Recommendation: Develop a blueprint for a regional specialty care delivery network for the uninsured.

What we heard:  Gaps in access to specialty care mean that patients coping with illness may delay care or get lost in a confusing system at a time when they are most vulnerable.

What we’ve done to date to advance this recommendation:

• Collected information existing specialty care programs and networks that seek to improve access to specialty care for the uninsured in our region

• Convened leaders of these programs and primary care safety net leaders in December 2007 to discuss current challenges and opportunities in improving access to specialty care for the uninsured.

These activities were done in partnership with the Regional Primary Care Coalition, a local collaboration of health funders and primary care coalition leaders.

What we’ve learned:

There are roughly three types of programs that have been developed to provide access to specialty care for the uninsured in our region:

• Large, formalized networks of specialty care physicians who are reimbursed for services through public funding, such as the DC Healthcare Alliance, Fairfax County Health Access Program

• Large, formalized networks of volunteer specialty care physicians who provide free services to patients of multiple community based clinics through a nonprofit intermediary, such as the D.C. Archdiocesan Health Care Network, Project Access of Montgomery County, Project Access of Northern Virginia

• Small formalized networks of volunteer specialty care physicians who provide free services to patients of a single community based clinic

It is critical that these programs coordinate their efforts, so that we can provide high quality, patient-centered care to the greatest number of uninsured patients in our region. There are a number of ways we can work together to improve the accessibility and quality of care. We need to push for better reimbursement rates for specialists and test innovative models for co-locating specialists. We need to invest in care coordination or case management to improve patient experience and quality of care. We also need to support the implementation of electronic health records and other innovative technologies.

Next steps:

We will continue to work with our partners at the Regional Primary Care Coalition to advocate for and foster the development of coordinated, cross-jurisdictional, patient-centered systems of community-based health care in our region. This includes access to high quality specialty care services.

Resources, model programs and practices:

Access to Specialty Care and Medical Services in Community Health Centers, a 2007 article published in Health Affairs