Project Access Northwest Helps Patients Access Medical Care

By Melissa Johnson
Development Director
Project Access Northwest

Original Publish Date: August 9, 2016

The Affordable Care Act has been in place for three years and has largely succeeded in delivering on most of the initial promises. The number of uninsured Americans has fallen significantly, and many more have signed up for Medicaid in states that have expanded eligibility. Prior to implementation, Washington State had estimated that an additional 300,000 people would sign up for the Medicaid option with the expansion. Instead, almost 1,700,000 are now insured under the program. The demand was far greater than anticipated.

Despite the successes, there are still people who fall through the gaps. Having insurance does not always mean access to coverage, especially specialty care and dental care. There are still many barriers. In some cases, people find the health care system difficult to navigate. There may be language barriers or unfamiliarity with the system itself. Many people may now have medical coverage, but still lack dental coverage. Others may still find that coverage is not affordable. They may not be eligible for tax subsidies or even with the subsidies, find the premiums beyond their means. There are low-income people who still may not qualify to purchase on the Exchange and older individuals may not be eligible for Medicare because they haven’t worked enough to qualify. Many people purchased plans that may have appeared affordable but included high deductibles and co-payments. Myriad challenges remain.

For Medicaid enrollees, access to specialty care services also remains challenging due to the low Medicaid reimbursement rates which are often below the specialist’s cost of providing care. There is a limit to the number of Medicaid patients the physician can treat while still maintaining a financially viable practice. Combined with the huge increase in demand since the start of the Affordable Care Act (a 59% increase in Washington), this creates a significant barrier to accessing care for the low income population. While community health centers provide primary are for the uninsured and Medicaid populations, if an uninsured or Medicaid patient needs specialty care, they often can’t find a provider willing to see them. Patients with commercial insurance have many options; the low-income patient has few. If a commercially-insured patient requires a specialist, they would have access to care. For the uninsured or Medicaid insured patient, a comparable situation or diagnosis could be life-limiting.

In Seattle, a nonprofit is working to increase access to care for these populations through a distributed network of care. Project Access Northwest was created in 2006 to serve uninsured patients who needed specialty care but who had no access to it. Through early partnerships with local hospitals and healthcare leaders, Project Access NW designed a model where specialists agreed to see a discrete number of patients and provide the necessary care at no charge when the patient is uninsured. And accept the Medicaid reimbursement rate for those who are enrolled in Medicaid. All ancillary and hospital services were also available to the patients being cared for. Initially serving King County, Project Access NW has expanded to serve patients in Snohomish and Kitsap Counties with programs designed to provide access to care for the uninsured and underinsured in our communities.

The Care Coordination Program matches patients in need with specialty care providers and hospital partners and helps patients navigate a sometimes complex health care system. Patients may have a primary care provider in a safety net clinic but have a specialty care need. Their primary care provider refers them to Project Access NW. An intake specialist reviews the paperwork, and a Registered Nurse reviews the referral to determine the appropriate specialty and to ensure that all needed labs, tests, and imaging are included. The care coordinator works with the patient to schedule the appointments and arrange for interpretation services if necessary. Because patients arrive with all the necessary information, the specialist is able to provide care without additional delays.

Within the Care Coordination Program, the patient receives confirmation of the appointment, interpreters are ordered when needed, and reminder telephone calls are placed. The specialist receives an informed patient and all the information needed for the patient’s care at the time of the initial visit, and a patient who shows up for the appointment. Project Access NW patients have a less than 5% no-show rate compared to a Medicaid/uninsured average of 30%. The Care Coordination Program removes the barriers to the clients accessing care while reducing the paperwork and management burden on the provider. This enables providers to focus on care and serve a larger number of low-income patients.

Another program at Project Access NW is the Premium Assistance Program. This is designed for Washington State residents who are not eligible for Medicaid or Medicare. While these individuals are eligible to purchase private health insurance on the Washington Health Benefits Exchange, they may find that paying the premiums is a financial hardship. Project Access NW works with hospital systems and other partners to help ensure that low-income people have access to insurance that is affordable. The number of people served is based on the amount of funding committed to the program. As a result of this program, these individuals have insurance and are able to access care. Project Access NW is one of only 3 programs in the state allowed to run this program outside of the tribes.

The most recent Project Access NW program is a Primary Link program that connects uninsured and Medicaid users of the local hospitals with Primary Care Homes. Whether they are seen in the Emergency Department for an issue that was more appropriate for primary care or they are being discharged after a hospital stay, Primary Link connects them with a local provider in a timely fashion. Having a primary care home makes the patient healthier, reduces inappropriate Emergency Department visits, decreases hospital re-admissions and creates a better overall experience for the patient while benefitting the hospital and community.

Since 2006, PANW has served more than 34,000 people in more than 40 specialties and more than 41 different languages. These programs increase access and reduce cost to the providers and to the community. By insuring that patients receive necessary care, the overall health of our community is also improved.

To learn more about Project Access NW and to read about some of the patients served, please visit www.projectaccessnw.org