Taxonomy II Part I-A.1 (Family Medicine Center Payor Mix)

Last Updated on April 16, 2022 by Lee Burnett, DO, FAAFP

NATIONAL PROJECT ON THE COMMUNITY BENEFITS

OF FAMILY MEDICINE RESIDENCY PROGRAMS

CUMULATIVE QUESTIONNAIRE RESPONSES

TAXONOMY SECTION II PART I-A.1

(Family Medicine Center Payor Mix)

SD II.1 (L7) Do you regard your residency program as a key access point for health care services to a disenfranchised population?  Yes __ No __

If yes, explain:

Yes:

Dayton

Decatur                        (No doctor Emergency Room admits)

Indiana U Methodist     (Urban population)

Kansas U                     (Yes, mostly acute and critically ill – No, less routine healthcare)

Klamath Falls               (We and the local FQHC provide most access for Medicaid and Uninsured population)

Mercer                         (Our walk-in clinic (open 8 am to 7 pm) provides care to any patient unable to see their personal physician in a timely manner)

Riverside                      (It is a safety net hospital program)

Salt Lake City              (1/2 FPR co-located in 2 CHC sites serving underserved; 1.2 FPR located in “private” university facilities)

UC Irvine                     (Our family practice center is a federally-qualified health center.  It is the major outpatient source of health care for uninsured/ underinsured patients in our health system)

UC San Diego              (We are the only ones in the university who provide primary care for uninsured)

Whittier

No:

MCE Birmingham

Lexington

Yes (site-visited profiled programs):

Northridge                    (On two levels:  we act as the panel admitting physicians for hospital emergency room including obstetrics and pediatrics; and as an outpatient family practice center with a large medical and underserved population. The FPR will see anyone for acute care. Do the EMTLA (emergency room and clinic) rules affect other programs as much as at Northridge Hospital where the effect is huge?  No patient can be triaged or refused care.)

UCLA                          (We are only county-run family medicine clinic in the San Fernando Valley; and are responsible for three homeless clinics)

Harbor                         (For the uninsured working poor, for those with documentation issues (illegal aliens), the homeless, and teens at high risk)

UCSD Traditional         (Care is provided at community health center sites, especially St Vincent de Paul Village; and at student-run free clinics.  UCSD Hillcrest is filled with unfunded patients.  We take unassigned call every five days.)

Scripps Chula Vista      (By expanding services in CHCs, providing access to sliding fee scales, up to 100% discount with a $10 co-pay; inpatient coverage for much of San Ysidro CHC and satellite clinic patients)

UCSD St Vincent

White Memorial            (Program located in East Los Angeles, a Health Professional Shortage Area; population is reflected in FHC patient base, with 90% Medi-Cal/Healthy Families and 10% other)

Riverside                      (For the uninsured; for Medi-Cal; for the homeless)

Durant                          (We have become the community’s major primary care provider for Medicaid and the indigent)

OSU Tulsa                   (We are one of the largest access points for Medicaid in the State of Oklahoma)

USC Univ & SG          (The Pasadena (San Gabriel Hospital) family practice center and community health centers serve veterans, Medi-Cal PPOs, Healthy Families)

Modesto                      (We are the safety net provider for Stanislaus County, California.  We provide all medical care services for medically indigent adults and 65% of Medicaid (with the Golden Valley community health center providing the remainder)

Saints                           (We are the only program to take Medicaid in a geographical area with a large Medicaid population.  We see 60 patients a day, all impoverished and disenfranchised.)

Indiana U Methodist     (We serve an urban, racially diverse Medicare, Medicaid, uninsured, disadvantaged patient population)

Whittier                        (We serve patients with no primary care doctor, no insurance, Medicaid, the homeless, and tertiary care patients from          Harbor/UCLA, UCI, the VA, LAUSC and UCLA Med Center that live in our community.)

