Opinion: Project Access has improved health care access to the Asheville community

“Bonnie” was in her early 50s when she first saw me for diabetes. She and her husband had limited income, part-time jobs, and could not afford health care insurance. I waived my fees for her visits, but she could not pay for labs, X-rays, medications and specialist care. So she saw me sporadically while the complications of her diabetes worsened, and she became disabled after an amputation.

A better scenario for “Bonnie” was access to a full spectrum of health care services so her diabetes was well controlled without complications.

Physicians in Buncombe County have a history of providing free medical care to those in need. But this care was generally on a case-by-case basis, where the patient often asked the physician to donate care, and did not include lab tests, X-rays, medications or hospital stays.

In 1994, the Robert Wood Johnson Foundation created a funding stream for private physician groups to increase access to health services for low-income, uninsured people. The Buncombe County Medical Society (now the Western Carolina Medical Society) applied for, and received, a planning grant to investigate options to improve access. A planning group composed of interested people and organizations conducted town meetings and focus groups and commissioned a phone survey about access and health behaviors. All this data pointed toward the high cost of health care as the major deterrent to accessing health care. This data was presented at a large community meeting with the unanimous decision to focus on ways to reduce cost and increase health care access for the lower income/uninsured in Buncombe County.

The Buncombe County Medical Society spearheaded the effort and over the course of 1995 developed an organized program called Project Access, which was centered on physicians donating their care, accompanied by free hospital services, free medications and free translation services. Dr. Phil Davis, Dr. Jim Powell and I were instrumental in recruiting physicians by focusing on “It’s the right thing to do.” In January 1996, the first patient was enrolled.

Patients could call and be enrolled by BCMS or be referred by their physicians or hospital. Physicians agreed to accept 10- to 20 patients per year to their practices. More than 80% of community-based physicians participated. Mission Hospital did not bill patients for any services requested by physicians, including outpatient (labs, X-rays) and inpatient services.

What were the results? People got the care they needed.

More than 50% of patients returned to work. More than 90% (vs. 70% before) of people had a primary care home. A large portion of primary care for the uninsured in the 1990s was provided at the Buncombe County Health Department. Once Project Access started, this clinic was able to double the primary care patients seen from two to four per hour by having specialists who would see patients for free consultation. Once the health department clinic transitioned over to the Minnie Jones Center, PA continued to provide specialty referral appointments for their patients. Other community health centers joined, as did Mountain Area Health Education Center and private primary care practices. Private primary care doctors enrolled their existing uninsured patients and after experiencing how easy it was for their PA patients to receive care in the program, they often agreed to see more PA patients. Specialty physicians (such as GI, cardiology, oncology, dermatology, and orthopedics) knew that PA patients were being equitably distributed among specialists, so no one doctor saw significantly more PA patients than any other.

Between 5,000 and 6,000 people received specialty services per year through our Project Access. The Western Carolina Medical Society Project Access now serves Buncombe and Madison counties. CareReach through its programs MATCH and the Toe River Project Access provides uninsured access in Avery, McDowell, Mitchell and Yancey counties.

Project Access has been the recipient of multiple national awards, including the prestigious 1998 Innovations in American Government Award from Harvard. More than 100 counties nationwide replicated our PA, with the guidance of several of our physician leaders. PA is a great example of WNC spearheading health care innovations by developing and piloting a program that improves access for our community and many others nationwide.

Project Access was started by our community physicians and has been a gift that we have been happy to provide, without hesitation, for 25 years and counting. Physicians believe that health care is a right in our region, and that PA is the right thing to do.

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Suzanne Landis MD, MPH has devoted her medical career to improving access to high quality primary care and to training young physicians.

This article originally appeared on Asheville Citizen Times: Opinion: Project Access has improved health care access to the Asheville community