Though no similar program exists in the Pittsburgh region, there are programs in Indianapolis, Cleveland, Baltimore, suburban Philadelphia and elsewhere that bring together the health centers that serve the poor and the health systems that control the specialists and diagnostic services. They work to coordinate care so that any patient who needs specialty care can get it.
Groups of specialists also have tried to organize to provide such care, as a group in Pennsylvania's Lancaster County is doing.
Not all the efforts have succeeded or endured. But their organizers all recognized the problem and tried to solve what has been a systemic health quandary for decades.
One of those projects, the Cuyahoga Health Access Partnership in Cleveland grew out of an effort that began in 2008 when all the major medical systems, federally qualified health centers and free clinics there came together to talk about access.
"We had all the players gathered around the table and said, 'We've got some of the highest quality healthcare available in the country here, we need to find a way to get uninsured people access,' " said Sara Hackenbracht, the program's executive director since 2011.
The result was that the major hospital systems, with the exception of University Hospital, agreed to make their specialists and diagnostic services available to patients who were qualified for charity or discounted care through the program.
The program takes any uninsured adult, 19 to 64 years old, who made 200% or less than the federal poverty guidelines.
By the end of 2012, 3,088 residents had been qualified through CHAP, and the program had made 4,035 specialty care referrals for them.
Perhaps most importantly to the hospitals, Hackenbracht said that surveys of CHAP patients show that 57% of them reported using emergency rooms less than before they were in CHAP, and 75% of those patients said they had not used the emergency room at all.
The program continues to grow, despite Ohio having adopted Medicaid expansion under the Affordable Care Act, meaning that fewer patients are without insurance coverage.
And now, Hackenbracht said, CHAP's board is talking about a new challenge: Underinsured patients who got their high-deductible or high co-pay insurance through the Affordable Care Act marketplace.
"I think we're going to have to move in that direction" and take on underinsured patients, she said.
Community health centers have long kept their own lists of specialists who were amenable to helping disadvantaged patients, and some had unwritten agreements with some hospitals that they could refer patients to.
But the Health Resource and Services Administration, which oversees federal health centers, recently began pushing health centers to get such agreements in writing to build more access for their patients.
In this region, only the Theiss health center and UPMC have such a formal relationship, though others have some ties.
Payne, whose struggling network of 11 health centers in some of the poorest areas of Allegheny County, is in conversation with UPMC to create an affiliation that would help support Primary Health Care Services.
"It would help us both," Payne said. "We'd be more financially secure and we'd be able to keep more people out of the emergency room."
Will Cook, president of UPMC Mercy, said he couldn't comment on the discussions, but said such an affiliation might happen.
"We are eager to talk to him because having FQHCs in neighborhoods is the future of health care, in my mind," he said. "They're already in the neighborhoods, which overcomes the transportation issues the poor deal with, and they're part of the neighborhoods."