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.
Access Program has the partnership of:
Medical Society of Sedgwick County
United Way of the Plains
Christi Regional Medical Center
Surgery and Recovery Center
Network of Kansas
of Kansas School of Medicine - Wichita and its school associate
Wichita City Council and the Sedgwick County Commission
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)
Governor's Public Health Improvement Commission
259/Wichita Public School System
Christi Community Mission Services and Parish Nursing Program
Access is a physician-led community-based effort to coordinate donated voluntary
medical care for low-income, uninsured people living in Sedgwick County,
Kansas. It is based n a model designed and implemented by the Buncombe
County Medical Society in Asheville, North Carolina.
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& Outreach Strategy
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.
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.
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 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.
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.
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:
must live in Sedgwick County
not currently receiving state or federal medical benefits like
Medicaid or Medicare (although they may qualify for these
family income does not exceed 150% of the federal poverty level
(e.g., $25,000 annually for a family of four)
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.
patients have more consistent access to a wider variety of donated
services because of a coordinated system of enrollment and
more focused recruitment effort has provided an increased
continuum of services available until now (e.g., laboratory work,
durable medical equipment, rehabilitation services etc.).
prescription funding provides the medications patients need to get
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
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.
people are getting well quicker and are able to get back to work,
pay their bills and taxes and become productive citizens again.
health outcomes should improve for those enrolled as the program
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.
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
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hurdles include trying to integrate the Project Access concept
into the complex system of care being provided by residency and
low-income clinics. Multiple netting to coordinate our
efforts at each clinic have been quite useful in developing trust
and comfort. Ongoing communication and problem-solving
sessions will be essential.
concern was expressed about having SRS staff at the clinics.
However, patients have been very comfortable interacting with SRS
staff because they are in the clinic not in a big, intimidating
building downtown. Because of that approximately 20% of our
patients are now being enrolled in other medical programs for
which they are eligible. That has positively impacted the
physicians have expressed concern about participating in this new
program. We have a group of physicians who make contact with
their colleagues to recruit additional providers. The
coordinated enrollment and referral process has helped achieve
fears. Our goal is to systematically refer patients and not
to make referrals to physicians who have reached their maximum
commitment. To resolve the political issue we have
encountered, we have identified key people who have credibility
with those individuals who have managed to calm physician
concerns. Organizationally, we have gone through the normal
growing pains of a new-program development.
operations council and staff encountered some problems regarding
some government funding prescription costs. The funding
comes from the federal level with specific expectations for
program procedures that did not fit with Project Access. The
leadership of the local government agency was a strong advocate
for the program and was successful in negotiating an agreement
that fit both the funder's basic expectations and the Project
services have been scarce for Non-English speaking patients who
become enrolled. The clinic sites have interpreters
available. Office staff must reach into the community to
seek interpreters when needed. A multi-cultural mobilization
coalition exists in Wichita with plans to write a shared grant to
develop a pool of interpreters who will be available to all member
agencies of their coalition.
major concern is that with patient needs that extend beyond the
capacity of our medical community. This requires us to
continually recruit all physicians and providers. We must
also find other avenues for serving uninsured people that may
include a new insurance program which will fund some care for
patients, allowing the volunteer program to serve a smaller core
of people falling through the cracks between publicly funded
medical programs and insurance-funded programs.
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living in Sedgwick County who meets eligibility requirements and needs specific
medical care may enroll. According to the 1990 Census, the population of
Sedgwick County is approximately 400,000. As many as 50,000 Sedgwick County
residents are uninsured based on figures gathered from a Community Health
Assessment completed in 1998.
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