 Philadelphians were enrolled in Medicaid in 2003.4 Uninsured and low income populations in Philadelphia are served by two types of ambulatory care providers: those operated by the Philadelphia Department of Public Health’s Ambulatory Health Services (AHS) office and stand alone consolidated health centers supported primarily by BPHC. Although, the health department-run clinics are federally qualified health center (FQHC) look-alike clinics, they are supported primarily through local government dollars.
City-wide, AHS operates eight health care centers annually serving 100,000 patients who produce 330,000 visits. The majority of these patients are uninsured. The seven stand-alone health centers (many with multiple sites) in Philadelphia are all HFP members. Patient demographics and payor mix differ by health center and site. Generally, Medicaid beneficiaries make up more than half of the patient population at HFP consolidated health centers and another 24-40 percent of these individuals are uninsured. HFP and AHS collaborate on many fronts including the data warehouse. Stakeholders describe HFP as a de facto Primary Care Association for Philadelphia’s safety net health centers.
Methods. The site visit to Philadelphia, which took place on February 27, 2004, involved initial telephone and email contacts followed with in-person interviews with 24 respondents representing 7 institutions involved in the primary health care safety net in the city. Table 1 below lists all health centers and other stakeholders interviewed as part of the site visit and follow-up telephone calls.
Consolidated HealthCenter Respondents
|Greater Philadelphia Health Action||GPHA is the largest member of the HFP, with 7 sites across Philadelphia. It is a CHC and serves 48,000 patients through over 110,000 billable encounters per year.|
|Delaware Valley Community Health||DVCH is the second largest member CHC, with 3 sites serving 26,978 patients over 112,611 encounters in 2003. The center is currently implementing a pilot electronic medical record (EMR) program.|
|Covenant House Health Services||Covenant House saw 7,100 patients in 2003 and is planning to expand. The center is the only CHC in the northwest section of Philadelphia.|
|Spectrum Health Services||Spectrum Health operates 2 sites and serves around 7,000 patients annually. It is a CHC and was one of the HFP’s founding members.|
|Quality Community Care||Quality Community Care is a CHC operating four sites around Philadelphia, 2 of which are school based. They serve 12,000 patients annually.|
|The Health Federation of Philadelphia||The HFP is a member organization for safety net health centers in the Philadelphia area. It currently has seven member consolidated health centers and works closely with the city’s Department of Health.|
|Philadelphia Department of Public Health, Office of Ambulatory Health Services (AHS)||AHS operates 8 safety net Health Centers located in Philadelphia, which combined serve 100,000 people annually. AHS is planning on contributing its patient data to the Health Federation’s data warehouse.|
Telephone and in-person interviews with respondents were conducted using open-ended discussion guides, providing for a consistent structure to each exchange while allowing sufficient flexibility to capture all relevant information from respondents. In addition, a table shell was emailed to information systems staff at respondent health centers prior to the site visit to facilitate collection of standard information relating to infrastructure and technical capacity. For each scheduled site visit interview, the NORC team prepared materials that outlined our preliminary knowledge of the respondent and highlighted outstanding questions to address during the interview. Examples of discussion guides, other data gathering tools and preparation materials used in the site visit are included as Appendices A and B.