Project Access WichitaSedgwick County, Kansas

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Project AccessWichita/Sedgwick County, Kansas

• Allen Nelson
• Tulsa, Oklahoma
• January 29, 2004

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Sedgwick County, KS(Wichita)

• 452,869 total population
• 55,000 uninsured people (13 of the population)
  this number is growing
  
• Sedgwick County medical hub
• KUMS/12 residency programs
• 793 active members of the MSSC/254 resident
  physicians
  
• Seven hospital systems (4 acute facilities and 5
  specialty hospitals)
  
• Six clinics for the medically underserved

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Employment Status by Health Insurance
StatusSedgwick County, 1996
Source Sedgwick County Community Health
Assessment, 1996. Telephone Survey.
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Project Access Timeline

• October 1998
• Fall/winter 1998
• April 15, 1999

• First visit to Asheville, NC by Dr. Paul Uhlig
  and other local leaders
  
• Planning meetings to identify partners including
  SRS, UW, City, and County
  
• First large community-wide forum

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Project Access Timeline

• July 1, 1999
• August 1999
• September 1, 1999

• United Way of the Plains grant
• Staff hired
• Doors opened

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Project Access Timeline

• Clinics and SRS eligibility specialists phased
  in
  
• Robert Wood Johnson Foundation planning grant
• RWJF three-year implementation grant and HRSAs
  Community Access Program grant
  
• United Way agency member and 2nd-year HRSA CAP
  grant
  
• Web site fully operational
• Launched new volunteer dental project

• Sept 1, 1999 -April 2000
• January 2000
• 2001
• 2002
• 2003

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Partners Contributions

• Medical Society of Sedgwick County and its
  physician members
  
• Hospital systems
• Six clinics

• Executive leadership, donated office space
• Donated office visits, surgeries
• Donated inpatient and outpatient services
• Enrollment sites
• Outreach to patients in need
• Care coordination

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Partners Contributions

• Six full-time eligibility specialists
  repositioned at the clinics
  
• Primary care clinics request enrollments
• Specialty care clinics accept referrals
• Fill prescriptions at 15 below average wholesale
  cost-no filling fees

• Social and Rehabilitation Services (SRS)
• Twelve residency programs
• Pharmacies

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Partners Contributions

• Inpatient and outpatient rehabilitation services
• Limited durable medical equipment
• Hospice services
• Executive leadership
• Special studies
• New volunteer dental project launched in October

• Others
• KU School of Medicine
• Wichita District Dental Society

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Provider Participation

• 8 participating hospitals
• 75 of MSSC physician members participate
• Primary care physicians10 patients/year
• Specialists20 patients/year
• 142 primary care providers
• 403 specialists
• A total of 9,480 possible referrals
• 50 physicians donate time in the clinics
• 36 participating dentists

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Funders Contributions

• 25,000 start-up funds
• In-kind office space, executive director
• Start-up funds totaling 70,000
• Donations of care
• Venture grant for start-up funds
• UW Agency Annual Membership

• MSSC
• Three hospitals
• United Way of the Plains

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Funders Contributions

• Wichita City Council and the Sedgwick County
  Commission
  
• The Robert Wood Johnson Foundation
• Federal HRSA CAP
• Kansas Health Found.

• 500,000 for prescriptions
• 4 year grant to build infrastructure
• 2 annual grants to build infrastructure
• Grant for outreach and interpreters

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Funders Contributions

• Wichita Community Foundation, United Methodist
  Health Ministry Fund, Knight Donor Foundation and
  Kansas Health Foundation

• New volunteer dental project

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Eligibility for Enrollment

• Patients must
• Be US citizens or lawful permanent US residents
• Live in Sedgwick County
• Have no health insurance (dental patients have no
  dental insurance)
  
• Not be covered under medical benefits programs
  like Medicaid, Medicare, S-CHIP (although they
  may be eligible)
  
• Have a gross household income at or below 150 of
  Federal Poverty Level
  
• Verify income and address

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MSSC Project Access Features

