What makes the alliance unique is its mix of partners. What makes it effective is the way those partners have set aside personal agendas for the community, according to Krishna.
W. H. Bud Oehlert, a cardiologist who now works as a consultant (and was installed as the president of the Oklahoma State Medical Association last week), serves as co-chairman of the alliances physician and hospital recruitment committee. In developing the alliances model, Oehlert researched between 20 and 30 initiatives in other states. Only those projects with clinics at multiple access points in a community were of interest to Oehlert. He also studied those that were sustainable.
One of the things that became evident as I was studying: You had to generate a funding system to keep it alive that was separate besides a limited year grant, Oehlert said.
Oehlert cited Wichita Project Access in Kansas and Buncombe County Medical Society Project Access in Asheville, N.C., as two initiatives the alliance looked to as models. The American Project Access Network is a national, not-for-profit organization that coordinates physician charity care for low-income, uninsured people. Established in North Carolina in 1996, there are more than 50 Project Access initiatives nationwide today, according to Kayla West, the organizations executive director. West said the most effective projects are those that have engaged the physician community and worked out a collaborative. After that, money tends to follow, West said.
Oklahoma already has a Project Access initiative through the Central Oklahoma Integrated Network System, which collaborates with other healthcare safety net providers , including the alliance. In essence, the alliance was inspired by Project Access models but is its own entity. The group also looked to the Wichita model because Kansas established the Charitable Healthcare Provider Program in 1991, which allows volunteer physicians to be considered state employees in the event they are sued for malpractice.
Pamela Cross, the alliances project coordinator, said the group developed as a hybrid of other models, and it continues to research what other cities and states are doing well. In Oklahoma, the alliance includes the Oklahoma County Medical Society, the Oklahoma City-County Health Department, the Central Oklahoma Integrated Network System, or COINSwhich provides some technical support to the clinics, maintains a referral system to providers and trains community health workersand Skyline Urban Ministry as partners; Butterfield Memorial Foundation and Integris Health as funding partners; and all nine of Oklahoma Countys full-service hospitals: Deaconess Hospital, Edmond Medical Center, Integris Baptist Medical Center, Integris Southwest Medical Center, Mercy Health Center, Midwest Regional Medical Center, Oklahoma University Medical Centers Childrens and Presbyterian hospitals, and St. Anthony Hospital.
Were only competing with helping people, Krishna said of the partnership, adding later that the alliance has five major components: physicians, hospitals, community (such as schools and small businesses), government and big business. Involvement from each of these groupseach one of which can benefit from helping to treat the uninsuredis essential to the alliances success, Krishna said.
Highly respected among others in the alliance and called a great humanitarian by one committee member, Krishna is a native of India who specialized in internal medicine and worked in England before moving to Oklahoma in the 70s. On April 19, 1995, he was the chief of staff at St. Anthony Hospital when the Alfred P. Murrah Federal Building bombing killed 168 people in Oklahoma City. Calling the event a pivotal point in the cultural shift of Oklahoma, Krishna said he saw true heroism by ordinary citizens on that horrific day 12 years ago.
If we really care, we can make wonders here in the plains of the United States, Krishna said.
In the same way, Krishna hopes citizens will band together to solve the regions current crisis of caring for the uninsured. He emphasizes the importance of community involvement as he promotes the work of the alliance, which grew from a physician-hospital summit Krishna coordinated in October 2005, when he served as president of the Oklahoma County Medical Society. A group of 40 participants attended a meeting of what was then known as the Health Consortium to discuss the growing problem of the uninsured. Jana Timberlake, executive director of the Oklahoma County Medical Society, said the timing was right for those players to come together, and that it was very unusual for rival hospitals to set aside competition for this effort.
The issue of the uninsured is not a doctor or hospital problem to solve, Timberlake said. It is a community issue that affects the entire community. We need to be owners in it.
One of the participants at that initial meeting was Jon Lowry, an epidemiologist and the special projects coordinator for the Oklahoma City-County Health Department. Lowry, who serves as chairman of the alliances steering committee, was invited to introduce the idea of area hospitals sharing their emergency-room data with the health department.
Our city in 2005 had 10 emergency room departments, Lowry said (Oklahoma University had three emergency departments and merged to two). We got all 10 hospitals to give us data. That was huge. As a result of our analysis and partnership, we are getting that data every 30 days.
At a follow-up summit one year later, this time with about 70 participants, Lowry announced the results from data gathered throughout 2005, which showed that 53% of the 298,000 ER visits in those hospitals were for nonemergent care. Also, more than 106,000 of nonemergency ER visits in that year were by patients who were uninsured or underinsured. Of those, half were 20 years old or younger and one-third were working adults.
A lot of the uninsured people show up for emergency room services for problems that are nonemergent, said Jay Cannon, president of the Oklahoma Medical Society, who serves on the alliances steering and hospital and physician recruitment committees. If you go there for anything, it will cost $200 or $300. With this program, we hope to have clinics established 24 hours a day so that people have a medical home where they can go to when they get sick, adding that the medical-home model is much more cost-effective and also more satisfying to the patient. Physicians have always provided free care, Cannon said. This seems like a structured way to do it so people are cared for in an efficient manner.
Armed with data from the health department and a commitment from some dedicated volunteers, the alliance received funding from two major sources to develop its pilot project at three free clinics. The Butterfield Memorial Foundation, an Oklahoma City-based Christian charitable organization, granted $250,000 to the Skyline Urban Ministry on behalf of the alliance to fund the free clinic project for one year. Skyline Urban Ministry is a mission of the Oklahoma Conference of the United Methodist Church that was incorporated in 1974. Butterfield can give only to Christian organizations, so it made the grant to Skyline on behalf of the Health Alliance for the Uninsured. Integris, meanwhile, committed additional funding for three years to hire Cross, the alliances full-time project coordinator.
Susan Agel, program officer at Butterfield, said there are a lot of grass-roots clinics in the area that are not likely to make it on their own. The Butterfield Memorial Foundation is hopeful that this pilot project will lead to a system of coordinated clinics and that it will bring together volunteer physicians and citizens to donate their time and money.
Nothing of this sort will work without community underpinning, said Evan Collins, president of the Butterfield Memorial Foundation. We hope if this model works well, we can export it to other communities and replicate the same thing.