Care Coordination Adds Certainty During Difficult Times
Written by: Daniel Baker | Published: 8/16/21 On April 19, Yvette Hammond received a call about a patient who was in dire need of a specialist. Pretty standard for the Clinical Manager of Project Access – a program operated by the Primary Care Coalition [PCC] that connects uninsured and underinsured patients to vital specialty care. And here’s the kicker; Project Access doesn’t just coordinate patient care, they have a network of dedicated specialists that contract with the organization to provide care at a reduced rate; and patients cover a copay.
But this wasn’t a standard call.
Laura, the patient, spoke to me through an interpreter. In early April, she felt a strong pain and went to the Emergency Room [ER]. At the ER, doctors saw gallstones and a mass on her liver -- but they weren’t sure if the mass was cancerous. By their directive, she was told to contact her primary care physician for further inspection. The threat of cancer is troubling on its own, but even more so when you factor in that Laura is pregnant.
Laura has been a part of PCC’s Montgomery Cares – which provides primary care to uninsured and underinsured patients in Montgomery County – for eight years. She knew some of the clinics had specialty care but had never seen a specialist herself.
Hammond knew that they needed to fast-track the process to connect Laura to a specialist. Project Access doesn’t have the funds to provide very costly cancer treatment so, “when someone has cancer, there’s usually a delay because we have to apply to the Maryland Cancer Fund [a state-funded grant],” Hammond explained.
However, the state doesn’t expedite cases; the process can’t be rushed. “Knowing it can take six to eight weeks, I asked the state if there were any red flags,” Hammond said. None came up. “I went forward with the appointments anyway,” Hammond continued. “For her [Laura], six weeks wasn’t going to work with a large, potentially cancerous mass. It could be detrimental to her health and her unborn child.”
The trick was getting Laura the best care she needed in the time frame she needed, without taking too big of a financial blow to Project Access. The program’s ability to help patients avoid financial disaster is just as important as the care.
“Project Access takes away the financial burden and accelerates ease of care by scheduling appointments,” said Shire McNamara, Office Manager for Urology and General Surgery with Adventist HealthCare Adventist Medical Group – a team of urologists, general surgeons, oncologists, and infectious disease experts. Her team receives referrals from Project Access and is on the other end of the equation in terms of connecting patients to the proper specialist.
It’s not a simple equation. Each Project Access case includes a ton of moving pieces, Hammond explained. She, herself, is a registered nurse and reviews the medical aspects of the case. The client services team schedules appointments and provides all documentation to the specialist team – such as with McNamara’s office – before they see a patient. Coordinating the surgery with both the hospital and anesthesia team is yet another aspect of the process. Laura’s case in particular highlights how special Project Access is.
“Many states have programs for under- or uninsured mothers, but they cut-out once the baby is six-to-eight weeks old, and then there’s no care for the mother,” McNamara said. “With Laura, she could deliver her baby, address the issue, and not have to worry about if her insurance will cover it.”
Ana Gamero is one of the Client Services Specialist on Hammond’s team. She’s working on Laura’s case and noted the difficulty in communicating with patients while not being able to divulge too much medical information. When she first spoke to Laura, the patient wasn’t aware of the possibility of cancer. “It’s kind of tough on us,” Gamero explained, “because we can’t go into detail. We can’t say, ‘you might have cancer.’.”
Gamero has worked with a population similar to Laura, for well over a decade. “I like learning and knowing how I can help someone who needs it.”
Karla Rodriguez, the other Client Services Specialist at the PCC underscored the importance of being bilingual. A lot of the population that Project Access serves only speaks Spanish. “When they find someone who speaks to them in their language, they’re very happy and I’m happy too. When I was younger, my mom went to a lot of medical appointments, and I had to translate for her,” Rodriguez said.
Laura lauded the efforts of the Project Access team. She lost her job due to COVID-19 so her husband’s income needs to cover the rest of their bills for their children. “It’s important to have these kinds of programs to assist people who don’t have health insurance,” Laura said. “Without Project Access, it would’ve been really difficult to find specialty care.”
More testing is needed, but because of Laura’s pregnancy, they must wait. Once the baby is born – due in the fall – they'll do more tests. Uncertainty abound, Laura can rest assured knowing that Project Access will be there to schedule, book, and coordinate the specialty care she needs. ----- *The article has not been reviewed or approved by Montgomery County Department of Health and Human Services (DHHS)*