Project Access Dallas Partners
Founding Partners
City Square formerly Central
Dallas Ministries
Dallas County Medical Society
Dallas/Fort Worth Hospital Council
Health Texas Provider Network
Charity Medical Clinic
Enrollment Sites
Brother Bill’s Helping Hand
City Square formerly CDM
Christ’s Family Clinic
Diabetes Health &
Wellness Institute
Grand Prairie Wellness Clinic
Healing Hands Ministries
Hope Clinic Garland
Irving Interfaith Clinic
Metrocrest Family Medical Clinic
Mission East Dallas
North Dallas Shared Ministries
Pharmacy Support
Caremark
Hospital Support
Baylor Institute for Rehabilitation
Baylor Jack & Jane Hamilton
Heart and Vascular Hospital
Baylor Medical Center at Garland
Baylor Medical Center at Irving
Baylor Specialty Hospital
Baylor University Medical Center
Children’s Medical Center
Las Colinas Medical Center
Medical City Dallas
Methodist Charlton Medical Center
Methodist Dallas Medical Center
Our Children’s House at Baylor
Parkland Health & Hospital System
Texas Health Presbyterian
Hospital Dallas
St. Paul University Hospital
Texas Scottish Rite Hospital
for Children
Zale Lipshy University Hospital
Physicians’ Foundation for Health
Systems Excellence
Texas Health Resources
Texas Medical Association
Thompson & Knight, LLP
University of Texas Southwestern
Medical Center
Community Partners
Mental Health/
Behavioral Health
Baylor Health Care System
Blue Cross/Blue Shield of Texas
Caring for Children Foundation
of Texas
The Cirrus Companies
Dallas County
Commissioners Court
DCMS Foundation
McCune Charitable Foundation
Parkland Health & Hospital System
Green Oaks Hospital at Medical
City Dallas
Pastoral Counseling & Education
Center
Ancillary Services
Support
4 Better Sleep
American Health Imaging
Med Provider
North Central Surgery Center
Park Central Surgery Center
Patient’s Comprehensive Cancer
Center in Carrollton
Pediatric Surgery Center
Prime Diagnostic
Quest Diagnostic
Sam’s Club Hearing Centers
Southwest Diagnostic
Imaging Center
Texas Institute for Surgery
Two Forest Imaging
Laboratory Services
Support
Clinical Pathology Laboratories
Laboratory Corporation of America
Enrollment:
PAD finished 2011 with a 12-month average of 3,178 active enrollees.
Enrollments have remained active (~116 new patients per month) from
11 community clinics and hundreds of private physicians, maintaining
the total patient enrollment at approximately 3,000.
Care Navigation:
PAD has seen a 14% increase in the number of enrollees needing care
navigation, particularly transportation. Providing this service helped
reduce specialty physician visit “no-show” rates by 40% (12% no-shows
in 2011; 20% in 2010).
Specialty Care Referrals:
PAD completed 1,947 specialty care physician referrals (73% of all 2011
specialty requests). This helped ensure that PAD enrollees received
timely specialty physician consultations and care, decreasing their
need for hospital utilization to stabilize their chronic diseases. This
was accomplished by a concerted effort to recruit additional physician
volunteers; PAD added 240 physician volunteers (152 primary care
and 88 specialty care) in 2011. With the assistance of private specialty
physicians and the continued support of the University of Texas
Southwestern Medical Center and Parkland physicians, we have reduced
the average wait time for a specialty care appointment to 50 days, with
urgent appointments made within 2 weeks.
Quality in Diabetes Care:
Since 2009, PAD has collaborated with the Diabetes Equity Project* to
improve diabetes care management for PAD enrollees. Combined with
PAD’s pharmacy support, care navigation, and primary and specialty care
physician access, diabetic patients have realized a 15% improvement in
average HgbA1c control (8.7% baseline; 7.4% after 12 months).** Further,
the DEP’s surveillance data reveals a 53% increase in the percentage
of diabetic patients experiencing good (HgbA1c < 7%) diabetes control
(32.7% at baseline; 50.2% after 12 months).
Pharmacy:
During the first half of 2011, PAD experienced a 30% increase in
pharmaceutical costs (to $23.41 per patient per month). The number of
prescriptions per patient increased 21%, with the costs per prescription
rising 7%. As a result, PAD made major changes to its pharmacy
benefit, helping to bring spending under sustainable budgetary control.
