PROJECT ACCESS
Wichita, KS

April 2000

        §       Background

Planning began in the Summer of 1998; the program became operational September 1, 1999.  The Coalition was formed in the summer of 1998 and is still in development.

The Project Access Program has the partnership of:

• The Medical Society of Sedgwick County

• The United Way of the Plains

• Wesley Medical Center

• Via Christi Regional Medical Center

• Riverside Health System

• Kansas Heart Hospital

• Kansas Surgery and Recovery Center

• Most area pharmacies

• Prescription Network of Kansas

• University of Kansas School of Medicine - Wichita and its school associate residency, clinics

• The Wichita City Council and the Sedgwick County Commission

• Social Rehabilitation Services

• Six area low income clinics (Guadalupe Clinic, Hunter Health Clinic, the Wichita/Sedgwick County Department of Community Health Clinic, United Methodist Health Clinic, Center for Health and Wellness, and the Good Samaritan Clinic) which are all members of the Sedgwick County Association for the Medically Underserved (SCAMU)

• Wichita State University

• Newman University

• Kansas Governor's Public Health Improvement Commission

• USD 259/Wichita Public School System

• Via Christi Community Mission Services and Parish Nursing Program

• Kansas Health Foundation

Financing Strategy

 Our financing strategy currently includes funding from the United Way of the Plains, the Sedgwick County Commission, the Wichita City Council, cash donations from each hospital system, the Medical Society of Sedgwick County, private donations and new funding from the Robert Wood Johnson Foundation.  This funding does not cover any services provided; it funds only staff and office expenses for Project Access and prescriptions.  The majority of activities consist of donated care and services.  This will work in our community because we hope to continually broaden our referral base.  We also plan to seek ongoing financial and community support  as we develop a strategy for removing the barriers to health coverage for the working poor.

Patients enroll in six local low-income clinics providing primary care.  Kansas' Social and Rehabilitative Services (SRS) provides a full-time eligibility specialist at each clinic.  Patients are referred out for donated medical care provided by physicians, hospitals and a variety of auxiliary services including medical supplies, home health and hospital care.  Patients are also enrolled in other state medical programs if they are eligible.  Physicians and our primary care residency clinics may also request that we enroll patients on their established caseloads.  These enrollments occur through the Project Access Office.  Patients are enrolled for short periods of time and receive Identification Prescription Cards.

The SRS specialist and our office staff have access to a computer system program, which manages all our data on patients and providers.  Our city and governments have committed to fund prescriptions.  Patients pay a $4.00 co-pay per prescription.  The Prescription Network of Kansas manages our prescription program on contract.  Fifty-five of our local pharmacies fill prescriptions at cost.

Outreach Strategy

Outreach for the current program includes a coordinated enrollment process through low-income clinics, residency clinics and at the request of private physicians.  We have made contact with many community organizations to present the program.  Several media stories have also included stories about Project Access.  The program included in the Local United Way of the Plains Care Link, a computerized referral list for social service agencies.  We plan to reach prospective patients through organized media events as we develop our plan for the Robert Wood Johnson Foundation grant activities, we will reach out through neighborhood initiative, focus groups, and gather feedback for suggested strategies for uninsured people, medical providers, small-business owners, large employers, the medical community and other interested parties.

Delivery System

Care has been delivered to the uninsured through a complex system of low-income and residency clinics.  Hospitals and other providers agree to donate some procedures and services to uninsured patients.  Certain doctors have carried a large portion of the responsibility.  Some physicians have agreed to see uninsured patients and then consider it donated care.  However, it has historically been difficult to find enough physicians within particular specialties to assist with the high volume of patients.  The current system is not coordinated many patients are unable to access specialty care either because they are unable to pay or because of the limited availability of physicians.  Patients have historically not completed their treatment plan as well because they are unable to pay for their medications.  Still, there have been many people and organizations working hard to serve the uninsured among us who have a great interest in improving what is already in place.

Project Access coordinated eligibility and enrollment through a network of low-income and residency primary care clinics when patients need specialty care beyond the scope of those clinics.  A partnership with our Social Rehabilitation services has allowed a full-time eligibility specialist to be housed at each low-income clinic.  The SRS eligibility specialist enrolls patients in Project Access and other state or federal medical programs for which patients are eligible.  Participating physicians may also request enrollment for patients on their established caseload.  Project Access eligibility criteria are as follows:

• Patients must live in Sedgwick County

• Patients are not currently receiving state or federal medical benefits like Medicaid or Medicare (although they may qualify for these programs)

• Patients' family income does not exceed 150% of the federal poverty level (e.g., $25,000 annually for a family of four)

Patients are enrolled for three months for specialty care and six months for primary care.  Patients may have their enrollment extended at physician requests.  Patients receive a Patient Identification Card and a Prescription Card and are then referred to a specialist in the community who donate their services.  Patients also have access to inpatient and outpatient services at all area hospitals.  Pharmacies fill prescriptions at cost (patients pay $4.00 co-pay per prescription), the rest is purchased by City and Council funding.  Providers report the contributions of care to our office for tracking purposes.  This information is regularly reported to the community.  A computer program called CARES (purchased from Asheville, North Carolina's Project Access Program), allows the Medical Society's service to access the CARES Program, enter patient data, find physicians available for referrals within any particular specialty and enter appointment information.

Patient Benefits:

• More patients have more consistent access to a wider variety of donated services because of a coordinated system of enrollment and referrals.

• A more focused recruitment effort has provided an increased continuum of services available until now (e.g., laboratory work, durable medical equipment, rehabilitation services etc.).

• The prescription funding provides the medications patients need to get well.

Physician Benefits:

• Each physician who contributes care defines the number of referrals he/she is willing to accept in a year, which is a selling point for doctors who were fearful of being overwhelmed by non-paying patients.

• there is now a coordinated system for enrollment and referrals allowing physicians to spend more time treating patients, not seeking out ancillary care for patients.  Recognition is built into the program through newsletters, word of mouth and the media.

Community Benefits:

• Sick people are getting well quicker and are able to get back to work, pay their bills and taxes and become productive citizens again.

• Overall health outcomes should improve for those enrolled as the program progresses

• Emergency room visits by the uninsured population should go down as people receive medical intervention sooner, not as they are experiencing illnesses in their final more acute stages.

• The kind compassionate care giving provided for many years now has community-wide support, recognition and energy to expand.

The focus on the needs of the uninsured now positions our community for a concentrated effort to tackle the issues which have led to such high numbers of uninsured people.

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