Developing and Financing the Project Access System of Care in Wichita/Sedgwick County KS for the Medical Society of Sedgwick County, 2001.
Edwin Fonner, Jr., DrPH |
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Applicant Community. On behalf of uninsured persons in Wichita/Sedgwick County KS, Project Access is the CAP applicant. The Central Plains Regional Health Care Foundation (CPRHCF) manages Project Access and is the intended recipient of HRSA funds. CPRHCF is affiliated with the Medical Society of Sedgwick County and participates in RWJF Communities in Charge initiative.
Description of Target Population. Estimates of the total number of uninsured under age 65 in the area range from 37,220 to over 55,000 persons. Several inner city communities contain up to one-third of the area’s uninsured. Of greatest concern are lower-income individuals throughout the county, persons at higher-than-average risk of serious and costly illness, certain inner city residents, those eligible but not enrolled in public programs (like HealthWave and Medicaid), and small businesses unable to afford premiums for employee health insurance. We have comparative data on each group. Current System of Care for the Uninsured and Program Partners. Project Access currently includes 535 practicing physicians, six indigent care clinics (including one FQHC), 3 acute hospital systems and four specialty hospitals, 12 residency clinics, 65 pharmacies, and other providers donating services in a coordinated way for the uninsured. Area indigent care clinics and residency clinics provide a medical home for approximately 35,000 uninsured patients. A subgroup of over 1,925 enrolled patients have received $8.8 million in specialty and hospital care and more than $300,000 in prescription drugs since operation began on September 1, 1999. This system of care builds upon a replication of the Buncombe County, NC Project Access program. Some key community supporters of Project Access include City and County government ($500,000 annually in prescription funding), the United Way of the Plains ($200,000 for administrative expenses), The Robert Wood Johnson Foundation ($700,000 over 3 years for program expansion activities), and the Kansas Health Foundation ($100,000 for outreach/interpreter services). Goal of the Proposed Project. Our goal is to implement a complete, sustainable system of care for disadvantaged uninsured residents built around the operational, physician-led Project Access program. Project Access is engaged in a seven-point Phase Two refinement and expansion. We are shaping an explicit system of care for the uninsured with indigent care clinics as hub for a referral system. SRS helps coordinate eligibility determination, but we need better enrollment data. We include many providers and are adding school nurses and mental health providers. However, we must manage cases more effectively and discourage ER use and inappropriate care. We need prevention, early detection, education, and disease management to reduce costly episodic care. Proposed Grant Activities. We are requesting $1 million in funds from HRSA to enhance the system of care for the uninsured. Including indigent care clinic resources, we have matching contributions of $10,000,000 annually from participating physicians and hospitals, $500,000 annually for prescription medications from local government, partner agency funding from the United Way of the Plains ($106,000 through 2001), an in-kind donation of 6 full-time, repositioned eligibility workers from the Kansas Department of Social and Rehabilitation Services ($206,000 annually), and $700,000 from RWJF. CAP program objectives reinforce RWJF Communities in Charge work. Objective One – Improve System Entry and Patient Routing. We will analyze the utilization of inpatient, ER, and outpatient services by the uninsured across all hospital systems to develop collaborative policies on patient routing and triage. Enhancing availability of clinical services after-hours and near the ER will be piloted. A Call-a-Nurse option (funded by RWJF) and other means of routing patients beyond acute care to more appropriate primary care will be piloted. Senior executive leadership will be engaged to facilitate communications and coordinate work. The number of access points for the Project Access system of care will be enhanced and tied to interpretation and other services for improved cultural sensitivity. Objective Two – Extend the Enrollment and Tracking Information System. To improve information sharing, a centrally located enrollment database and patient tracking system will be implemented. Connectivity between clinics and other Project Access providers will be formalized to facilitate data capture, case management, and patient education. HRSA funds will augment work currently in progress with RWJF funding. Objective Three – Implement Case Management, Prevention, and Health Education. Case managers will be used to educate providers, ensure continuity of care for patients, and build capacity among providers to manage uninsured patients effectively. Prenatal care and disease management on cardiovascular disease, asthma, diabetes, and hypertension will be targeted first. Patients and primary care providers will be encouraged to participate in health education and prevention initiatives. Expected Outcomes. HRSA funding will help us expand our program, improve the linkage between hospitals and indigent care clinics, and position us to assume more responsibility for a more broadly defined collaborative safety net system in Wichita/Sedgwick County. Case management and extended service hours will help reduce ER usage and promote reallocation of resources to providing more effective and appropriate care. This collaborative model, especially with state premium subsidies, could be a forerunner to a truly center community supported health center. Objective One will improve our capacity to serve patients appropriately by including hospitals in the eligibility determination and case management processes. This can reduce expensive acute care, reduce the severity of illness (i.e., the case mix index), and stimulate more predictable use of system resources and less costly episodic care. The enrollment database and tracking system (Objective Two) will improve information sharing, reduce duplicated services, help detect gaps in service, and promote incremental consolidation of other functions. Objective Three will promote consistent patient follow-up and thorough use of screening, prevention, and disease management. HRSA funding will promote more cohesive, informed, and mobilized leadership among providers, physicians, local government, and community leaders. |