Additionally, we added a Pharmaceutical Assistance Program Navigator
(PAP-N) in September 2011 to help patients obtain free brand-name
medications from pharmaceutical companies. The PAP-N has assisted
149 patients obtain 240 unique brand-name prescriptions, saving PAD
more than $22,350 in annual prescription costs for these patients. These
changes have helped reduce PAD’s monthly pharmaceutical costs by
69% and stabilized the program’s budget.
Donations in Care:
PAD’s volunteer provider network donated a record $9.7 million in care to
PAD enrollees during 2011:
• $4.5 million from local physicians
• $5.2 million from local hospitals and ancillary partners
As this report demonstrates, we have made tremendous progress
over the last nine years and look forward to 2012 and our 10th year of
operation.
Working together with you,
Jim Walton, DO, MBA
Medical Director, Project Access Dallas
*Diabetes Equity Project — Funded by the Merck Co. Foundation’s Alliance to Reduce Disparities in Diabetes
**Walton JW, Snead C, Collingsworth A, Schmidt K. Reducing Diabetes Disparities Through the Implementation of a Community Health Worker-led Diabetes Self-Management Education Program. Fam Comm Health,
2012; 35 (2): 161-171.
140 E. 12th Street | P.O. Box 4680
Dallas, Texas 75208
www.projectaccess.info
Update from the Medical Director
Jim Walton, DO, MBA
A patient’s story best describes the value of Project Access
Dallas. Imagine a local hospital leader faced with a friend’s
request to help an uninsured relative. The relative just
received a cardiac diagnosis made during a recent ED
visit for chest pain. The condition wasn’t serious enough to
require admission, but the patient was told it was urgent
enough to deserve attention by a physician within the next
1 to 2 weeks.
With no health insurance, the patient turned for help to a relative involved in
healthcare administration. A few phone calls later, the patient had an appointment
with a local PAD charity clinic’s primary care physician. That physician deemed the
condition urgent, and the patient was scheduled to see a volunteer PAD cardiologist,
who performed a stress test and echocardiogram in the office. Within 2 weeks the
patient went from an ED visit to cardiac catheterization and a diagnosis of coronary
artery disease needing bypass surgery. Amazing as it seems, the final chapter of the
story has the patient receiving bypass surgery at Parkland Hospital, without having
had a heart attack. As you will see in this annual report, the value of hundreds of
similar stories is measurable. The value to the patients and their families is priceless!
In 2010, Omar Jackson was on vacation in the Dominican Republic. Although he recently
had been laid off from his job of 25 years in the telecommunications industry, he was
hopeful that a new job was on the horizon. He had solid work experience, an education
from Cornell University, and the desire to work. Surely, he’d be fine, he thought.
Jackson’s trip and life changed in an instant.
At 48, he suffered a stroke during his vacation. He immediately got on a plane back to Dallas, but he doesn’t
know how he had the presence of mind to get to the airport, book a flight home, and then go straight from
the airport to a hospital. His insurance coverage from his previous job expired when he’d been in the hospital
for 2 weeks. Then his savings ran out. Although he wasn’t physically ready to leave the hospital, he was out
of money and saw no alternative.
That was until the hospital enrollment coordinator for Project Access Dallas came into Jackson’s room to tell
him about the program. But he was wary; he had been in the hospital for 3 weeks and was looking for options,
ACTIVE ENROLLEES
PHYSICIAN VOLUNTEERS
The decrease in number of PAD enrollees reflects efforts to align the number
of active patients with the capacity of the physician volunteer network.
Project Access Dallas gained 240 physician volunteers in 2011 and improved
communication with volunteers through a monthly e-mail newsletter.*
2,500
2011
625
1,125
0
2008
2009
2010
2011
0
3,279
2010
4,046
2009
2,250
2,027
2008
1,250
738
1,559
0
1,062
1,000
3,375
2,894
2,847
2,000
2,227
1,875
1,913
3,000
The decrease in number of referrals reflects efforts
active patients with the capacity of the physician v
4,500
2,081
3,984
4,000
ANCILLARY & SPECIAL
REFERRALS
2008
2009
2010
but not like this. He didn’t need or want a handout.
Eventually, he conceded that he needed help, and
he enrolled in the program.
“I didn’t realize how down and out I was,” he
says, recalling his initial hesitation about enrolling
in PAD. “But, now I can’t imagine where I’d be
without it.”
When he was released from the hospital after a
2-month stay, he spent some time in outpatient
rehab, but he couldn’t drive, he couldn’t cook
and he couldn’t get up the stairs to his secondfloor apartment. He needed help in every facet of
his life, and PAD came through. PAD helped him
change apartments, provided access to food, and
drove him to all his doctor’s appointments —
including a few rehab appointments in Euless.
LTY
“I would never be able to do it without PAD,”
Jackson says. “They have done everything for me.
