Wisconsin: Milwaukee County General Assistance Medical Program's Community-Based Primary Care Model

August 11, 2004

Overview


Wisconsin's General Assistance Medical Program (GAMP) provides health care coverage to indigent Milwaukee County residents who are not eligible for other forms of public coverage (such as Medicaid and the State Children's Health Insurance Program) and are not enrolled in private coverage. The county redesigned the GAMP program into a community-based primary care model in the late 1990s to achieve two interrelated goals: to provide increased primary care services, and to do so via community-based clinics. The new design was intended to improve effectiveness and efficiency of care. Prior to this, indigent patients relied on the emergency room of the county hospital, which created access barriers for enrollees and cost inefficiencies for the county. Under the redesigned model, GAMP enrollees select a participating clinic as their primary care provider, which is then responsible for providing and coordinating services. The clinic coordinates specialty care for the enrollee by working with specialists and hospitals that participate in the GAMP network. The program covered a total of 24,000 individuals in calendar year 2003, with some 10,000 to 12,000 individuals enrolled at any given time. All in all, GAMP estimated that it saved $4.2 million in 2000 (in comparison to the projected costs had the previous system remained in place). Administrators believe that inpatient and outpatient costs have been controlled largely through a Utilization Management program that ensures delivery of care in the appropriate settings and using appropriate resources.

October 2004