Pomona                        (We serve the homeless, mentally ill, patients with end stage chronic disease, people of color, and the unemployed)

Arrowhead                   (We are the providers of care for all indigent patients of San Bernardino County)

Loma Linda                  (75-85% of the patients that the residents care for are underserved, based on their demographics and place of residence)

Stockton                      (Our clientele is comprised of the indigent and Medi-Cal recipients.  There are not enough doctors who serve these groups)

Louisville                      (We accept new patients; we do not discriminate on the basis of insurance; our residents participate in indigient clinics; the GLO clinic is run with medical students and faculty and operates as a free clinic; the HOPE clinic operates out of a church; the teenage pregnancy clinic TAPS operates at two sites through the AHEC program and through Kentucky’s KICS program)

MCE Birmingham         (Except for the ER, we are the only provider in the hospital group that accepts Medicaid.  Although we are not a free clinic, about 60% of our patients are Medicaid)

Glendale                       (We are located within a federally-designated Medically Underserved Area; we have a proportionately large percentage of Medi-Cal, recent immigrants; because we provide comprehensive services, patients have access to a lot of care they might not otherwise receive; our faculty and residents in the aggregate are fluent in a range of languages represented in the community, which attract patients to this residency program)

OU Tulsa                     (The residency program serves an indigent population and a Hispanic population, a high proportion of which are undocumented aliens.  It is one of the largest providers of Medicaid in the region, especially for obstetrics)

OU Oklahoma City      (50% of 56,000 annual visits are Medicaid; 47% are uninsured; 16% are Medicare)

*NPCB P2 1.1 (SD II.1.1a (new)) Does your residency program provide the medical home for substantial numbers of patients in the following categories:

Medicaid patients in capitated systems? Yes __ No __

If yes, estimate percentage (of total patients) ___

Yes:

Dayton Community       (60% at Good Samaritan FHC; 25% at Indian Ripple FHC)

Miami Valley                (48%)

Natividad                     (50%)

Klamath Falls               (50%)

Lehigh Valley                (35% – just about all Medicaid are capitated)

Mercy Toledo              (15-16%)

Kaiser LA                    (5-10%)

Las Vegas                    (10%)

Fresno                          (45%)

OHSU Portland            (The percentage differs at each clinic. OHSU: 23%; Gabriel Park 13%; Richmond: 53%)

Yes (2005 E-mail Questionnaire):

Harbor                         (25%)

UC Irvine                     (20%)

Loma Linda                  (65%)

Glendale                       (35%)

Yes (Phase 2 Responses):

Sparrow                       (24%)

Long Beach                  (32%)

U Penn                         (23%)

Crozer-Keystone          (26%)

Jefferson                       (33%)

McKeesport                 (70%)

Oahu                            (5%)

Shadyside                     (3%)

Johnstown                    (18)

Altoona                        (15%)

St Margaret                  (20%)

No:

Decatur

Mercer

Tyler

Springfield

Glasgow

Lexington

No (2005 E-mail Questionnaire):

UCSD St Vincent

Modesto

Arrowhead

No (Phase 2 Responses):

Huntsville

Ventura

Fairfax

*SD II.1.1b (new) Does your residency program provide the medical home for substantial numbers of patients in the following categories:

Medicaid patients not enrolled in capitated systems? Yes __ No __

If yes, estimate the percentage (of total patients) ___

Yes:

Miami Valley                (2%)

Decatur                        (25%)

Mercer                         (25%)

Natividad                     (7%)

Klamath Falls               (5%)

Lehigh Valley                (Very few; Pennsylvania is all capitated except for the first month)

Mercy Toledo              (2-3%)

Tyler                            (18%)

Las Vegas                    (7.5%)

Fresno                          (15%)

Springfield                    (35%)

Glasgow                       (35%)

Lexington                     (19-21%)

OHSU                         (The percentage differs at each clinic. OHSU: 12%; Gabriel Park 7%; Richmond: 27%)

Yes (2005 E-mail Questionnaire):

Harbor                         (1%)

UCSD St Vincent         (4%)

UC Irvine                     (5%)

Modesto                      (82%)

Arrowhead                   (27%)

Loma Linda                  (28%)

Glendale                       (25%)

Yes (Phase 2 Responses):

Huntsville                      (?)

