New Ideas for Long Time Rural Health Care Concerns

By: Sarah Jane Stewart, Virginia Rural Health Association

How does a rural hospital administrator tackle the problem of uncompensated care when it’s 15% of his expenses or $15 million in free care?  What do you do in a rural county (population 52,000) where the unemployment rate is 7.9% and 14% are on food stamps?  How do you work with a struggling free clinic and a small community health center located 15 minutes down the road?   How do you arrange for specialty care when there are few specialists in the county, and most are located in the large city 40 minutes away?  

Bill Jacobsen, CEO of Carilion Franklin Memorial Hospital in Rocky Mount, VA, pondered all these questions and organized a conference to explore how to create a comprehensive, coordinated health care system for Franklin County. 

One model that has been used successfully in other localities is the Project Access model, which links specialty care providers with uninsured, indigent patients and anchors them in a medical home for primary care and coordination.  Pioneered in Asheville, N.C., it has been successfully adapted throughout the country, including in Columbia, SC. and Roanoke, VA.   Forty health care professionals and interested persons gathered on January 8, 2010 at the Carilion Franklin Memorial Hospital to learn from the successful models in South Carolina and in Roanoke, VA, and to discuss how to incorporate components of these “best practices” into a system of care in Franklin County.    Representatives from Richland Care in Columbia, SC; Access Health SC; and Roanoke’s Project Access explained how their systems got started and how they currently function. 

• Richland Care in the Columbia, S.C.area, is sponsored by the local hospital and coordinates care through 13 medical home sites and 18 contracted specialists.  They offer a 24 hour nurse phone line, and a self-help reference guide.  This program is now funded 75% by the hospital. 
• Access Health SC is administered by the South Carolina Hospital Association and provides technical assistance and funding coordination to help communities form their own Project Access programs.  Collaboration is the key to making these endeavors successful in each community. 
• The Roanoke Academy of Medicine got interested in the Project Access model in 2003 through the efforts of one of its physicians, Dr. Robert Keeley.   He approached specialists one by one, while the office managers were approached by Executive Director Kate Ellman.  Soon Project Access was organized and the list of participating providers swelled to over 300.  Three primary care clinics were enlisted as medical homes, as well as several private primary care physicians.  In 2009, 126 patients were helped representing $2.3 million in care.  This amounts to an impressive $15.86 in donated care for every $1 cost of administering the program.  The network of physicians numbers 502 now, with 59 dentists also participating.  Project Access has been replicated in seven sites around Virginia, from the Peninsula area to Northern Virginia, Central Virginia and Southside Virginia. 

After listening to the presentations about these models, participants of the conference met in small groups to define barriers and propose solutions that will result in an integrated health system of primary care, specialty care and hospital care as appropriate.  A needs assessment is already in the making.  With all the ideas generated, and a lot of good will, something is bound to happen.  When a community meets and addresses its problems in a collaborative manner, there is no limit to what they can do.   Bill Jacobsen has already found some solutions!