Project Access NOW: overcoming barriers to care |
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CareOregon is part of collaborative to help the uninsuredShe knew she had breast cancer and needed surgery. But she had no health insurance and care was going to cost more than she could afford. So she delayed seeing a specialist for several months. By then it was too late. She died. She had not yet turned 35. It was a grim statistic when it appeared in the headlines: One Oregonian per day dies due to lack of health insurance, according to a report by Families USA. Doctors in Oregon can see the faces behind the statistics. Like Dr. Katherine Morris’s cancer patient. “If she had primary care, if she had access to specialty care, it’s highly likely that this would have been caught earlier and she would have had a chance,” says Dr. Morris, a surgical oncologist in practice at Legacy Good Samaritan Hospital.
Dr. Morris is also among the health care professionals, hospitals and health plans teaming up to reduce the number of uninsured patients who don’t get the specialist care they need. Project Access NOW (PANOW) is a collaborative effort to give infrastructure to donated health care and to coordinate access to specialists and other health services for low-income uninsured patients. Project Access rolled out in Clark and Multnomah counties March 3 and Washington County April 1. Clackamas County is in the early stages of planning. “What Project Access does is make it easier to donate care to the most vulnerable by coordinating a volunteer network and arranging for free testing, medications and procedures,” says Linda Nilsen‑Solares, PANOW executive director. CareOregon is a partnerCareOregon will provide patient identification cards and handle claims paperwork at no cost for Project Access in Clackamas, Multnomah and Washington counties. Columbia United Providers will provide the same services in Clark County. “That’s huge,” Nilsen-Solares says. “It’s another piece of what makes Project Access work so well. “We will know how many patients were served and by whom. We will know how many appointments a patient made to a specific volunteer. We will be able to report the value of charges that were written off by volunteers. And we’ll be able to assure equity between hospital systems and even subspecialty volunteers.” Claims Examiner Supervisor Jeremy Brown says that Project Access is expected to have about 40 clients within 6 months. He notes that CareOregon’s vision and mission is to assure that Oregonians have access to high quality health care, regardless of income or social circumstances. “That’s pretty much what Project Access is trying to do,” he says. The “safety net’s safety netDr. Morris explains how specialist care for the uninsured is arranged in the absence of Project Access. Like many health care providers, she often provides free health care for those in need. Federally qualified safety net clinics give care, regardless of ability to pay. But when a patient needs more than the safety net can provide, then both patient and doctor face formidable obstacles. Even when a specialist like Dr. Morris is willing to provide care, too often the doctor or safety net clinic has to track down and identify labs, diagnostic imaging providers and hospitals willing to give services free. Cancer surgery, for example, can involve radiology, anesthesiology, nursing, hospital inpatient services, pathology and support staff such as respiratory and occupational therapy. It requires a great deal of coordination and can be very complex, Dr. Morris says. “I can do the charity case, but all the other parts have to be arranged by the hospital,” she says. “If I can’t get that support, I can’t do what I need to do.” Coordinating these services can delay surgery by a couple of weeks and it can use valuable time and resources that the doctor or clinic could have spent on diagnosis and treatment. And the patient can delay getting care until the condition is more serious—or critical. Project Access’ role is to recruit volunteers and provide coordination. As soon as a problem is identified that needs services beyond those of the safety net clinic, the patient is referred to Project Access. Project Access care coordinators facilitate treatment through a network of volunteer specialists, hospitals and other health care service providers. “We see Project Access NOW as the ‘safety net’s safety net,’” Nilsen‑Solares says. “We want potentially serious medical problems to be resolved rather than having patients return again and again to have the symptoms treated by the safety net clinic, or having them wait until there is a crisis.” Access depends on collaborationProject Access “is not the complete solution for heath care,” says Nilsen-Solares. “It’s an interim step. We’re coordinating needed services while creating little additional infrastructure and no duplication. “We’re also building the relationships that we’ll need for any significant health care reform in our community.” Project Access NOW and the United Way of the Columbia-Willamette have a strategic partnership to make effective use of resources, promote volunteerism and ensure clear, measurable outcomes that make a difference in our communities. In each county, Project Access is coordinated within existing safety net clinics: the Coalition of Community Health Clinics’ 12 independent clinics in Multnomah County (and six county health department clinics will join soon), Free Clinic of Southwest Washington in Clark County and Essential Health Clinic in Washington County. All the health systems and larger insurers in the metropolitan area have joined the effort. “Certainly in the history of our area, there is nothing that has had all the health systems working together so closely to support the safety net,” Nilsen‑Solares says. “We’re very proud of that.” |
Background, Project Access of Northwest Oregon & Washington
Who is eligible?A patient will be prequalified as eligible if he or she lives in the county and has: income no greater than 200 percent of the Federal Poverty Level, an established medical need and no access to insurance. Without prequalification by Project Access, patients who need charity care would have to provide proof of income for each different provider. Without Project Access, all the separate components that make up a complicated procedure such as cancer surgery would be cobbled together through a great deal of hospital, physician and patient effort. With Project Access, it becomes as simple for patients as enrolling in the program, receiving ID cards and showing up to their appointments. Project Access NOW needs these volunteers:
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