April 2004 · Volume 86 · Number 3

Community Health Care Reform 
Introducing the 100%/0 Campaign 

by Jennifer Folta and John Scanlon
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
ICMA’s Health Success Project

ICMA began a partnership with the Bureau of Primary Health Care in October of 2000, to work with communities in achieving 100 percent access and zero health-status disparities. ICMA worked with local governments in communities identified by the Health Resources and Services Administration as having the greatest need for better access to health care (or designation as medically underserved areas) and as having disparities in health status (high infant mortality rates, low average life expectancy, and other indicators).

ICMA, through its Health Success project, has increased the awareness and involvement of local government professionals in improving access to health care. It provides educational materials highlighting community initiatives through ICMA’s extensive communication network, and cultivates national leadership roles through a core group of local government managers who work toward creating a peer mentoring system.

Local government managers and their staffs can learn more about the 100%/0 campaign by contacting Jennifer Folta at 202/962-3554 or at jfolta@icma.org. A CD-ROM of ICMA’s recent Webcast entitled Saving Money, Saving Lives: Improving Local Government Access to Healthcare will be available for purchase on May 1, 2004, at http://lgean.org. 

The report on the 100%/0 campaign cited in this article can be obtained through the IBM Center for the Business of Government, at www.businessofgovernment.org. The report is entitled Extraordinary Results on National Goals: Networks and Partnerships in the Bureau of Primary Health Care’s 100%/0 Campaign and was written by John Scanlon.

The IBM Center is an important resource on management practice for city and county managers. It contains a large set of timely reports and books on the latest innovations in government management, and it follows trends in federal, state, and local government management practice by funding and publishing empirical research. For information on applying for a research grant, visit the Web site at www.businessofgovernment.org/research.asp.	
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.

The IBM report highlights two of the original models that work. Buncombe County, North Carolina, is a small rural community where 100 percent access has been achieved through physician leadership, in partnership with county government. County government’s commitment to primary care has been aligned with Project Access, a physician volunteer care program involving the entire physician community.

Project Access gives the uninsured efficient, timely access to specialty care and to pharmacy services. With the program in place, the primary care safety net has experienced dramatic improvements in productivity and capacity, and the hospital system has seen important reductions in emergency-room use. With the safety net operating as an integrated delivery system, Buncombe County is able to provide almost all of its 15,000 uninsured residents with access to health care. The Buncombe County Medical Society and its director, Alan McKenzie, are playing leadership roles in bringing this model to dozens of other communities.

Hillsborough County, Florida, another early success, took a different path. The trigger was a property-tax crisis caused by state requirements to provide indigent care. Political leaders and county government managers organized a community campaign to adopt a new financing strategy: a special sales tax. They replaced an emergency-driven delivery system in financial crisis with a comprehensive, coordinated managed-care network that drove costs down.

The program was seeing 34,000 of the estimated 39,000 potential enrollees by 1998. This county government program has tracked dramatic increases in access and reductions in costs. Phyllis Busansky, a former elected county commissioner who led the campaign, sees the Hillsborough model as a way to achieve “better health for more people at less cost.” She works with communities to find the special financing strategy that works locally.
Today, the 100%/0 campaign is a national movement that involves hundreds of communities and is coordinated by several national organizations. Additional information on this campaign is available through the Community Health Leadership Network, Communities Joined in Action, by visiting the Web site at www.cjaonline.net; e-mail can be directed to CJA@crhn.org.
To learn more about how Project Access can be started in your community, visit the Web site of the American Project Access Network, at www.apanonline.org. To find out how a community can organize itself as a regional access network able to deliver 100 percent access, visit the Georgia Health Policy Center, through its Web site at www.gsu.edu/ghpc.

Jennifer Folta is a project manager at the International City/County Management Association (jfolta@icma.org), Washington, D.C., and John Scanlon is a partner, JSEA, Inc. (jwscanlon@aol.com), Fairfax, Virginia.