Ventura                        (60%)

Long Beach                  (15%)

Crozer-Keystone          (01.6%)

Jefferson                       (1%)

Oahu                            (30%)

Shadyside                     (_)

Johnstown                    (18%)

Altoona                        (15%)

St Margaret                  (6%)

Fairfax                          (1%)

No:

Dayton Community

Kaiser LA                    (They are seen in the free clinics that are part of the residency experience)

No (Phase 2 Responses):

Sparrow

U Penn                         (Only a few visitors from out of town)

McKeesport

*SD II.1.1c (new) Does your residency program provide the medical home for substantial numbers of patients in the following categories:

Medicare patients? Yes __ No __

If yes, estimate percentage (of total patients) ___

Yes:

Dayton Community       (25% at Good Samaritan FHC; 40% at Indian Ripple FHC)

Miami Valley                (20%)

Decatur                        (22%)

Mercer                         (25%)

Natividad                     (10%)

Klamath Falls               (30%)

Lehigh Valley                (20%)

Mercy Toledo              (40%)

Kaiser LA                    (20-25% of practice; 80% of inpatients)

Tyler                            (50%)

Las Vegas                    (43%)

Fresno                          (10%)

Springfield                    (15%)

Glasgow                       (20%)

Lexington                     (12%)

OHSU Portland            (The percentage differs at each clinic. OHSU: 15%; Gabriel Park 40%; Richmond: 10%)

Yes (2005 E-mail Questionnaire):

Harbor                         (12%)

UCSD St Vincent         (4%)

UC Irvine                     (30%)

Modesto                      (11%)

Arrowhead                   (14%)

Loma Linda                  (3%)

Glendale                       (10%)

Yes (Phase 2 Responses):

Sparrow                       (14%)

Huntsville                      (?)

Ventura                        (20%)

Long Beach                  (5%)

U Penn                         (17%)

Crozer-Keystone          (9%)

Jefferson                       (10%)

McKeesport                 (20%)

Oahu                            (25%)

Shadyside                     (25%?)

Johnstown                    (28%)

Altoona                        (30%)

St Margaret                  (15%)

Fairfax                          (15%)

*SD II.1.1d (new) Does your residency program provide the medical home for substantial numbers of patients in the following categories:

Medically indigents/uninsured/self-pay? Yes __ No __

If yes, estimate percentage (of total patients) ___

Yes:

Dayton Community       (10% at Good Samaritan FHC; 5% at Indian Ripple FHC)

Miami Valley                (10%)

Decatur                        (4%)

Mercer                         (5%)

Natividad                     (23%)

Klamath Falls               (5%)

Lehigh Valley                (10%)

Mercy Toledo              (5%)

Tyler                            (7%)

Las Vegas                    (18%)

Fresno                          (25%)

Springfield                    (3%)

Glasgow                       (24%)

Lexington                     (27%?)

OHSU Portland            (The percentage differs at each clinic. OHSU: 1%; Gabriel Park 1%; Richmond: 10%)

Yes (2005 E-mail Questionnaire):

Harbor                         (50%)

UCSD St Vincent         (92%)

UC Irvine                     (45%)

Modesto                      (6%)

Arrowhead                   (57%)

Loma Linda                  (2%)

Glendale                       (5%)

Yes (Phase 2 Responses):

Sparrow                       (51%)

Huntsville                      (?)

Ventura                        (10%)

Long Beach                  (2%, through its Westside CHC linkage)

U Penn                         (<1% uninsured <4% undetermined)

Crozer-Keystone          (11%)

McKeesport                 (5%)

Oahu                            (8%)

Shadyside                     (12%?)

Johnstown                    (2%)

Altoona                        (30%)

St Margaret                  (15%)

Fairfax                          (4%)

No:

Kaiser LA                    (Yes, in the free clinics in which the residency participates)

No (Phase 2 Responses):

Jefferson

*SD II.1.1e (new) Does your residency program provide the medical home for substantial numbers of patients in the following categories:

Private sector health insurance? Yes __ No __

If yes, estimate percentage (of total patients) ___

Yes:

Dayton Community       (5% at Good Samaritan FHC; 30% at Indian Ripple FHC)

Miami Valley                (20%)

Decatur                        (49%)

Mercer                         (45%)

Natividad                     (10%)

Klamath Falls               (10%)

Lehigh Valley                (35%)

Mercy Toledo              (36%)

Tyler                            (25%)

Las Vegas                    (21%)

Fresno                          (5%)

Springfield                    (47%)

Glasgow                       (19%)

Lexington                     (31%+)

OHSU Portland            (The percentage differs at each clinic. OHSU: 60-70%; Gabriel Park 60-70%; Richmond: 1%)

Yes (2005 E-mail Questionnaire):

Harbor                         (3%)

Modesto                      (1%)

Arrowhead                   (2%)

Loma Linda                  (2%)

Glendale                       (25%)

Yes (Phase 2 Responses):

Sparrow                       (5%)

Huntsville                      (?)

