Project Access to Specialty Care

Specialty Services for Uninsured Made Possible through Project Access

There are an estimated 19,000 people in New Haven without medical insurance. Fortunately for those who need specialty healthcare services, there's Project Access-New Haven (PA-NH).

"We started to talk about creating Project Access in New Haven in 2008," recalls Dr. Suzanne Lagarde, a gastroenterologist who serves as the CEO of Fair Haven Community Health Center and is the Board Chair of PA-NH. "We are forever grateful to The Community Foundation because they were the first ones to really support us when we were just an idea, awarding first a $50,000 grant in 2009, and then a $150,000 multi-year grant the next year."

Funding from The Community Foundation was made possible through unrestricted and preference funds, like the Josephine Burgess and Sara Lavery Funds, which were created with a preference to be used "for the treatment or prevention of disease" and "for cancer research, treatment and alleviation of pain, and information services."

"Before we started we looked at 10 programs - large and small across the country to get a feel of how they operated," says Dr. Lagarde. "For every dollar, they spent they were able to generate $4-5 dollars of care. What was really exciting is that we found we could produce similar cost savings. In the first 9 months, we were open, PA-NH generated over $700,000 in care and did it for only $175,000."

"There's no system to ensure the timely delivery of specialty care, laboratory or imaging services in our region," says Dr. Lagarde. "That's where PA-NH comes in. Because we can intervene promptly, we can save patients unnecessary and potentially harmful wait times as well as save money."

PA-NH has a full spectrum of care though it doesn't treat patients directly. There are 6 access points for a patient. PA-NH Patient Navigators work with the referring physicians who are for the most part primary care doctors working in the 2 neighborhood clinics (Fair Haven Community Health and Cornell Scott Hill Health Clinic), the clinics at Yale-New Haven Hospital, or the emergency rooms. Referrals from private doctors who have patients who lost their insurance and now need help have also been received.

One crucial factor is enlisting the donated services of specialists like Dr. Emily Fine of Fine & Gillette who specializes in OBGYN work. When asked why she became one of the 300 specialists who volunteer their services with Project Access – New Haven, she explains that "anything that allows people access to healthcare both in terms of acute need and preventive is appealing to me."

Hear why Dr. Fine thinks Project Access-New Haven is a great thing for this community

PA-NH is the product of area specialists who saw a need in the community and wanted to do something about it. It coordinates donated specialty health care services from local specialists for uninsured individuals earning under 250% below the federal poverty level. Potential patients must also meet a residency requirement of living in New Haven or one of the 6 geographically abutting towns and be at least 18 years of age. The Project Access model of health care delivery is in over 50 cities across the nation.

Very early on, physicians from Yale University's Robert Wood Johnson Clinical Scholars Program were on board to assist in creating a program with strong infrastructure and community connections. Leadership from both Yale-New Haven Hospital and the Hospital of St. Raphael saw the need for such a program and committed to providing, free of charge, all ancillary services such as imaging, lab, and inpatient care when needed.

"Once referred, we determine if a patient meets our eligibility criteria. If they do then they are covered for an episode of care, for either 6 months or until that episode of care is resolved," says Lagarde. "We're not an Insurance. We're trying to deal with urgent needs and getting them met. We're dealing with urgent care and are very proud of the fact that once a patient gets accepted the average time from being accepted to seeing a specialist is on the order of a couple of weeks, but if their need is really urgent, we have been able to arrange care within days."

To ensure timely delivery of care, PA-NH also works with the patients to address healthcare barriers such as foreign language, child care, and transportation issues.

What kind of difference does PA-NH make?

Project Access-New Haven has had referrals to address a whole host of medical concerns, including thyroid cancer, problems with the eye, and uterine issues.

"One single mom with 2 children had a mass in her neck," says Dr. Lagarde. "After a biopsy was done, she was found to have an aggressive lymphoma. We connected her with a specialist at Smilow Cancer Center and now she's getting good care. We also helped eliminate the child care issues she had which could have interfered with her treatment."

There's also a case of a 37-year-old, uninsured woman who was hospitalized for several days as a result of gallstone pain.

"This was prior to Project Access being open," recalls Lagarde. "We know that the hospitalization alone cost $68,000 and if you put an approximate cost on what it all cost – three trips to the emergency room, one admission - it was $89,000. And she still didn't have her gallbladder out, which is why she was referred to us. Had we been open when her symptoms first presented, timely access to a surgeon would have avoided emergency room visits and hospitalization, her treatment would have cost about $10,000 and the patient would have suffered less."

Before the creation of PA-NH, Dr. Lagarde helped Reverend Tyson, who was uninsured and needed treatment for colon cancer, navigate the healthcare system. After chemotherapy, the port that was used to distribute the medicine was left in the West Haven resident due to his uninsured status. He was also unable to get follow-up CT imaging needed to determine whether cancer had spread. It wasn't until PA-NH, that Reverend Tyson was able to have the port removed and receive the needed CT scan.

What's next?

Under the affordable healthcare act, in 2014, another 32 million Americans are going to get covered under Medicaid. "But just because you have Medicaid, it doesn't mean a specialist will see you," says Lagarde. "In Connecticut, less than 50% of specialists participate in Medicaid. The other issue is hundreds of thousands of undocumented persons who are not eligible for state or federally funded health care programs. The end result is that Americans will still pay for them when they need emergency care. We need to figure out how to do it in a more cost-effective, timely, and humane way."

For more information about Project Access - New Haven, read the following Yale Medicine article. Or view their profile on giveGreater.org, where you can also make a gift.

If you are interested in creating a designated fund that will benefit PA-NH in perpetuity, please contact Sharon Cappetta at 203-777-7071.