insights (2006-08)

Making Health Care More Accessible

The Knoxville Academy of Medicine is making a valiant effort to systematically offer physician care without charge to low-income adults in Knox County who don’t have access to health insurance.

The physician group is collaborating with local hospitals on the formation of a health-care network that would also cover the cost of hospital stays and diagnostic services for those who are eligible. Clinics for the working poor such as InterFaith Health Clinic and Cherokee Health Systems have also been involved in its formation along with the Knox County Health Department.

The undertaking, known as Project Access, has been spurred in part by last year’s disenrollment of 191,000 adults (statewide) from TennCare. But Project Access’s reach is intended to be broader than just these unfortunates.

Starting March 1, any adult resident of Knox County whose income doesn’t exceed 200 percent of the federal poverty line can enroll provided their employer doesn’t offer health insurance. Much of the enrollment is expected to take place at primary-care clinics such as InterFaith and Cherokee, but it can also be accomplished by visiting Project Access’ offices at 115 Suburban Road or calling 531-9027.

It’s not yet clear how many doctors will volunteer to meet the needs of the estimated 25,000 Knox residents eligible for the program. UT Medical Center’s chief medical officer, Dr. John Lacey, who has been a prime mover in getting Project Access launched, says the goal is to enlist 75 percent of the KAM’s 728 physician members. But the enlistment process is just now getting underway in earnest. Primary-care doctors are being asked to see 10 patients year; specialists, 20 patients a year.

“We’re simply asking everyone to do their fair share, and we’ve got systems in place to assure that patients are allocated equitably among them,” Lacey says. Indeed, Project Access has a full-time staff of five to attend to everything from verifying patient eligibility and assigning primary-care doctors to making referrals to specialists and arranging patient appointments with them. Lacey puts a great deal of store in software obtained from a counterpart organization in Wichita for handling all of the data processing involved.

Local hospitals contributed $300,000 toward the program’s $450,000 annual budget, and a $127,000 state grant is covering most of the balance. The program’s executive director, Kimberly Weaver, is a doctor of a different sort: namely, a Ph.D. in business administration.

Hospitals have a big stake in the success of Project Access because it should hold down costly (to them) emergency-room visits by steering patients to a doctor’s office instead. Lacey stresses that both hospitals and many doctors have been providing a lot of charity care ever since when. “What’s new is organizing it all effectively and efficiently,” he says. And if KAM meets its goal of a 75 percent member signup it may well have a larger network of participating physicians than any health plan in the area.

Project Access stops short of being a full-fledged health plan, though, because it doesn’t offer prescription-drug coverage in any systematic way. Doctors are being encouraged to contribute drug samples they receive from manufacturers, and the Knox County Health Dept. has a Dispensary of Hope that can help fill this gap. Then, there’s the state’s RX Outreach program that makes a limited menu of generic drugs available to TennCare disenrollees at low cost, but that program is due to terminate on June 30.

Children aren’t eligible for Project Access because a.) they weren’t subject to TennCare disenrollment, and b.) Gov. Phil Bredesen has announced plans for extending coverage to 150,000 children who remain uninsured through a separate program known as S-Chip, under which federal matching funds are available on a more liberal basis than under Medicaid.

Bredesen has also heralded plans that are still in a formative stage for helping Tennessee’s 650,000 uninsured adults get some sort of coverage. But it seems unlikely that his “Cover Tennessee” initiative, as it’s known, will get enough funding to go very far toward solving the problem of the uninsured which not even the federal government has been able to address with more than token measures.

Before TennCare enrollment became increasingly restrictive and then curtailed, Tennessee went considerably further than any other state toward publicly meeting the health-care needs of those for whom private insurance was unavailable or unaffordable. Hence, Tennessee now has the greatest need for safety-net programs of the sort that have presumably kept these unfortunates from falling completely through the cracks in other states.

Indeed, according to KAM materials, Project Access is “based on a successful program begun in Asheville,” that has since been implemented in 70 other cities with 300 or more on the drawing boards. It will be most interesting to see how fully local doctors exhibit the “volunteer spirit” that Lacey is invoking in his efforts to make the program successful here. Certainly, the doctors, hospitals and health clinics who have collaborated on putting it together are all to be commended.