Ventura                        (10%)

Long Beach                  (Commercial capitated: 31%; See Tricare under “Other” below)

U Penn                         (55-60%)

Crozer-Keystone          (50%)

Jefferson                       (53%)

McKeesport                 (5%)

Oahu                            (25%)

Shadyside                     (12%?)

Johnstown                    (34%)

Altoona                        (20%)

St Margaret                  (34%)

Fairfax                          (80%)

No:

Kaiser LA                    (Generally not)

No (2005 E-mail Questionnaire):

UCSD St Vincent

UC Irvine

*SD II.1.1f (new) Does your residency program provide the medical home for substantial numbers of patients in the following categories:

Other category? Yes __ No __

If yes, estimate the percentage __

Describe the category _________________________________

Yes:

Glasgow                       (New employee physicals: 2%)

Yes (2005 E-mail Questionnaire):

Harbor                         (9%)

Yes (Phase 2 Responses):

Sparrow                       (6%)

Long Beach                  (15% Tricare PPO and straight combined)

U Penn                         (<3% Workman’s Comp; Auto Insurance)

Crozer-Keystone          (02.4% auto, commercial, CHAMPUS, Workman’s comp)

Jefferson                       (3%)

Oahu                            (7% Workers Comp; No-Fault Insurance)

Shadyside                     (?)

Altoona                        (10% Title X)

St Margaret                  (8% Family Health Council State Funds for Gynecologic Needs of Underserved)

No:

Dayton Community

Miami Valley

Decatur

Mercer

Natividad

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

Las Vegas

Fresno

Springfield

Lexington

OHSU Portland

No (2005 E-mail Questionnaire):

UCSD St Vincent

UC Irvine

Modesto

Arrowhead

Loma Linda

Glendale

No (Phase 2 Responses):

Huntsville

Ventura

McKeesport

Johnstown

Fairfax

*NPCB P2 II.2.2 (SD II.2.2 (new)) Does your residency program have a mechanism in place to determine if uninsured patients are eligible for Medicaid or other sources of health care reimbursement? Yes __ No __ If yes, describe:

Yes:

Dayton Community       (We use a social worker to determine eligibility)

Miami Valley                (We use a software program with 11 screens; if no insurance is found through that mechanism, a social worker will attempt them to find them appropriate reimbursement, if possible)

Decatur                        (Because the principal provider of care in the community is a community health center, we refer uninsured patients to the Public Aid Office, which arranges for their care at that center)

Mercer                         (We are part of a large system; we have indigent clinics available in Macon, or help the indigent apply to Medicaid, assisted by two accounting clerks trained in Medicaid enrollment processes.)

Natividad                     (Our hospital has financial counseling office, located 20 yards away from us)

Klamath Falls               (The staff of hospital social workers know the eligibility requirements of the Oregon Health Plan.  We refer patients to Cascades Comprehensive Care, an MCO for OHP, or to CareOregon)

Lehigh Valley                (We have a financial counselor, through the hospital, to assess eligibility; an officer manager starts a process, using an evaluation form that is synchronized with the appropriate enrollment form)

Mercy Toledo              (The front office is set up to plug patients into reimbursement resources; the patients receive informational packages.  The central hospital office is the principal coordinator)

Kaiser LA                    (If a non-plan patient seeks services, the services are provided.  We then explore other sources of healthcare reimbursement.)

