Doctors pitch in to fill the care gap

As a medical assistant for a health clinic, Iris Montalvo was used to helping patients with their medical problems. But earlier this fall, while at work, she faced a medical emergency of her own. “I came into work and I had this numbness on one side of my face,” she says. “I thought I’d had a stroke.”

Adding to Montalvo’s fear was the uncertainty of how she would pay for the medical care she knew she would need. The company where her husband worked had gone out of business, so she no longer had health insurance. “I was scared. I was thinking, ‘What am I going to do? I don’t have health insurance. This is going to cost me a fortune.’ ”

Specialty care at no cost

A doctor at the health center picked up the phone and called Project Access, a coalition of physicians, hospitals and community organizations that work together to provide specialty health care at no cost to low-income, uninsured patients.

Project Access was quick to respond, and Montalvo was soon talking to a Yale-New Haven Hospital urgent care clinic neurologist, who ordered a brain MRI, which Project Access scheduled for the next day. Subsequently, Project Access made another neurologist appointment for Montalvo just hours after the MRI would be available. Six hours after the test, Montalvo had a diagnosis: Bell’s palsy.

She has been following up with Yale Medical Group neurologist Jennifer Block Rosen, MD, a Project Access volunteer, who also diagnosed and prescribed treatment for Montalvo’s severe migraines. “I was very happy to get involved,” Dr. Rosen says.

Everyone working together

“This is an example of how the health care system can work when everybody is on the same page and working together,” says Chris Borgstrom, program manager for Project Access.

With an unemployment rate above 9 percent and many working adults lacking health insurance, the need for programs like Project Access is greater than ever. According to Borgstrom, roughly 14.9 percent or 19,000 people in New Haven alone are without health insurance. Additionally, some 10,000 to 15, 000 are estimated to be non-citizen residents who are ineligible for insurance.

The goal of Project Access is to provide “gap coverage” for people who don’t have health insurance and are ineligible for public programs such as Medicaid, Borgstrom says. The first Project Access began in 1996, and there are now 55 independent chapters around the country. The New Haven chapter was launched in 2010 and already has about 250 participating physicians from virtually all medical and surgical specialties and subspecialties.

Last summer, Yale School of Medicine Dean Robert Alpern and Yale Medical Group CEO David Leffell sent a letter to all Yale Medical Group physicians citing the importance of programs like Project Access and urging them to participate. “I'd say that letter alone accounted for roughly 20 individual or group sign-ups,” says Borgstrom, bringing total individual YMG participation to about 50. There are also entire sections that have pledged their support, including anesthesiology, lab medicine, diagnostic radiology, pathology and nuclear medicine. The Branford/Shoreline cardiologists as well as Yale Cancer Center oncologists are also on board.

Served 200 adults the first year

Project Access, which served about 200 adults in its first year, gets its patients through physician referrals and is available to people 18 years old and older. It doesn’t treat patients who need psychiatric or dental care, or those who require ongoing chronic disease management.

In order to be eligible, a patient must be without health insurance and have an income that is no more than 250 percent above the federal poverty level. The program receives financial support from Yale-New Haven Hospital and the Hospital of Saint Raphael, and from such donors as the Community Foundation for Greater New Haven.

Besides Borgstrom, Project Access has an executive director, a nurse and two bi-lingual case navigators, who Borgstrom calls the “backbone” of the program. They serve as liaisons between the patients and physicians and do everything from helping to schedule tests and follow-up appointments to ensuring that patients have a way to get to their appointments. Borgstrom points to an appointment no-show rate of only 4 percent as “testament to what we do.”

Fewer visits to the ER

While Project Access’s primary mission is to provide affordable medical care to patients without health insurance, a secondary goal is to reduce the strain that non-emergency visits place on hospital emergency rooms. People who don’t have health insurance typically they put off treatment or turn to emergency rooms, even when their health need isn’t a true emergency.

Noting that she went to medical school to help people, regardless of their insurance, Dr. Rosen says she found her Project Access experience “very rewarding. I would be glad to become more involved with the project,” she says.

This article was submitted by Mark Santore on January 6, 2014.

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Jennifer Block Rosen

Assistant Director, Neuromuscular Medicine