Project Access: Opening the door to health care

A North Carolina program began serving the poor in 1995. Now similar ventures are spreading across the nation.

By Damon Adams, amednews staff. Jan. 21, 2002.

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Doctors in Buncombe County in western North Carolina used to fend for themselves when it came to providing free medical care to the needy.

That changed in 1995, when doctors teamed up to volunteer their services through the Buncombe County Medical Society's Project Access program. The project is a coordinated network in which physicians give free care to low-income, uninsured residents at doctors' offices and clinics.

It all started in Asheville
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Since the first patient was seen in 1995, about 8,000 patients have been helped through the program, said Jeremy Russom, Project Access executive administrator who helps communities start similar programs.

The project has become a model for other communities across the nation, as 12 groups from Greenville, S.C., to Dallas have launched such systems. Another 50 communities nationwide are starting similar projects.

"We believe that everybody has a right to health care, and we have set up a system in our community that allows that to happen," said Suzanne Landis, MD, MPH, a family doctor in Asheville, N.C., who helped start Buncombe's Project Access. "Physicians have always provided charity care. The difference now is that it is organized."

Buncombe County's volunteer program has spawned more than 12 similar projects.

In the Buncombe program, specialists, primary care physicians and area hospitals donate care to uninsured patients. Specialists agree to see 20 patients per year; general practitioners handle 10 per year.

County government helps fund prescriptions written by the volunteer doctors. A centralized database helps coordinate efforts.

The project boasts 591 volunteer doctors. More than $4 million in medical services is provided free annually. Project Access has cut emergency visits by the uninsured, and 80% of patients report improved health since entering the program.

Spreading the message

That success has led doctors in places such as Sedgwick County, Kan., to model their programs after the Buncombe County project.

Health care leaders in Sedgwick County saw Project Access as a way to improve care for the uninsured and visited Buncombe County to learn about the project. Sedgwick leaders launched their nonprofit Project Access in Wichita in September 1999.

Nearly 2,800 patients are now enrolled in the Sedgwick program.

Each patient receives a Project Access ID card and a prescription card. Computer programs coordinate referrals to specialists and maintain patient information.

About 500 doctors, or two out of three physicians in the county, and all area hospitals participate. City and county governments commit $500,000 for medications each year, and pharmacies fill prescriptions at 15% below average wholesale prices.

Sedgwick's Project Access has logged $13 million in contributed care from doctors and hospitals, according to Anne Nelson, Project Access program director. More than $620,000 in drugs have been bought for patients, who have a $4 co-pay on prescriptions.

"It has taken off very quickly," Nelson said of the program, based at the Medical Society of Sedgwick County. "It's helped our community come together."

Danville, Va., also looked to Buncombe County as a model to aid the uninsured. Project Access of Danville began enrolling patients in July 2001. About 200 patients and 110 doctors participate.

Danville leaders say Project Access has forged a partnership among doctors, health agencies and political leaders. "There is a definite need to help the uninsured," said Kay Crane, executive director of Project Access of Danville. "To bring on all these partners is wonderful."

Terrence Cook, MD, an internist and allergist in Augusta, Ga., is sold on the benefits of Project Access.

Dr. Cook and other doctors and leaders in Richmond County looked at the Buncombe project as an example of how to create a coordinated system of volunteer physicians. The Richmond County Medical Society Project Access was established, and Dr. Cook was named to head the program.

The project has received startup funding from local government and is slated to begin in July.

Dr. Cook said Project Access helps make it easier for doctors to offer charity care. It also allows them to treat some patients without the constraints of managed care and insurance paperwork.

"It's practicing medicine the way it used to be," he said.

AMNews is looking for physicians to feature in this monthly series. If you know of a doctor who has a unique way of volunteering or giving back to the community, contact Damon Adams (312) 464-5411.

ADDITIONAL INFORMATION:

It all started in Asheville

Project Access was launched by the Buncombe County Medical Society, Asheville, N.C. It spread throughout the state, and beyond. Now there are 12 programs modeled after it.