"They all said she needed a specialist, but [before the program] I just couldn't afford it. Because of the program, I feel I can take my children in to see a doctor before something gets worse. To me it's the community helping the community. You can see who you're helping and you can see it's being used wisely."

- Christina Pace,
CHP member whose daughter has had a damaged ear drum reconstructed.

In the third year of the program, a new approach to case management settles in. Members are asked to think about the decisions that they are making and the resources that are available to them, the alternatives, the different ways of thinking about themselves and about their health.

During the third year, forms are simplified, data collection improved and individual goals moved closer to where the members are when they join the program. The rate of disenrollment for non-compliance falls. CHP members are beginning to call to reschedule missed appointments, something not often seen in the first two years.

Also in the third year, Clara Kyle reaches further out into the community, into schools, businesses and programs such as congregational nursing; in addition, she links up with referral sources such as Workforce Development Services and the Minority Business Development Coalition. By December enrollment has reached 750.

As the third year ends, Memorial commits to continued financial support, estimating that at the current rate of growth, the program will be serving 765 members by the end of 1997. By December 1997, enrollment does in fact reach 750. By that time, the enrollment area includes all of St. Joseph County. In fact, demand is beginning to stress the capacity of the program, as Indiana has entered the realm of welfare reform and hundreds of people, usually women, are no longer eligible for Medicaid. A second outreach worker is hired, and a second case manager is on staff. Over 250 physicians/providers are involved with CHP - more than 80 of them primary care providers. Health care providers from outside St. Joseph County and from outside the state are beginning to show an interest in replicating the program.

Bruce Greenberg: "I have learned. I know now that there is a relationship between providing health care and social issues. It's more than just arranging physician care. And others have learned too. They've learned that there's a limited amount of money and that you do have to be flexible. I think we've brought CHP a long way. I think the program has benefitted from a conservative and disciplined business perspective."

Marco Mariani, City Planner in South Bend: "If you're going to help a community, at some point you're going to have to decide if you're going to put your efforts into the physical or the social - into buildings and streets or into people. A lot of times the city has to concentrate on the physical, but thank God there's programs like CHP that can concentrate on people."

Mike Mather: "People used to go to the clinic and wait hours, sometimes most of a day. CHP has changed that. It's made primary care important for people and that's valuable. People's attitudes have changed, behavior has changed."

John Hagen: "The program helps people who don't know how to use the system. We've broached a subject that's larger than number of visits to the doctor: the program is working on larger health care determinants."

Phil Newbold: "You don't get your health through a physician. You get your health through the decisions that you make every day, and CHP is trying to help people make better decisions."

Alan Snell: "We've lowered costs and raised health care habits. We've created value while using fewer resources."

Janine Chambers: "The people that are doing this all have skills and expertise, and while the organizations they work for may operate differently, each partner brings something of value to the process. The difficult thing is to trust enough that you can open up and receive what other people have to offer."