Th Pr bl m e Problem
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Project Access Health Access for the Uninsured Rae Young Bond Chattanooga-Hamilton County Medical Society and Medical Foundation of Chattanooga g Th Problem The Pr bl m Primary y Care Health Centers provide p excellent primary care, but typically have limited access to specialty care, specialized l d llaboratory b testing, h hospitall services, and other needed services. As A a result, lt patients ti t use repeatt visits i it to t be monitored for chronic or emergency conditions that require specialty care. care Th Project The Pr j t Access A Approach Appr h Identify y gaps g p in the health care system y for low-income uninsured residents. Use the Project Access model to develop resources to bridge the gaps … specialty physician care, lab services, hospital care, and d other th services. i Th Project The Pr j t Access A Approach Appr h Essentially y a Clinic Without Walls. A system of coordinated health care for lowincome uninsured patients that organizes physician h i i volunteers l t and d other th partners t to t provide care before health conditions reach a crisis…and the ER. A partnership between the Medical Society and Foundation, and Hospitals I collaboration In ll b ti with ith hospitals, h it l h health lth agencies, and community leaders. Buncombe County’s “Project Access” An Integrated g Healthcare Deliveryy System y Office of Rural Health Residency Free Clinics Programs University Hospitals p Medical Society & Guiding Coalition Public Health Department Primary Care and Prevention Foundation Translation Outreach Enrollment Transportation Health Education United Way Faith-based Programs Maternal & Child Health Programs Public Health Clinic • preventive • primary care • dental • lab & x-ray • free drug programs • primary mental health Local G vernment Government NHSC Primary Care Physicians Specialists Medical Society Enrollment and Referrals Hospital Services Civic Groups Pharmacy y and Durable Medical Community social services HIV/AIDS Programs Mental Health Businesses Case Management School Health Programs Health Centers H Does How D Project Pr j t Access A Work? W rk? Potential patients are screened for eligibility by the Project Access office or at one of the participating health clinics. Participating physicians also can refer qualified patients to Project Access (so they can have access to needed tests and procedures). procedures) H Does How D Project Pr j t Access A Work? W rk? Project Access better coordinates charity care that doctors already provide, and h l more doctors helps d t treat t t uninsured i d patients. Physicians can spend their charity care time treating patients, rather than making phone calls to find someone to provide a test or procedure for the patient. H Does How D Project Pr j t Access A Work? W rk? Project Access patients and partners are tracked in a comprehensive database that d documents t care provided, id d health h lth indicators, and other critical information. Each patient is attached to a primary care home. Enrollees receive a PA Identification Card that documents their enrollment and enables providers to report on care. H Does How D Project Pr j t Access A Work? W rk? Each participating physician and facility creates a Project Access ID in their computer t system t to t generate t billing billi information to document care and then the care is written off to charity. charity PA ensures that care is distributed equitably throughout the system. system Individuals who do not qualify for Project Access are directed to other appropriate services H Does How D Project Pr j t Access A Work? W rk? Project Access staff provide care coordination services throughout enrollment, ll t scheduling h d li appointments i t t and d sending patient reminders, identifying specific needed resources to meet patient needs, recruiting new partners and providers,, and ensuring p g that care is provided equitably and efficiently. A Critical C ii lP Partnership hi to E Expand dA Access Increased Primary Care Safety Net Productivity and Capacity Associated with Access to Coordinated Specialty Care Network 1995 – 2004 Buncombe County Health Clinic, Buncombe County, NC Buncombe County Health Clinic 1995 1998 2004 Patients Served 6,000 9,000 12,500 5.0 3.5 2.5 45 minutes 30 minutes 20 minutes Staff referring to specialty care 8 FTE 2 FTE 1 FTE Physician time finding specialty care High Low low Average visits/patient/year Average g Length g of Visit H milt n County Hamilton C nt PA Partners P rtn r Chattanooga-Hamilton County Medical