Volunteer Physicians Line up Support for Uninsured in the Columbia Gorge

Unique county-run access program would also be first in Oregon to garner 100 percent participation

May 14, 2012 -- The idea behind Project Access NOW, a network of 2,800 volunteer physicians providing care to low-income patients in the Portland metro area, is spreading up the Columbia Gorge.

Hood River County officials have been meeting with Project Access organizers to replicate the program’s success and keep people who are uninsured out of hospital emergency rooms.

Trish Elliott, nursing supervisor for the county health department, hopes the fledgling program can serve 1,000 people starting June 1.

All the providers in the county, including private-practice clinics, are stepping up to volunteer their time to only get back a nominal fee based on people’s income. The goal of the Gorge Access Program, leaders say, is to provide eligibility and enrollment in a medical home for uninsured people, as well as to those who only have catastrophic insurance.

The county, with 33 percent uninsured compared to a 21 percent state average, includes a high number of adults who may never qualify for the Oregon Health Plan, noted County Commissioner Karen Joplin. Many people fall off the Oregon Health Plan based on their employment status in the county’s largely seasonal economy. As a rural area, Hood River County has few large employers providing dependable insurance coverage.

The crisis point came when a longtime low-income clinic announced that it had reached a breaking point. La Clinica, a federally qualified health center offering dental and primary services in Hood River and The Dalles, informed the county last year that it soon wouldn’t be able to continue to provide care on an open-door basis, as it has since 1986.

“We see a lot of people going from provider to provider and racking up bills, and pretty soon everyone’s overwhelmed, and besides, it fragments care,” Joplin said. “So if we can get them in a medical home, it will provide that continuity of care and allow everyone to focus on long-term health, saving everyone money in the end. It’s quite a coordination feat, but we’re almost there.”

Linda Nilsen-Solares, executive director of Project Access, said Hood River County’s initiative is unique because it’s being run by a governmental agency. The county is also looking at a broader cross section of the uninsured in the Gorge, she said because Project Access only provides care to people who qualify for full coverage under the current safety net. Programs in Salem and Eugene provide access through Marion-Polk County Medical Foundation and United Way of Lane County, which are both nonprofit.

“It’s a model of coordinating volunteer care that’s been around for more than 20 years,” Nilsen-Solares said. “But the situation in Hood River is breaking ground in several ways. They’re also small enough in their community that they have every single safety-net clinic at the table, and in the metro area there are too many for that.”

The public health department was eager to play a leading role, Joplin said, because it had been trying to maintain an infrastructure and offer coordinated care to low-income people. Working with smaller clinics made sense for the small, cash- strapped public health department that was already doing “a lot” of referral with social service agencies in the area.

“One of our core functions is referral and providing information,” Elliott said. “We’ve asked everyone to look at their practice and see how many patients they could accept in their practice. It’s on a volunteer basis, and we’ll need to constantly re-evaluate the spread of the load on providers.”

Although physicians who participate in Project Access are primarily employed by hospitals, privately-run clinics also participate.

Dr. Kristen Dillon of Columbia Gorge Family Medicine had been helping coordinate the move for more than a year as she tried to help the county consider ways to get better healthcare for less money. Dillion received a grant from PacificSource to look for specific health indicators that determine which population groups didn’t have access to a physician and had to rely on emergency rooms. She learned that families
with children aged 2-5 frequently fell into that category.

Now their income and household size will determine the size of their co-payments, and people have started receiving patient identity cards that don’t identify them as uninsured.

“They’ll be seen as a regular client in the practice, and they won’t have to worry about being sent to collections,” Elliott said.

Throughout the county, providers care for the uninsured, but the idea was to make certain people received primary and preventative care.

“In the long run this will shave emergency room costs in this population,” Elliott said.

Pacific Source handles the medical claims and reviews information such as the diseases that impact the uninsured and low-income people. The state can track how many people have colon cancer, for example, but that information hasn’t been available outside of the traditional primary care system.

Organizers hope the Gorge Access Program will continue expanding primary care options to uninsured throughout the state. A member of the Hood River County Commission on Children & Family, Joplin also serves on governing boards covering Sherman, Wasco and Hood River counties, including the Tri-County Mental Health Board and the Mid-Columbia Community Action Council.

She also helped create “what was originally a CCO stakeholders group that has naturally evolved into a regional partnership that will include Wasco County and possibly some other counties.”

Joplin argued that such solutions were showing promise, but the real fix would probably have to come from the state level.

“The qualifications for Oregon Health Plan would have to be adjusted to allow these currently uninsured people into the system,” she said. “The question is, how do you pay for it?”

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