In 1998, Paul Uhlig, MD, a fourth generation Kansas physician and a cardiothoracic surgeon, set the wheels in motion to improve access to health care for the 50,000 uninsured living in Wichita-Sedgwick County.

The community had been trying to address the problem for some time. However, the Sedgwick County indigent care services, established by dedicated health care professionals, were uncoordinated and struggling.

It was a situation in need of a remedy.

The inspiration for a new solution was Project Access, a successful health care model launched by the Buncombe County Medical Society in Asheville, North Carolina.

The idea behind Project Access is one of collaboration — everybody brings something tangible to the table to make it work. The program focuses on addressing health needs of the uninsured by creating a closer relationship between primary care clinics and specialty care providers.

This was clearly an idea worth exploring for Wichita-Sedgwick County. Leading the way would be the community’s physicians and many local leaders.

Dr. Uhlig first shared the Project Access model with the Medical Society of Sedgwick County (MSSC) Board of Directors.  Board members were immediately responsive and encouraged further study. Joining them in learning more about Project Access were hospital administrators, potential community funders, City Council members, County Commissioners, community clinic directors, the County Health Department’s head, pharmacists, and representatives from the state’s Medicaid Agency — the Department of Social and Rehabilitation Services (SRS). Thus, a new collaborative was born.

Starting in September 1998, over the course of several trips to North Carolina, collaborative members learned the details of the Asheville model and began to build relationships that could help create and nurture a local Project Access program.

Back in Wichita, they shared what they discovered and began to formulate the concepts of coordinating care for the uninsured in this new project:

• Physicians would provide services to the uninsured without the fear of being overwhelmed by numbers.
• Clinics could better access a full range of specialty care for their low-income patients.
• Hospitals would contain costs for their uninsured patient population because care would be better coordinated.
• The community would benefit from a healthier, more productive workforce.

By the end of 1998, the Project Access model received unanimous support from the MSSC’s board members. They recommended that the Central Plains Regional Health Care Foundation, a nonprofit affiliate of the Medical Society, serve as the program’s administrative agency.

On April 15, 1999, before an audience of 75 local leaders at a community forum, Alan McKenzie, director of Asheville’s Medical Society, described Project Access and its evolution. With this model as a guide, many of the community’s fears were allayed.

According to Dr. Michael Bates, then-MSSC president, “This is a simple solution in which everyone helps a little and everyone wins — our community becomes healthier and, most of all, patients who need help receive the care many of us take for granted.”

On June 1, at a joint meeting, the Wichita City Council and the Sedgwick County Commission were officially introduced to the Project Access model. All the key players attended the meeting — the city and county managers, executive directors of the Medical Society and United Way of the Plains, hospital CEOs, pharmacists, even the newspaper publisher.

It took the two governing bodies less than an hour to approve $500,000 to support Project Access’ prescription medication program.

“When the medical community showed support, it just fell into place,” observed Chris Cherches, the late Wichita city manager.

Project Access was now on the fast track to becoming operational with a launch deadline of September 1, 1999. Dr. Uhlig set the date when Project Access would serve its first patient to create a specific, foreseeable goal and to assertively push the community towards a realization of that goal.

An Operations Council was soon formed, under interim director, Betsy Bloxham, and it met once a week in intense meetings. A monthly newsletter was created to keep all the partners informed.

September 1 arrived. Under newly-hired program director Anne Nelson, Project Access officially opened its doors, starting at the smallest community care clinic. The program continued the process of adding one clinic a month to avoid overwhelming any of the participants. Project Access was off and running and heading in the right direction.

Project Access’ success lies in its relationship-building and thinking creatively to solve community health problems.

Everyone was asked to be involved in the solution — physicians, hospitals, funders, state, city and county governments, pharmacists and community health clinics. Through it all, partners recognized that this was the right thing to do.

When the Medical Society of Sedgwick County (MSSC) took Project Access under its wing, it ensured that there would be an adequate number of doctors available for participation.

In 1999, as Project Access became operational, Dr. Michael Bates served as the board president of Central Plains for two years. Eventually, the leadership role was passed on to Christopher Moeller, MD, who started as chairman of the Physician’s Participation Committee and served as board president until 2009. David Grainger, MD took the reigns as Central Plains’ president until 2011.  Thomas Bloxham, MD is the organization’s current board president.

Dr. Moeller first heard of Project Access in the 1999 when Dr. Uhlig presented the Project Access concept to the MSSC board.

“Under the auspices of the MSSC, a community-wide physician meeting introduced the project,” recalls Dr. Moeller. “It was at this meeting that I told Dr. Uhlig ‘I think this is the best project our Medical Society has ever been involved in as long as I’ve been here in Wichita. This is something I want to strongly support.’

The MSSC’s most important task was signing up physicians. “In our first year, we got about 30% of the physicians in Sedgwick County signed up, said Dr. Moeller. “We thought that, out of a Medical Society of 850 physicians, 30% was quite good — especially when you’re talking about a new project.” Today, about 60% of physicians participate in Project Access.