Society Medical Foundation of Chattanooga 3 Hospital Systems with 7 campuses Health Department 4 Health Department Health Centers 2 Federally Qualified Health Centers 2 hospital-affiliated osp ta a ated Health ea t Centers Ce te s P rtn r Partners Homeless Health Clinic Rehab Hospital & Private Rehab Facilities AIDS/HIV Clinic Regional Health Council UT College of Medicine, Chattanooga Community Research Council Later … Volunteers in Medicine Free Clinic The Results P j t Access Project A Patient P ti t Enrollment E ll t Project Access screens patients for eligibility. Patients who do not qualify are directed to other community resources or programs. Patients Screened 5 831 5,831 New Patients 3,294 Enrolled 4,390 Total Patients Active in one or more years (some multiple enrollments) Directed Di t d to t Other Resources 3 157 3,157 Pr j t Access Project A Patient P ti nt Load L d Patients are enrolled in Project Access for three to six months, until their care needs have been met Patients who have completed care can re-enroll if a new health need emerges Noncompliant patients are disenrolled Patients Currently Enrolled Patient Care Completed Noncompliant Patients Disenrolled 409 2,972 55 $34 million milli n off care r provided pr id d Care data is for 51 months of program operation (April 2004 – August 2008) Physician Care Delivered $5 342 245 $5,342,245 Hospital Care Delivered $28,679,141 Total Care Provided $34,021,386 S l t dD Selected Demographic m r phi El Elements m nt Total Number of Enrollments per Year Percentage of Patients Enrolled for Given Number of Days Reasons for Disenrollment, if Disenrolled in the Given Year Gender of Project Access Patients by Year Education of Project Access Patients by Year D t Tracked Data Tr k d by b Project Pr j t Access A P ti nt Demographics Patient D m r phi Income Range of Project Access Patients Ethnicity of Project Access Patients Marital Status of Project Access Patients Income Source/Employer Age Range Housing of Project Access Patients Family Size of Project Access Patients D t b Database Reports R p rt Primary y Care Home Appointments Diagnosis Codes Employer Enrollment data ER utilization l ER requiring Admission Other ER visits HCFA 1500 UB 92 HCFA 1500 Data D t Procedures, services, or supplies CPT/HCPCS Codes and modifiers Diagnosis Codes Dates of Service Place of Service ER utilization ER requiring Admission Other ER visits UB 92 Data UB-92 D Admitting Diagnosis Codes Dates of Service Place of Service ER utilization ER requiring Admission Other ER visits D t b Database Reports R p rt Specialty p y( (for 10 listed specialties) p ) Cardiology 485 Gastroenterology 117 Neurology 87 Obstetrics & Gynecology 138 Oncology l 115 Surgery, General 224 Ophthalmology 108 Orthopedics 381 Diagnostic Radiology 477 Total 2132 Pr j t Access Project A Outcomes O t m A coordinated network of care has been created. created Community health centers have access to specialty care for their low-income uninsured patients. The amount of charity care provided by doctors and hospitals is documented. P ti t are able Patients bl to t gett comprehensive h i care, including specialty care, before they seek help in an emergency room. room Pr j t Access Project A Outcomes O t 20% Now Insured — The p percentage g of former PA patients who have obtained health insurance coverage 42% Better Health — Former patients who rated their health status as good, very good or excellent compared to 31% before care 39% Fewer Physical Restrictions — Former PA patients who said they now have little to no restrictions on physical activities compared to 26% prior to care 38% No Limitations on Daily Work — Former PA patients who reported little to no limitations on daily d il work k inside i id or outside t id th the h home due d to t physical problems compared to 30% prior to care Pr j t Access Project A Summary S r $ $34 Million — Value of free health care p provided since April 2004 ($5.3 million by physicians; $28.6 million by hospitals). Value of care provided by p y partner p clinics is not included. 625 — Participating volunteer physicians 3 — Participating hospital systems 11 — Participating P ti i ti h health lth centers t 5,831 — People screened to determine eligibility 3,157 — Individuals who have received care 500 — Average number of patients enrolled each month 2 972 — People who 2,972 ho did not qualify q alif but b t were e e referred to other community resources “Statistics are people with the tears wiped away.” away ” Sir Richard Doll, British Biologist “Many y hands make light g work.” 14th Century Proverb
