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Communities
Joined In Action
PMB 212, 1910 E. 4th Avenue
Olympia, WA 98506-4632
Phone/Fax: 360-489-0496
e-mail:
info@cjaonline.net |
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Visit
Communities >
North
Carolina
Project
Access
Buncombe
County Medical Society
Community
Size: Approx. 206,000
Program
Started: 1996
Overview
& Structure:
Project
Access is an integrated system of free clinics, private
and public physicians, hospitals and pharmacies
providing access to the full continuum of care to
low-income, uninsured citizens with incomes up to 200%
of the federal poverty level. Located in Buncombe County
(Asheville), N.C., the program provides preventive,
primary and specialty care, hospitalization and low-cost
pharmaceuticals. Private primary care physicians and
specialists donate care to patients referred from
community-based clinics. Physician volunteer commitments
and patient referrals are managed through a centralized,
online database coordinated by the Buncombe County
Medical Society, which administers the program. Twelve
other communities nationwide now have operational
Project Access programs modeled after Buncombe, and
another 50 communities are at various stages of
replicating the model.
Features:
- High
physician participation (85% of local private doctors in
network), which allows more manageable and year.
- Equitable
distribution of patients seeking care. Each physician is
asked to see no more than 10-20 patients per
- Physician
pledges and services tracked by software to ensure
“fair share.”
- Free
labs and X-rays.
- Low-cost
medications .
- Centralized
financial screening and patient referrals.
- Centralized
physician and hospital charity care tracking.
- “Good
Samaritan Legislation” and special malpractice
protection policy reduce risks for free clinics and
volunteer physicians.
- Transportation
coordination .
- Appointment
confirmation system and patient responsibility contract.
Outcomes:
- Reduced
ER utilization for targeted population from 28% to 8%
(’95-’98).
- 80%
patients report improved health status.
- Reduced
monthly per capita health care costs from $500 (7/97) to
$300 (12/99).
- Reduced
hospital charity care 23% (’97 vs. ’99).
- $3.5
million in services donated by private physicians, $2
million donated by hospitals (2000).
- Virtually
eliminated minority health disparity for pre-term
delivery.
- [21%
to 13%, African-American; 16% to 13%, Hispanic; 12% to
11%, Caucasian – 1998 and 2000 data.
- Missed
appointment rate of less than 7% (2000).
- Value
of services: 40/60 physician/hospital (’97) vs 60/40
(’00).
Eligibility/number
served:
Low-income
individuals with incomes up to 200% of the federal
poverty level.
Program
serving nearly 15,000 individuals per year, virtually
all of targeted population.
Financing/Costs:
Private
primary care physicians, specialists and hospitals
donate their services, while the County picks up the tab
for pharmaceuticals they prescribe. County funding of
$400,000 per year to the Buncombe County Medical Society
pays for prescriptions (approx. $350,000) and
administration (1-1/2 positions).
Lessons
learned:
- Identify,
recruit and nurture physician champions.
- Organize
pacing events to create and sustain momentum.
- Surface
and validate expected return on investments to enlist
partners.
- Identify
community-based financing and existing assets that may
be untapped or underutilized.
- Develop
sample business plans to secure system resources.
- Work
with the media early and often to promote the issue and
project.
- Provide
means for centralized reporting of diagnoses, procedures
and value of services donated.
- Offer
online system for centralized application, referrals and
enrollment (CARES system software).
- Share
results of multi-year trend data.
- Share
format and lessons learned from baseline and comparison
community health assessments.
Contact:
American Project Access Network
304 Summit Street
Asheville, N.C. 28803
828-274-9820 (p)
828-274-2093 (f)
info@apanonline.org
www.apanonline.org
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