Specialty Access for Uninsured Program

Developing a system that will ensure specialty care for low-income, uninsured adults in Milwaukee County

Full Project Name:Specialty Access for Uninsured Program (SAUP) in Milwaukee CountyPrimary Community Organization:Milwaukee Health Care PartnershipPrimary Academic Partner:John Fangman, MD, MedicineAward Amount:703976

Award Date

January2013

Project Duration:48 months

Project Description Narrative:

Access to specialty health care services for uninsured, low-income individuals is a major public health issue. The United States Census Bureau reported that 50.7 million, or 16.7%, of the U.S. population lacked health insurance in 2009, up from 46.3 million, or 15.4%, in 2008. The 2009 Wisconsin Department of Health Services (DHS) Family Survey estimated that 489,000 Wisconsin residents (9%) were uninsured at any point in time in the year.

While there are challenges and disparities in access to primary care services for low-income, uninsured individuals, access to specialty care is documented as a pressing issue. Nationally, a 2007 article in Health Affairs reported the results of a survey of specialty referral patterns in 814 Federally Qualified Health Centers (FQHCs). According to the FQHC medical directors surveyed, approximately 25% of patient visits resulted in medically necessary referrals for specialty care services. Locally, inadequate access to specialty care for low-income, uninsured adults is especially acute in Milwaukee County. In a 2009 survey of Primary Care Providers (PCPs) in Milwaukee's safety net clinics (FQHCs and neighborhood-based free and community clinics) PCPs reported that access to specialty care was their top concern.

Project partners aim to develop a system that will ensure timely, clinically appropriate, managed access to specialty care for low-income, uninsured adults in Milwaukee County through a structured model pairing safety net clinics and health systems.

Community partners: Ascension: St. Ben's Clinic, Milwaukee Health Services, Inc, Angel of Hope Health Care Clinic, Sixteenth Street Community Health Centers, Aurora Health Care: Aurora Walker's Point Community Clinic, Bread of Healing Clinic, Sixteenth Street Community Health Centers, Froedtert & the Medical College of Wisconsin: AIDS Resource Center of Wisconsin, Outreach Community Health Centers, Progressive Community Health Centers, Sixteenth Street Community Health Centers

Additional MCW academic partners: Joan Neuner, MD, MPH, Medicine; Marie Wolff, PhD, Family and Community Medicine; Amy Kistner, MS, LPC, Family and Community Medicine

Outcomes & Lessons Learned:

Facilitated access to specialty care for uninsured patients, successfully pairing safety net clinics with a health system partner to create nine clinic/health system dyads that were successfully launched during the project period
Developed and implemented effective screening, enrollment, referral and care coordination processes, working collaboratively across the clinic/health system partners to obtain agreement on clinic determinations of eligibility which contributed to reducing replication of financial screenings, delays in scheduling, and documented a high show rate of 93%
Evaluated patient, primary care provider, and specialist experiences to identify barriers and obstacles and inform refinement of processes. Among clinic staff surveyed, 90% felt that referral to specialty services was helpful to their patients and 59% indicated that the program has had a great impact on their clinic
Achieved continued collaboration from partners, which resulted in the Milwaukee Health Care Partnership Board endorsing support for the SAUP beyond project funding and opportunities to explore expanding the model to additional safety net clinics
Disseminated project information and outcomes through presentations at various meetings and events as well as a published article in Health Care Financial Management
Leveraged $647,964 in funding from other sources