They even helped me apply for disability income; I
had no idea I could get something like that.”
his experiences with the clinic as “great, very
attentive and very thorough.” He says that the
clinic’s physician, Mary Beth Felty, MD, called him
one evening at home, just to check on him.
Jackson grew up in New York City and moved
to Dallas in 1999. He says, “It was 77 degrees
here in December. I’ve only been back to New
York once.”
“I couldn’t believe it. No one calls me at night!
And she just wanted to give me some feedback,”
he says.
While he’s enjoyed his time in Dallas, his family
and most of his friends still are in New York.
“PAD is my family and support
system here,” he says.
A lot of that feeling of familial support comes from
the staff at Healing Hands Clinic. He describes
COMMUNITY HEALTH
NAVIGATED ENROLLEES
s to align the number of
volunteer network.
The number of navigated enrollees increased after PAD added pharmacy
navigation for patients of private physicians (0 in 2010 vs. 145 in 2011).**
Jackson has been back to the emergency room
only once since his initial visit — after he suffered
a fall and needed stitches on his head. He’s getting
the medical attention and the care that he needs
from PAD and his medical home to get back on his
feet and return to his normal life. He’s applying for
jobs and again looking forward to the future. From
here, the future looks pretty bright.
PRESCRIPTIONS FILLED
DONAT
The rise in number of prescriptions filled is consistent with our focus on
enrolling patients who have comorbidities, in conjunction with a higher
first-quarter patient enrollment and a larger annual pharmacy allowance.
The increase i
by all PAD part
procedures an
1,521
24,000
7,500,000
25,551
1,334
1,200
10,000,000
31,926
32,000
1,600
5,000,000
16,000
800
238
2008
2009
2010
2011
0
11,250
0
11,206
2011
2008
2,500,000
2009
2010
2011
0
3,742,087
743
8,000
400
2008
PHYSICiAN VOLUNTEERS OF THE YEAR
PRIMARY CARE
Sarah Helfand, MD – Pediatrics
SPECIALTY CARE
Sarah Helfand, MD, a PAD volunteer since 2002, works tirelessly
at Healing Hands Ministry. According to her peers, she inspires
others to volunteer to serve the working poor of Dallas County. Dr.
Helfand serves on the PAD Leadership Committee at Methodist
Medical Center and on the DCMS board of directors. She
participates in DCMS community events, such as doing physicals
at health fairs, answering questions in the “Ask the Doctor” booth,
and volunteering on Medical Missions Day.
Howard Weiner, MD, has volunteered with PAD since 2002. He has
offered unlimited appointments in PAD’s most needed specialty
this year, seeing as many patients as PAD could send. Since the
inception of Project Access Dallas, Dr. Weiner has been influential
in getting support from the leadership at Presbyterian Hospital of
Dallas. He is an exceptional volunteer and a great leader for Project
Access Dallas.
Howard Weiner, MD – Gastroenterology
* PAD also began contacting physician offices that had seen a PAD patient within the previous 30 days to answer any questions and to obtain feedback. We successfully encouraged peer-to-peer recruitment with a contest focusing on a top-needed specialty.
** We experienced a significant increase in episodic referral patients (537 in 2010 vs. 892 in 2011), despite a significant drop in the number of full-time navigated patients (797 in 2010 vs. 484 in 2011). Primarily, the large increase in episodic patients served resulted
from increases in the capacity of our Community Health Navigation program (addition of a donated van, increased capability of our CHN staff due to CHW training and certification, and increased capacity to provide certain types of durable medical equipment, such as
CPAP and oxygen therapies). We transported almost twice as many patients in 2011 as in 2010 (675 vs. 343) and provided several kinds of durable medical equipment to more than 150 patients in 2011, compared to fewer than 20 patients in 2010.
TED SERVICES
OPERATING EXPENSES PER PATIENT
is a result of improved data collection and reporting
tners. Services included office visits, diagnostic
nd surgeries.
Operating expense per patient increased in 2011. This is consistent with
resizing the program to meet network supply, and providing new services
and staff to assist with patient care.
7.4%
0
8.7%
2011
723
2010
7.0%
1,087
1,301
1,000
8.0%
HgbA1c
1,966
9,760,967
1,500
5,512,044
4,474,528
2009
Diabetes Equity Project: Diabetic PAD Enrollees participating in DEP
had a 15% INCREASE in disease control. (Average HgbA1c 2009-2011)
9.0%
2,000
500
DIABETES CARE
MANAGEMENT
6.0%
2008
2009
2010
2011
0
Baseline
After 12 Months