Tyler                            (The hospital determines eligibility before referral to the family medicine center)

Las Vegas                    (Inpatient: yes; outpatient: no)

Fresno                          (The front desk at UMC and Sequoia FMCs does this)

Springfield                    (Patients work with central group collections to determine if they qualify fo Medicaid, Kidcare, or charity care)

Glasgow                       (Patients are screened and counseled when they present.  We look for any and all ways to help them take care of needs, but no social worker is on site; we have a Community Medical Care program for working, uninsured patients from Barren County, Kentucky)

Lexington                     (There is a part time social worker associated with this assignment; KMFS has patient finance worker who screens uninsured patients)

OHSU Portland

Yes (Phase 2 Responses):

Sparrow                       (We have a patient support services section for in-patients and a Medicaid office for outpatients)

Huntsville                      (There is a unified business office for all academic practices; a person in that office is in charge of determining eligibility)

Ventura                        (There is an eligibility office across our parking lot that helps persons qualify)

Long Beach                  (An eligibility office is adjacent to the family medicine center; it has employees trained in qualifying persons for capitated Medicaid programs)

U Penn                         (Our billing office)

Crozer-Keystone          (Our billing coordinator meets with patients to get them on a payment plan or refers them to the social services coordinator)

Jefferson                       (A social worker, social work students and office manager help persons obtain reimbursement)

McKeesport                 (Our medical assistants go through the process of helping the uninsured get on Medicaid)

Oahu                            (Our clinic manager counsels them)

Shadyside                     (We pay a social worker to do just that)

Johnstown                    (Hospital’s billing office and social services help us; if uninsured, we tray to find public assistance or charity care)

Altoona                        (case management services helps coordinate)

St Margaret                  (Social work referral in-house)

Fairfax                          (Case review by director of billing)

*NPCB P2 II.2.3 (SD II.2.3 (new)) Does your residency program assist such patients in enrolling in such reimbursement systems? Yes __ No __ If yes, describe how this is done:

Yes:

Dayton Community       (A social worker helps with paperwork)

Miami Valley                (Through our social worker)

Decatur                        (See answer to question SD II.2.2 above)

Mercer                         (See answer to question SD II.2.2 above)

Natividad                     (The counseling office is staffed by county social services eligibility workers)

Klamath Falls               (We refer them to the correct agencies to assist them)

Lehigh Valley                (We give them the proper forms; help with contacts.  There is a Sliding fee scale through the hospital’s charity care program and access to pharmaceutical assistance)

Mercy Toledo              (See answer to question SD II.2.2 above)

Kaiser LA                    (We look to get reimbursed for any care delivered, whenever possible)

Las Vegas                    (We give them the telephone number and address of where they need to apply; we do not do their paperwork)

Fresno                          (A financial person at front office assists them)

Glasgow                       (We give them telephone numbers; we facilitate the process)

Lexington                     (The group practice does this rather than the academic department, except the latter provides the social worker.  There is some help with prescription drugs)

OHSU Portland

Yes (Phase 2 responses):

Sparrow                       (A case worker in the Medicaid office assists with application; ineligible hardship cases can apply to health system for assistance)

Huntsville                      (Our business office does this for the residency program)

Ventura                        (Eligibility office helps patients qualify)

Long Beach                  (Adjacent eligibility office assists patients)

Jefferson                       (Social workers do this)

McKeesport                 (Persons not eligible for Medicaid can seek charity care from University of Pittsburgh Medical Center; we also have ties with an FQHC that might be used)

Oahu                            (We submit applications to Medicaid, put patients on a grant for uninsured care during interim that Medicaid application is processed)

Shadyside

Johnstown

St Margaret                  (We do a one-on-one review of application questions with patients to help them qualify for the UPMC free care program or other revenue sources)

Fairfax                          (Director of billing puts patient in contact with community eligibility offices)

No:

Tyler

Springfield

No (Phase 2 responses):

U Penn

Crozer-Keystone

Altoona

NPCB P2 II.4 (SD II.4 (New)) Does your program use a sliding fee scale for lower income patients?  Yes __ No __ Comments:

Yes:

Scripps Chula Vista      (The program is fully integrated with San Ysidro Health Systems.  This can be leveraged by UCSD to allow for specialty care.)

