Kansas Health Institute | Information For Policy Makers. Health for Kansans.

WICHITA — "It's huge. It really is. Where Project Access exists in those three areas, it does make a big difference."

Those are the word of Cathy Harding, executive director of the Kansas Association for the Medically Underserved, an organization that represents the state's safety net clinics.

She is describing distinct but similar programs currently active in Wichita, Topeka and Kansas City.

Project Access in those cities, and in a growing number of others like them across the country, match the donated services of doctors, hospitals, pharmaceutical companies and other medical providers with sick, working people who earn too much to qualify for Medicaid but not enough to afford private health insurance.

In Kansas, each of the Project Access operations cited by Harding were launched under the auspices of the local medical society, each of which continues to provide important support, including office space and working links to the societies' members and leaders.

In Wichita and surrounding Sedgwick County there are thought to be about 58,000 people who don't have health insurance and Project Access there helps about 900 patients daily. More than 570 local physicians donate time to the program and most of the cities major clinics and hospitals also participate, according to Anne Nelson, the program's director.

Nelson, who started her career as a social worker, has been running the Wichita program since the beginning and has seen it grow.

"We've had very significant growth," Nelson said, "almost doubling since 2008. It's exciting. We have a very progressive medical society, very entrepreneurial."

The Wichita program is the second oldest in the nation (the first was in Buncombe County, North Carolina) and has served more than 9,100 patients since it was launched in 1999.

Nelson said once Wichita doctors sign up for the program, they tend to stick with it.

"The ones who leave retire, die or leave Wichita," she said.

The Wichita program was successful enough to become a model for others around the country, including Health Access in Topeka, which was started in 2002 by the Shawnee County Medical Society.

"Our medical society knew about what was happening in Wichita and wanted to start one here," said Karla Hedquist, program director for Health Access in Topeka.

Since then, Shawnee county medical providers have provided more than $40 million worth of free medical care.

"I am so impressed with our medical community," Hedquist said. "I had no idea the extent of the donations before I came to work for this program. We have 80 percent of the local providers here in Shawnee County donating to Health Access and/or the Marion Clinic (a safety net clinic.) That's about 320 or so. It's an ever changing number."

Hedquist said the program in Topeka currently has 2,334 active patients receiving primary, specialty or pharmaceutical care. This year Health Access is on course to provide more than $4 million in free care all done with an operational budget of about $365,000 a year, most of which pays for the staff of four, three of whom are part-time workers.

"We are a small staff and have mighty software," Hedquist said.

Blue Cross Blue Shield of Kansas and of Kansas City provide the access projects free electronic claims processing, so that the program directors can keep track of the services rendered.

The programs are similar in each of the cities but also slightly different. In Wichita and Topeka, there is greater focus on primary care services.

The program started by the Johnson and Wydandotte County Medical Societies in 2006 focuses solely on advanced or speciality care after society officials were approached by safety net clinic operators looking for places they could refer their patients who needed more attention than the safety net clinics were equipped to provide.

The Kansas City program also relies mostly on funding from the region's three main hospital legacy foundations, which are the REACH Foundation, The Health Care Foundation of Greater Kansas City and the Wyandotte Health Foundation . In Shawnee County, funding comes from a wider variety of sources, including United Way and assistance from city and county governments.

But each of the access projects is seen as indispensable by the safety net clinics that never seem to have enough resources to meet the growing needs of recession-stricken Kansans.

When a safety net clinic in Wichita, Topeka or Kansas City finds a patient has cancer or some other condition too difficult to treat in a primary care setting, they know where to turn for help.

"They automatically know they have someone to refer to," Harding said. "In communities where that isn't present, they spend a lot of time on the phone trying to find an oncologist or whoever is needed to take that patient. The medical societies deserve some recognition for this because they're the ones that got this ball rolling.

Jacque Amspacker is executive director of the Medical Society of Johnson and Wyandotte Counties and also oversees the access project there, which is known as Wy/Jo Care.

She and other program directors said there is a loose network of access projects across the nation that are helpful to communities that are trying to start one of their own.

"You can take different pieces from programs you think might work in your area," she said. "You can pick and choose, just kind of piece it together and see what works for your area."

Amspacker said one service evolved in Kansas City after hospital emergency rooms began calling the program asking if it could place ER patients in medical homes, a term which refers to getting a patient into an ongoing relationship with a primary care provider partly so they don't use emergency rooms as the medical stop of first resort regardless the severity of the ailment.

"That's not something we were really planning on doing," she said, "but things are moving more that way."

The projects also have been early adopters of electronic medical records, recognizing quickly the benefit they provide for quick and efficient communication of patient histories to doctors and other providers.

"All our referrals are electronic," Amspacker said, "which cuts down a lot on the paperwork."