• Enrollment occurs at six clinics for the
  medically underserved (Hunter, Guadalupe, Health
  Department, Center for Health and Wellness, Good
  Samaritan and United Methodist)
• Six SRS eligibility specialists have been
  repositioned in the six clinics to enroll
  patients into Project Access and into state
  medical programs
• Patients may also be enrolled at the request of
  participating physicians and some residency
  programs
  
• Dental patients are referred for enrollment by
  emergency department physicians

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Management Information System

• Patient enrollment and demographic data and
  participating physician and dentist data
  
• SRS workers and Project Access staff access the
  system to enroll patients into the database and
  identify the next available physicians
  
• Prescription Network of Kansas database manages
  pharmacy and prescription data

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Management Information System

• Providers submit billing forms, for tracking
  purposes
  
• Physicians submit HCFAs
• Hospitals submit UB92s
• Dentists submit billing forms
• Information from the forms is entered into a
  Microsoft Access database
  
• Annual evaluation reports are generated
• Reports available at www.projectaccess.net

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Enrollments and Services to Date

• Since September 1, 1999
• 4,536 patients enrolled
• Value of contributed care 26.3 million
• Hospitals 18.4 million
• Physicians 7.9 million
• Additional labs, ambulatory surgery centers, and
  other ancillary services
  
• Prescription medications purchased with City and
  County funds 1,670,747 (73,982 Rx claims
  filed)
  
• 275,000 prescription medications donated by
  pharmaceutical companies

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Our Patient Population

• 85 are at or below 125 of FPL15 are at
  126-150 of FPL
  
• 62 are female, 38 are male
• Mostly middle aged (31-50)
• 55 are Caucasian and 45 represent minority
  populations
  
• 75 high school diploma or less
• 47 live alone
• 60 are employed and most rent their homes

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Our Patient Population

• Most common primary diagnoses included
• Malignant neoplasms
• Diabetes
• Chest pain
• Rheumatoid arthritis
• Abdominal pain
• Hypertension
• Back disorders

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Our Patient Population

• Most common medication therapeutic classes
  (2002)
  
• Antidepressants
• Misc. GI drugs
• Cardiac drugs
• Opiate Agonists
• Nonsteroidal Anti-Inflammatory drugs
• Misc. Anticonvulsants
• Antilipemic agents
• Misc. Antidiabetic agents
• Antihistamine drugs
• Estrogens

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• Return on Investment
• 6-point improvement of health status measured
  with pre and post administered SF-8 survey
  
• Cost savings to community of 10 million by
  coordinating patients care
  
• Patient satisfaction surveys
• 94 of patients report being very satisfied or
  satisfied with Project Access
  
• Highest satisfaction relates to Rx program and
  physician services
  
• Physician satisfaction surveys
• 85 of physicians report being very satisfied
  or satisfied with Project Access
  

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Return on Investment

• Countys 2004 investment for a new .75 FTE staff
  position will result in a 275,000 return
  
• RWJFs 2003 financial investment resulted in new
  access points including a dental initiative to
  serve 900 to 1,800 individuals
  
• In 2002, the United Way of the Plains 180,000
  annual investment in coordinating a system of
  voluntary medical care yielded 6,656,282 in
  donated care for patients

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Additional Program Activities

• Increase access to services including medical,
  dental and mental health
  
• Develop access to a pool of interpreters/translat
  ors
  
• Implement a Call-a-Nurse service for enrolled
  patients
  
• Develop a computerized patient enrollment and
  tracking system across provider systems
  
• Case management teams co-located at four hospital
  emergency departments
  
• A broad-based, community-wide hospital study
• Patient and provider education
• Move the uninsured to the rolls of the insured

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Organizational Chart
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National Awards

• American Association of Medical Society
  Executives (AMMSE) Spirit Award
  
• Counseling and Mediation Service
• 2002 Samaritan Award

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Contact Information

• Allen Nelson, Supervisor
• Project Access Patient Services
• 1102 S. Hillside
• Wichita, KS 67211
• Office 316-688-0600
• Fax [phone]
• Allennelson_at_projectaccess.net
• www.projectaccess.net