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MSSC
PROJECT ACCESS
Wichita,
KS
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Objectives
See Program Design
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Program Design
Project
Access is a physician-led, community-based effort to coordinate donated medical
care and services for low-income, uninsured residents of Sedgwick County,
Kansas. It is based on a model implemented by the Buncombe County
Medical Society in Asheville, North Carolina. Project Access has expanded
and now coordinates a variety of other projects as well. Additional
activities include a Call-A-Nurse service available for enrolled patients on
evenings and Saturdays, a hospital emergency department case management program,
several large-scale data studies, a new volunteer dental initiative, and patient
and provider education activities.
According
to updated 2002 Census Bureau statistics, the population of Sedgwick County
includes approximately 453,000 residents. An estimated 50,000 Sedgwick
County residents are uninsured based on figures gathered from a Community Health
Assessment Project completed by the University of Kansas School of
Medicine-Wichita (KUMC) in 1998 and updated in 2001.
Eligibility
determination and enrollment occur through a network of low-cost community
clinics when patients need specialty care that is beyond the scope of their
primary care clinic providers. Full time eligibility specialists, employed
by the Social Rehabilitation Services, are co-located at these community
clinics. The eligibility specialists determine patients' eligibility for
Project Access and other programs including Medicaid, S-CHIP (Healthwave in
Kansas), food stamps and other services.
Participating
physicians and the primary care residency programs may also request enrollment
for their patients on their established caseload. Staff in the Project
Access office processes these enrollments.
Project
Access eligibility criteria include patients who:
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Are
US citizens or lawful permanent residents
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Reside
in Sedgwick County
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Have
no health insurance coverage and are not currently receiving Medicaid,
Medicare or other medical benefits (although eligible patients will be
assisted in applying for these programs when appropriate)
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Have
a household income at or below 150% of the federal poverty level
Patients
are enrolled for three months for specialty care and six months for primary
care. They may have their enrollment extended if they are still being
treated by participating physicians and are still eligible for the
program. Enrollees receive a Patient Identification Card and a
Prescription Card and are then referred to physicians to access care and
services. Project Access offers a prescription program (patients pay a
$4.00 co-pay per prescription). City and County funds cover prescription
medication costs. Providers report the contributions to care to the
Project Access office for tracking purposes. Approximately 75% of Medical
Society members participate, all area hospitals donate services, 65 pharmacies
fill prescriptions at 15% average wholesale cost and do not charge filling fees,
and other providers offer donated services including hospice care, some lab work
and some durable medical equipment. A variety of computer programs are
utilized to track patient enrollments, demographics, provider commitments, and
administrative data regarding specific care and services provided.
Project
Access has also implemented a hospital emergency department case management
project. Case Management teams (consisting of nurses and social workers)
are placed at all four emergency departments. Teams work specifically with
high utilizers of the ERs. Goals include assisting patients in connecting
to primary care providers, providing health related education and information
for patients to help them take a more active role in managing their healthcare.
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Financing & Outreach Strategies
Financing Strategy
Project Access receives
in-kind support from the Medical Society of Sedgwick County, Kansas' SRS and
participating medical providers. Funders include the United Way of the
Plains, the Sedgwick County Commission, the Wichita City Council, the Kansas
Health Foundation, the Robert Wood Johnson Foundation, HRSA's Community Access
Program, the Wichita Community Foundation, the Knight Foundation Donor Advised
Fund, the United Methodist Health Ministry Fund, and private cash
donations. Cash contributions and grants do not pay for medical care; they
fund the administrative expenses and a wide variety of program activities being
implemented in the community.
Outreach Strategy
Outreach for the program
includes a coordinated enrollment process within the points of entry through
low-cost community clinics, residency clinics and private physicians.
Television ads (in English and Spanish) aired on specifically identified cable
stations and a communications specialist hired on a contract basis have taken
the message to the community. The program is also listed in the local
United Way of the Plains' CareLink, a computerized referral list for social
service agencies, the police department, and is accessible through the Internet. Staff presents to many organizations and have brochures in
three languages that are widely distributed. Ongoing media stories also
include information about Project Access. Project Access has become a
resource to area media regarding broader issues associated with the uninsured,
which helps with outreach as well.
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Accomplishments to Date
From
September 1, 1999 through March 1, 2004, 4,700 patients have accessed more than
$24 million in donated medical care provided by participating physicians and
hospitals. Nearly $1.75 million in prescription medications have been
purchased with City and County funds and an additional $300,000 in donated
prescription medications has been leveraged from pharmacy companies; patient assistance
programs. SRS has determined the eligibility of more than 40,000
patients for Medicaid, S-CHIP, (Healthwave in Kansas), Project Access, food
stamps, and other programs. The Call-A-Nurse service offers enrolled
patients support, information and assistance in navigating the healthcare
system.
Patients
are showing significant health status improvement as measured with SF-8 survey
(administered pre and post enrollment) and patients and physicians report high
rates of satisfaction with the program. The community has experienced a
cost savings of approximately $15 million in care because of the coordinated and
organized process of serving this patient population.
More
than 1,000 hospital ER patients have received specialized case management
services. The project has measured a 59% reduction in the ER utilization
by this patient population. Significant increase in health status is being
measured in these patients, and a significant cost avoidance has been
experienced. Future goals for Project Access include:
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Strengthening
our primary care system by assessing current capacity and future needs,
developing a more unified voice when requesting expanded or new federal and
local public and private funding, implementing a computerized patient
enrollment and tracking system to link clinics and Project Access together
to a common database, and other collaborative ventures to redesign the
manner in which healthcare services are provided to our area's uninsured.
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Implementing
a broad-based program evaluation that assesses patient and provider
satisfaction, patient health status, productivity and locus of control,
tracks trends in administrative data provided by participating physicians,
dentists and hospitals, trends in prescription usage, and measures overall
program outcomes including the hospital case management project and the
Call-A-Nurse program.
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Developing
a long-term sustainability plan to continue local support for our successes
and to move us forward on new initiatives.
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Challenges
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Recruitment
and retention of physicians in some specialty areas
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Issues
regarding the special needs of our community's undocumented immigrants
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HIPAA
compliance issues and navigating the Hospital Institutional Review Board
process
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Contact
Us
Anne
Nelson, MSFT
Project Access Program Director
Central Plains Regional Health Care Foundation
1102 South Hillside
Wichita, KS 67211
Phone: (316) 688-0600
Fax: (316) 688-0831
E-mail: annenelson@projectaccess.net
Web Address: www.projectaccess.net
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