What makes Project Access most acceptable to physicians is that every doctor sees a fair share of uninsured patients — no more than 20 specialty patients or 10 primary care patients annually, unless of course they desire to sign up for more.

Furthermore, when participating physicians receive a referral, they know that the patient’s income has been evaluated and that the patient is experiencing difficult life circumstances. Participating providers have a phone number to call with questions or needs for their patients.  Project Access staff developed a new software program Charisma Salus ™ (www.charismasalus.com), which tracks all the program’s patient and provider data.

Because many uninsured people go to local emergency departments for medical needs that often should be treated and managed in a primary care setting, much of the escalated costs for care for the uninsured are borne by the hospitals. So, the CEOs of Via Christi Health Systems and Wesley Medical Center quickly embraced the benefits of participation in Project Access.  Early in the planning process, a hospital committee defined the processes for Project Access patient admissions.

Initially, there was significant pent up demand for Project Access specialty care and patient enrollments were quite high.  Enrollments leveled off over time however.

As the program’s success has grown, several local specialty hospitals signed on to accept patient referrals.

For years community clinics (FQHCs and privately-funded clinics) had to negotiate with doctors and hospitals to get treatment and diagnostic testing for their uninsured patients. It was a hit-or-miss approach.  Clinicians often called the same few physicians and spent time making phone calls instead of seeing patients.

Enter Project Access. It recognizes the caring medical community that always existed in Wichita-Sedgwick County. Physicians who previously said no to the clinics were now saying yes to a well-managed system that proposed a well-defined percentage of donated care.  The formerly informal handshake agreement is now an official, codified system that has helped move people from crisis management into a coordinated system of comprehensive care.

Early in the planning process of Project Access, Central Plains Regional Health Care Foundation leaders approached the president of the United Way of the Plains. He was impressed with the Project Access model; immediate interest was sparked. However, since the organization wasn’t a member agency, the funding fell into the category of a Venture Grant. To their credit, the United Way board thought it was worth the risk. And it paid off.

Another initial source of funding came from the Robert Wood Johnson Foundation. The organization applied for a $150,000 grant under the foundation’s “Communities in Charge” initiative and a one-year grant was awarded in January 2000, followed the next year with a Phase II, 3-year, $700,000 grant.

Also in 2000, a $100,000 grant for outreach and interpreter services was awarded by the Kansas Health Foundation. Later that year, KHF presented an additional gift of $50,000.

As an even greater testament to the dedication and hard work of the Project Access community partnership, the organization received a $1 million HRSA Community Access Program grant to help fund expansion and other programs.

The grants were helpful, but it’s been a mandate that Project Access have long-term sustainable funding, something they actively pursued.

Prior to the launch of Project Access, a missing component was prescription medication funding. This would be the role for local government leaders, who agreed to provide an annual commitment totaling $500,000 for enrollees’ prescription medication needs.

Funding from the City of Wichita (CSBG) and Sedgwick County is part of a yearly budget process. They continue today as long-time funding partners of the Project Access program.

The role the State of Kansas played in this unique community partnership broke new ground. The regional SRS Office repositioned eligibility specialists to work full time in the area’s community clinics. In each clinic, an SRS specialist enrolls patients into Medicaid and Kansas’ S-CHIP program, food stamps, etc…and they enroll clinic patients in Project Access. The state government is better able to serve the needs of thousands of patients every year, many of whom are eligible for publicly-funded programs. And Project Access provides another avenue for care for those who are not eligible for Medicaid services. This unique three-way partnership between Project Access, the community clinics and the State of Kansas still exists today.

The involvement of pharmacists began when the MSSC contacted Prescription Network of Kansas (PNK), a pharmacy benefits management company. PBMs manage the prescription portion of a health plan either directly for an employer, managed care organizations such as HMOs or PPOs, and for programs that help indigent populations.

The services that PNK offers Project Access include contracting, processing, reporting, and centralized invoicing. Because PNK agreed to work directly with participating pharmacies, Project Access was relieved of a significant administrative burden.

They provide an electronic, real-time processing system that allows participating pharmacies to instantaneously file their claims online. PNK directly bills Project Access, sending them detailed utilization reports, which are beneficial in care coordination. PNK, handles all payments to the pharmacies.  Project Access, in turn, pays PNK on a bi-monthly basis.

PNK’s system captures information regarding utilization trends and expenditures.  The reports provide accountability for Project Access — important since the prescription medication program is publicly funded.

The pharmacies’ contribution to Project Access is that they do not charge dispensing fees.

In addition, Project Access leverages donated medications from pharmaceutical companies on behalf of enrolled patients. This prevents spending funds for a significant amount of medications needed by patients.

Project Access bears an obligation to a whole community of people: patients, funders, health care providers, governments, taxpayers— to ensure that funding is spent efficiently and effectively.

To ensure the program’s goals are attained, comprehensive evaluations are routinely conducted by external evaluators from various institutions like the University of Kansas School of Medicine-Wichita and Wichita State University’s Hugo Wall School of Public Administration.

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Project Access is a successful program that has reached maturity. The organization has since launched additional initiatives including two significant care management programs—and leveraged the community partnerships established through Project Access to get them started.