Blue Ridge Regional Hospital - Toe River Project Access

Overview

Toe River Project Access (TRPA), a core program of the Blue Ridge Regional Hospital (BRRH) Foundation, was launched in November 2003 as a “virtual clinic” to help low-income, uninsured residents of Mitchell and Yancey Counties gain access to comprehensive health care. TRPA, in partnership with area physicians, dentists, optometrists, and BRRH, provides comprehensive access to health care for some of the community’s most vulnerable residents, and spreads the burden of care for low-income, uninsured residents across the full spectrum of providers. TRPA secures a medical home for those who have no health care access, no private health insurance, and fall outside of government assistance programs.

Impact

TRPA is a great asset to our community. Without this program, many of the communities’ most vulnerable residents would not be able to receive the care they need or afford their medications. Since its inception, TRPA has provided 1,048 uninsured residents of Mitchell and Yancey Counties with more than $4.2 million in free medical care. In exit surveys, 90 percent of TRPA’s clients say their health has stabilized or improved as a direct result of the program. Because clients now have a medical home to treat their chronic illnesses, emergency department visits by TRPA clients have decreased by more than 72 percent in the last six years.

Challenges/success factors

During TRPA’s formation, it was challenging to communicate available services with the target populations, primarily due to the isolated territory and culture prevalent in the area. Program leaders have worked closely with area churches, which through their advocacy have assisted in reaching, enrolling, and improving the health of many patients. Initially, the Department of Social Services was to be responsible for enrolling patients into TRPA if they were not eligible for Medicaid. However, due to logistics and legal constraints, it was determined that TRPA would be better suited for the enrollment process.

An additional challenge was encountered when physician offices reported their charity care to TRPA. Due to physicians’ misunderstanding of the extra workload the original concept placed on their office staff, tracking and calculating this pro bono care was excessively inefficient. As a result, TRPA created a new, standardized reporting system where information could be easily communicated and tracked while simultaneously reducing the workload on individual offices.

Current challenges include the changes health care reform will bring to the Project Access landscape; ongoing funding as competitiveness for funding increases, maintaining the same level of commitment from providers, and lack of sufficient providers to expand services.

In terms of success, TRPA’s concept as a “virtual” free clinic worked because it significantly reduced start-up costs in an area without the resources to sustain a self-supporting free clinic. Program leaders believe that the project also succeeded because all of the major stakeholders in health care and social services were present during the initial planning, providing valuable insight and feedback about their experiences with the indigent patient population. This reduced competitiveness and helped to avoid duplication of services.

Future direction/sustainability

Through fundraising activities with BRRH Foundation, Toe River Project Access has been working toward a self-sustaining status and will continue to do so into the near future.

Advice to others

Understand how the different health care providers function within the constraints of their own organizations, and understand the provider base, patient population, and community to be served by the project. It is also important to understand the motivating factors that will encourage providers, such as physician champions, to become and stay involved.

Contact: Aubrey Stewart
Coordinator, Toe River Project Access
Telephone: 828-766-1850
E-mail: Aubrey.stewart@msj.org