UC Irvine

Durant

OSU Tulsa

USC Univ & SG

Modesto                      (In Hughson Medical Office; some discounting elsewhere in system)

Whittier

Pomona

Arrowhead                   (We talk with patients to get an idea of their financial situation; we make arrangements for a comfortable payment plan)

Loma Linda                  (Yes, at the Sac Norton clinic; no in the Loma Linda family health center)

Stockton                      (These arrangements are set up through the business office.  Each patient receives a financial screening)

Louisville

MCE Birmingham         (We work with our patients and discount services, but do not do financial assessments.  We will take as little as $25/visit)

Glendale

OU Tulsa

OU Oklahoma City      (A financial eligibility test is administered, with documentation and approval required)

Dayton Community       (The hospital just instituted one)

Miami Valley                (Patients meet with social workers first, then the billers)

Natividad

Lehigh Valley                (There is a sliding scale charity care system; not the traditional fee scale, but one that is responsive to the uninsured)

Mercy Toledo

Kaiser LA                    (For Medicaid patients only; the remainder of the patients are covered by the terms of their employer’s health plans)

Tyler

Las Vegas

Fresno                          (Selma and Sequoia FMCs do)

Springfield                    (Difficult form to fill out)

Glasgow

OHSU Portland

Yes (Phase 2 Responses):

Huntsville

No:

UCSD Traditional

UCSD St Vincent         (St Vincent de Paul Village operates a 100% free clinic)

White Memorial            (One is being developed)

Riverside                      (All patients are taken)

Saints

Indiana U Methodist     (No for clinical services, but yes for mental health)

Decatur

Mercer                         (There is a method to do so, by getting into the Anderson system)

Klamath Falls

Lexington

No (Phase 2 Responses):

Sparrow                       (Not formally; we have a hardship application, which may have a similar impact)

*NPCB P2 II.2.4.2 (5NWCB) Does your program have a formal mechanism for reducing or eliminating clinic charges for lower income patients?

Yes __ No __ If yes, describe:

Yes (Phase 2 Responses):

Ventura                        (We have a sliding fee scale for those patients that do not qualify for Medicaid, MIA or other programs)

Crozer-Keystone          (Sliding scale based on wages)

Jefferson                       (Sliding scale mechanism)

Oahu                            (We have kind of a sliding scale; we offer 20% discount for self-pay; we try to get people on uninsured care; we have a keen awareness of health care costs.  One of our faculty is a Robert Wood Johnson Fellow whose work is in prescribing to uninsured and Medicaid patients (learning how to control pharmaceutical costs and explaining what the “payment status” is of each pharmaceutical.)

Shadyside                     (UPMC has a mechanism for dispensing charity care, which is as bureaucratic as Medicaid.  There are formal processes for reducing both the front and backend costs.)

Johnstown                    (We have a “no charge” policy that is administered by the hospital billing office)

Altoona                        (We can refer women patients to our women’s health section, where care is based on stated, not verified, income)

St Margaret                  (Eligible patients can obtain UPMC financial assistance)

No (Phase 2 Responses):

U Penn

McKeesport                 (The UPMC Health System prohibits us from doing this; we would like to)

Fairfax

No Response Recorded:

Long Beach

*NPCB P II.4.3 (5NWCB) If the answer to NPCB P2 II.4.2 is no, does your program have an informal mechanism for doing so?  Yes __ No __ Describe:

Yes (Phase 2 Responses):

U Penn

McKeesport                 (We will help with some our family planning group; not very extensive)

Fairfax                          (Not a formal mechanism per se; however, at the discretion of the provider, we can reduce the charge by 25 or 50% and set up a billing plan with the billing supervisor)

*NPCB P2 II.5.1 (SD II.5.1 (New)) What are the principal payor sources for the patient care services provided by your residency program? (To the extent possible, provide such information for the past five years.)

UCSD Traditional         (Medicare; Medi-Cal; Capitated Medi-Cal (no longer accepted); Tricare (for U.S. Navy dependents); commercial managed care)

Scripps Chula Vista      (25% are uninsured; the remainder principally are Medicaid, Medicare and county services patients)

UCSD St Vincent         (No payors for past five years)

UC Irvine                     (Cal Optima 35-40%; unfunded (i.e., cash pay) 25-35%; Medical services for indigents 10-15%; remainder are a mix of Medicare, other indemnity insurance, HMOs other than Cal-Optima; and PPOs)

White Memorial            (Medicaid; state sponsored programs (SCHIP; Access for Infants and Mothers (AIM); California KIDS; Medicare; private insurance; state categorical pograms like FAMPAC, CPSP, CHDP; cash pay)

Riverside                      (principally Medi-Cal, followed by 2) Medicare and 3) Indigent Care)

Durant                          (Medicaid; sliding fee scale; private insurance; some private pay)

