What was the problem that needed to be addressed?
San Diego County currently has no public funded hospitals or safety-net clinics available for its low-income, uninsured patients. Prior to Project Access patients had few resources to receive needed care.
What was the innovation?
In order to increase access to diagnostic imaging services and specialty care, the San Diego County Medical Society Foundation created Project Access. Project Access serves as a care coordination program for San Diego’s low-income, uninsured patients. The Project Access San Diego network includes:
- 80+ referring community clinics
- 625+ volunteer medical professionals
- 10 hospitals
- 14 outpatient surgical centers
- Additional ancillary health services including diagnostic imaging, labs, medical equipment, physical therapy, and more
Project Access staff serve as the patient’s advocacy team and liaison between a primary care provider and needed specialty and diagnostic imaging services. After Project Access receives a patient referral, the medical director and a patient care manager review the case. Once approved, the patient care manager provides the patient with process navigation, assistance with their treatment plan, translation services, and transportation to ensure patients are receiving all needed care. To make specialty visits more efficient, patient care managers assure that any labs or imaging services needed are completed prior to the specialty visit. Since the number of specialty appointments, surgeries, and procedures have increased from 2.3 – 4% over the past seven years, patient care management has become an even more critical part of the program. After the patient receives all needed services, the patient committee determines when the patient graduates from the program.
The case management process for a patient is as follows:
How is this innovation funded?
Project Access is funded solely on grants, donations, and community fundraisers. All health services including testing, diagnostics, surgery personnel, and equipment are donated by local physicians, hospitals, and ancillary health providers.
Who were the key partners needed?
Project Access fundamentally depends on partnerships with physicians, surgery centers, hospitals, and other healthcare centers. Donations of time, equipment, anesthesia and access to space are all key elements to facilitating free healthcare to individuals who need it most.
“Really we need everyone who participates. If we lose physicians, we don’t have anyone to see patients. If we have physicians but no facility…we can’t perform the surgeries. Community clinics as well, if they aren’t referring patients, we can’t see anyone and keep the program running. Everyone is important.”
–Barbara Mandel, Executive Director of Project Access
What were the results?
- 2,700+ individuals lives improved
- Increased volunteer opportunities for physicians
Patients have had:
- 88% decrease in emergency department visits
- 94% decrease in hospital stays
- 75%+ decrease in number of work days missed
What lessons were learned?
- Relationships are key. Project access depends on volunteer physicians, hospital collaboration and community relationships to provide needed care to patients. Partnering organizations provide needed equipment, facilities, anesthesia and continual care for patients.
- Funding can be a challenge. Considering Project Access does not charge for its services, it is imperative to ensure community members understand the scope of Project Access. Word of mouth plays a key role in funding and patient referrals. The Project Access team works hard to ensure that they are sharing their patient’s stories and applying for funding whenever possible.
- Physician recruitment and retention are factors for success. Project Access tries to ensure that volunteering is fun and easy. They have physician recognition events and send out thank you and holiday cards to show their appreciation. Physicians’ sign volunteer contracts with Project Access and most renew their commitments at the end of their term. Simple volunteer processes, shown appreciation and enjoyable work environments provide increased volunteer retention.