Grassroots movement grants medical home, access to uninsured

WHILE LEGISLATORS AND healthcare stakeholders across the country wrangle over the problem of the nation's 46.5 million uninsured, a grassroots movement called Project Access is having an impact on the health of thousands of uninsured Americans.

While a relatively new movement, Project Access is based on two very old-fashioned notions: volunteerism and collaboration. Specialists and general practitioners volunteer their time and partner with hospitals, pharmacies, insurers and other healthcare stakeholders to provide uninsured patients with a medical home and access to the care and services they need.

Physicians aren't new to the volunteer arena. A 2006 report on volunteer healthcare programs commissioned by the Kellogg Foundation found that in the late 1990s, more than 260,000 physicians were providing at least some level of charity care. That's a number that dwarfs the roughly 1,000 federally qualified community health centers and 1,300 public community hospitals currently in operation. Consequently, even though each of those physicians might only see a handful of uninsured patients, collectively, they have the potential to affect millions of lives. Unfortunately, that impact has too often been blunted by a range of obstacles.

Even though physicians want to provide free care, growing organizational, financial and time pressures are making it increasingly difficult for them to do so. A 2001 physician survey conducted by the Center for Studying Health System Change reported the proportion of physicians providing charity care declined to 72% from 76% just two years earlier.

UNITING FOR CHANGE

Project Access is combating those trends by taking a simple, coordinated approach. The program was launched in 1995 in Buncombe County, N.C., with funding from the Robert Wood Johnson Foundation's Reach Out program. The county medical society invited all of the county's 700 primary and specialty physicians to donate part of their time to care for uninsured patients who did not qualify for Medicare or Medicaid and who earned less than 200% of the federal poverty level. Within a year, 70% of the county's physicians volunteered to help.

Given that strong physician support, medical society delegates then approached Mission Hospitals asking that they provide free hospitalization and testing for Project Access patients, says Suzanne Landis, MD, MPH, who spearheaded the movement. The idea was in keeping with the hospital's mandate to provide charity care, but it also made good financial sense in light of the costs of treating uninsured patients, such as ED visits and emergency admissions as well as administrative costs associated with trying to collect payment.

As the movement grew, Project Access attracted new partners. One partner donated laboratory services. Pharmacies in the county waived dispensing fees. Two durable medical equipment companies donated products, community clinics were transformed into medical homes for Project Access patients, and the county commissioners provided funding for medication and program administration.

Within two years, Project Access patients in Buncombe County were more likely to report that they were in good or excellent health than were insured patients.

Today, roughly 630 or 90% of Buncombe County's physicians participate, and Project Access provides nearly $12 million in medical care to the Greater Asheville, N.C., community, says Dr. Landis. Volunteer physicians treat about 2,700 patients annually, and the program serves as a primary-care home for more than 90% of the nearly 27,000 uninsured in the county.

Patients, who might once have let minor complaints fester until they required a trip to the emergency department, can seek care from a Project Access primary care provider who can prescribe the necessary medications, order the necessary tests or refer the patient to the appropriate specialist for care.

Most gratifying of all, says Dr. Landis, is the fact that the Asheville project has been duplicated in roughly 50 communities from Anchorage to Palm Beach. The various Project Access sites differ in terms of their funding sources, caps on patient income levels and community partners. Some don't even bear the Project Access name. Still, they all share the same basic commitment to providing free medical care through a coordinated network of volunteer providers.

"We took the Asheville model and tweaked it," says James Walton, MD, vice president and chief health equity officer for Baylor Healthcare Systems in Dallas and medical director for Project Access Dallas.