Organization and Planning Grant Requirements

Phase One National Press Release

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

 

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         Guiding Principles

Project 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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       Initial Project Objectives

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        Financing & Outreach Strategy

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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       Challenges

  • Major 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.

  • Initial 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 program.

  • Many 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.

  • The 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 Access design.

  • Interpreter 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.

  • Another 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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       Demographics


Anyone 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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        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: http://www.projectaccess.net

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