OSU Tulsa                   (Medicaid; Medicare; Title XIX funds from Social Security)

USC Univ                    (Medicaid PPO; non-Medicaid HMO)

USC SG                      (Veterans Administration contracts; Medicaid managed care; some private insurance)

Modesto                      (1, Medi-Cal; 2, the medically indigent adult program; 3, Medi-Cal Blue Cross; 4, faculty participation in various HMOs)

Saints                           (1, Medicaid; 2, Tri-Care (military); 3, Medicare; 4, private insurance)

Indiana U Methodist     (1, Medicare; 2, Medicaid; 3, Fee-for-service (Anthem Blue Cross/Blue Shield); 4, Implan (Methodist Hospital)

Whittier                        (1. 65% are capitated (including capitated Medi-Cal); 2. traditional Medi-Cal; 3. non-capitated Medicare; r. a slightly lower population of PPOs (10-15%))

Pomona                        (1, IPA-HMO (ProMed) which serves the Medicare community; 2, Managed Care Medi-Cal; Los Angeles Department of Health Services public-private partnerships; Healthy Families)

Arrowhead                   (County indigent services; Medi-Cal; Medicare; a very small HMO population through HealthNet and Blue Cross)

Loma Linda                  (Medi-Cal; Medi-Cal HMO; Medi-Medi)

Stockton                      (Medicare; Medi-Cal; Medi-cal HMO; County HMO; self-pay)

Louisville                      (A regional, state-sponsored Medicaid HMO (Passport); HUMANA; Anthem; Blue Cross/Blue Shield; Medicare; Medicaid)

MCE Birmingham         (Medicaid; Medicare; some Blue Cross and self pay)

Glendale                       (Medicaid; Medicare: HMO; PPO)

OU Tulsa                     (Medicaid; private insurance programs; PPO programs)

OU Oklahoma City      (Capitated Medicaid 50%; Commercial Insurance including PPOs 25%; Medicare 16%; self-pay 4%; non-capitated Medicaid 3%; other (including contract with Student Health Center 1%)

Dayton Community       (At Good Samaritan: 1) Medicaid; 2) Medicare; 3) Insured; 4) Uninsured; At Indian Ripple, 1) Private, 2) Medicare, 3) Medicaid, 4) Self-pay)

Miami Valley                (Medicaid 50%; Medicare 20%; Private Sector Insurance 20%; Self-pay 10%)

Decatur                        (Private insurance 50%; Medicare 25%; Medicaid 20%; 5”% Indigent; the hospital itself may have a 50% indigent patient population)

Mercer                         (Medicaid 25%; Medicare 25%; Private Health Insurance 20%; Other 5%)

Natividad                     (Capitated Medicaid 50%; Non-Capitated Medicaid 7%; Medially Indigent 23%; Private Sector Health Insurance 10%)

Klamath Falls               (Oregon Medicaid; Medicare; California Medicaid; Private Insurance)

Lehigh Valley                (Managed Medicaid did not exist 5 years ago; Medicare has stayed the same; other Medicaid increased slightly)

Mercy Toledo              (Capitated Medicaid 15-16%; Non-capitated Medicaid 2-3%; Medicare 40%; Medically Indigent 5%; Private Sector Health Insurance 36%)

Kaiser LA                    (Employer-based Kaiser plans; Medicare)

Tyler                            (Medicare 50%; Medicaid 18%; Private Pay 25%; Medically Indigent 7%)

Las Vegas                    (Same as above)

Fresno                          (Medicaid (capitated); MI; Medicaid straight; Medicare; private)

Springfield                    (Commercial firms have moved into managed care, but the proportions reported above remain the same)

Glasgow                       (Same as reported above)

Lexington                     (University HMO 31%; all other private insurers 38%; Medicaid 14%; Medicare 17%; self-insured/non-insured 8%)

OHSU Portland            (1-Medicaid; 2-Medicare; 3-Private Insurance)

Phase 2 Responses:

Sparrow                       (1-Medically Indigent/Self Pay, 51%; 2-Medicaid, capitated 24%, 3-Medicare, 14%, 4-Private Health Insurance, 5%)

Huntsville                      (Blue Cross/Blue Shield; Medicaid; Medicare)

Last Updated (28 May 2006 21:35)