Health Care Solutions in the Real World

Across the country, providers and local governments are coming to the realization that providing some coordinated "free" care to the uninsured is not just humane, it saves money in the long run.

Here in central Kansas we've been ahead of that curve for a while. As the millenium approached and the number of uninsured kept rising, the community faced a problem. The community had been trying here and there, in bits and pieces, to help the uninsured get the care they needed. But their efforts were haphazard and unorganized. As a consequence, indigent care services already provided by the area’s dedicated health care professionals were uncoordinated and not seen as making a significant impact.

Dr. Paul Uhlig had a plan. Through the medical grapevine he'd learned of a new rural health care project in North Caolina that coordinated low-income medical services through community agencies. He decided to apply it to an urban area.

With the cooperation and support of community leaders, community clinics, the local United Way, the county Medical Society, local government, and that dreaded Medicaid "gateway" agency, the state Social and Rehabilitation Services, Dr. Uhlig set up Project Access. The idea was to organize and coordinate indigent/uninsured care to make it more effective and efficient, and it worked.

Patients would be evaluated at intake at any of the area hospitals or clinics, or referred by area physicians. SRS would do the income screening for qualifications, with eligibility set at 150% of federal poverty guidelines. And the city/county would do the bookkeeping.

The big stumbling point for physician participation was record-keeping and prescription support. Doctors and hospitals were already providing indigent care for free on an ad hoc basis, sometimes unknowingly. Without tracking and reporting, there was no reason for the physicians to participate--the program would just be an added burden on their records staff, and volunteering physicians would see their indigent case load rise as the patients were steered to those who volunteered, rather than being spread across the medical community at random. And without funding for prescriptions, there wasn't a lot of point in treating many of the patients. Seeing a doctor was all well and good, but if they couldn't pay for the medicines they required for treatment, nothing in the cycle would change. So pharmacies and drug companies were brought into the fold, to provide low and no-cost prescriptions for program participants.

Since its inception in 1999, Project Access has provided over $60 million in coordinated doctor/hospital/pharmaceutical indigent care in Sedgwick County. It continues to function successfully as a model for reducing overall community medical costs while providing health care for the uninsured by getting the patients into the continuum of care and out of the "emergency room overload" cycle. The operational cost of the program to date is a touch over $3 million, and the tracking and reporting to the providing physicians, hospitals, and pharmacies has enabled them to claim the care provided for tax purposes and encouraged participation rates exceeding 90% of area physicians.

That's 20 to 1 "leverage" on the program costs, and the overall savings to the community are estimated in the tens of millions. That's money that reduces medical charges to everyone, efficiency savings from breaking the "emergency room" cycle. It CAN be done. Project Access may be a stopgap on the road to universal health care, but it fills a major community need and more than pays for itself in increased system efficiency, simply through coordination of care. So when people tell you the health care system is hopeless, remember that health care solutions in your community are up to YOU.