Project Access

Q IFeature

Project Access West Tennessee

PAWT launches to fill gaps in healthcare for uninsured

Project Access West Tennessee, an integrated health improvement organization now serving West Tennessee, is the latest Project Access model program with a focus on coordinated efforts to increase healthcare access for low-income, uninsured people, aiming to reduce health disparity and inequity.

PAWT is committed to ensuring everyone in its service area can access the healthcare that they and their families need. PAWT is designed to bridge care gaps, improve health, and reduce avoidable healthcare cost and utilization. The program coordinates care between area hospitals, outpatient services and physician practices, along with a regional network of care providers and primary care services offered through safety-net clinics, health departments and federally-qualified health centers.

“Individual health departments, safety-net clinics and healthcare providers do the best they can to care for uninsured, resource-limited people,” said Project Access West Tennessee Executive Director, Nicole Scroggins. “But to truly improve the health of our communities and reach those who need our help the most, we all have to come together and work cooperatively and collaboratively.” With funding from the state of Tennessee Department of Health and support from Memphis Medical Foundation, this initiative has a regional focus, including rural and urban areas.

This new healthcare network was adapted from the national model of Project Access, and similar programs exist throughout the state in Hamilton County, Knoxville, Nashville, and the Appalachian Mountain area. All programs are currently in the process of expanding with the goal of total state coverage.

Through Project Access West Tennessee, uninsured patients who need specialty or diagnostic care are referred to the program from providers, hospitals, health departments, community clinics and faithbased centers. The network enrolls members based on a financial assessment, conducts social needs assessments and schedules necessary medical appointments, procedures, and testing. The regional program is building networks in Shelby County initially and will soon expand to cover their full region. The goal is to increase the number of individuals served month over month.

“Ultimately, this model of care delivery for Western Tennessee will show what is possible when we all work together to solve a community-wide problem,” said Scroggins. “We are very pleased with the level of support from the essential partnerships we have already made with so many providers. Our goal is to grow the network to completely fill the care gaps that exist. ”

PAWT’s first steps have been care coordination and meeting care gaps for Qessential services. It will focus on connecting people with diagnostic and specialty care, with an emphasis on those in need of treatment for urgent and Feature complex medical conditions. The care coordination team, which currently includes four care coordinators, will aid people with complex conditions, chronic disease or behavioral health issues and social needs. It will identify patients through referral sources, and it will provide disease and medication management education and counseling to prevent harm and unnecessary hospital visits. Throughout the process, the care team will also work with patients on prevention, health literacy and promoting healthy behaviors.

“This is a tremendous leap forward for our region, as we will be able to provide patients with the level of services that increase their access to the healthcare system and the quality of care they receive,” said Clint Cummins, MHA, CEO of Memphis Medical Foundation and Memphis Medical Society.

Patients who qualify for Project Access West Tennessee include those who do not have access to health insurance and whose income is at or below 200% of the Federal Poverty Level. When these patients are referred to the program through a safety net clinic or primary care, they take part in an enrollment process that further evaluates their eligibility and medical needs, as well as their potential need for social services and other assistance.

Why do Doctors Participate in Project Access?

• Project Access allows you and your group to efficiently manage and track the charity care that you have always provided. • Project Access allows you to define the amount of charity care that you are able and willing to provide. • Project Access creates a whole network of providers and healthcare services that are automatically available to you and your Project Access charity patients. • Project Access screens potential charity care patients before they are referred to you, verifying that they meet financial, residential, and healthcare need criteria. • Project Access charity care patients are eligible for services for a specific period of time and only as long as they continue to meet program criteria. • Project Access tracks both the nature and dollar value of the charity care so your efforts can be recognized and to ensure that the care is documented so physicians can receive protection under the

Volunteer Health Services Act (see below). This information is also a powerful tool to advance issues of importance to providers. • Project Access allows for an equitable distribution of services by physicians, hospitals, and other providers when attending to the needs of the underserved in our community. • Project Access prevents any single physician, physician group, hospital or other provider from being asked to provide more than a fair share of charity care. • Project Access creates an infrastructure that helps our entire community, including business, governments, media, and educational institutions, to support the provision of charity healthcare services. • The Tennessee General Assembly recognized the value of charity care by passing legislation that provides liability protection for physicians for charity care provided through a coordinated program such as Project Access. • It’s the right thing to do!

Q I In Practice Incentives are Powerful Motivators

By Kathy Hunt, Executive Director, Hunt & Associates

When I think of incentives, I think of one saying I heard …"It’s hard to get a person to do something unless they are paid to do it." At face value, this saying might seem harsh or cynical. But let’s explore it a bit.

If I had to synthesize this into a single thought, it could be this: Incentives are very important in the business side of medicine (as well as other industries). As we know, where there is no margin there is no mission. Business entities as a general principle seek to operate to the best of their ability. A well-run healthcare operation delivering lower cost and higher quality generally correlates with solid financial performance. Take profit and not for profit status out of consideration. This remains true of all healthcare entities to ensure long term viability and success. No entity with a strong service mission consciously chooses to perform less than optimally. Yet many US health care businesses shutter every day because they cannot adapt to changes in the environment of industry.

We are all paid based on some formula or model. In the case of healthcare, the waning days of pure fee for service may lead some to think it will always be a business of more volume than profit. There are signs that is not true anymore. The language of value (higher quality and lower cost) and changing incentives are working their way through the healthcare system and the most progressive players appear to be positioning away from volume alone and toward value. There are several great local examples of that concept. Even so, I’ve heard local administrators wrestle with why they should fully adapt at this time when they are not always paid by commercial payers based on value. They have a point. If you are not incentivized based on value concepts, you may not prioritize these new (sometimes more costly) structures until required to or before it’s too late.

Could it be that we must rise above our current payment model and proactively drive a value equation where we are paid based on performance? Not a new concept but what does that look like today? Well, imagine an organization embracing value-based strategy and negotiating the incentives necessary to further improve quality while replacing more expensive services with less expensive ones. Unless they have a value-based arrangement, that organization would just cut their own margins and the reality is that in large part they won’t be prone to do that. Yet when incentivized and equipped to do so, most will embrace value and in doing so take patient care and improved outcomes to the next level. There is our catch 22. Many are frozen in a model that doesn’t reward or incentivize cost or quality innovations. If your payment model dances around the edges of accountability and value, and doesn’t really embrace those concepts, it is easier to dismiss the impact or explain away the need and timeline to adapt.

If your time horizon in the business is three more years then retirement, perhaps it is not your current priority. But if you plan to be engaged and providing services in this industry in ten years, 14