Project Access Dallas Partners

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Founding Partners

City Square formerly Central

Dallas Ministries

Dallas County Medical Society

Dallas/Fort Worth Hospital Council

Health Texas Provider Network

Charity MediCal CliniC

enrollMent sites

Brother Bill’s Helping Hand

City Square formerly CDM

Christ’s Family Clinic

Diabetes Health &

Wellness Institute

Grand Prairie Wellness Clinic

Healing Hands Ministries

Hope Clinic Garland

Irving Interfaith Clinic

Metrocrest Family Medical Clinic

Mission East Dallas

North Dallas Shared Ministries

PharMaCy suPPort

Caremark

hosPital suPPort

Baylor Institute for Rehabilitation

Baylor Jack & Jane Hamilton

Heart and Vascular Hospital

Baylor Medical Center at Garland

Baylor Medical Center at Irving

Baylor Specialty Hospital

Baylor University Medical Center

Children’s Medical Center

Las Colinas Medical Center

Medical City Dallas

Methodist Charlton Medical Center

Methodist Dallas Medical Center

Our Children’s House at Baylor

Parkland Health & Hospital System

Texas Health Presbyterian

Hospital Dallas

St. Paul University Hospital

Texas Scottish Rite Hospital

for Children

Zale Lipshy University Hospital

CoMMunity Partners

Baylor Health Care System

Blue Cross/Blue Shield of Texas

Caring for Children Foundation

of Texas

The Cirrus Companies

Dallas County

Commissioners Court

DCMS Foundation

McCune Charitable Foundation

Parkland Health & Hospital System

Physicians’ Foundation for Health

Systems Excellence

Texas Health Resources

Texas Medical Association

Thompson & Knight, LLP

University of Texas Southwestern

Medical Center

Mental health/

Behavioral health

Green Oaks Hospital at Medical

City Dallas

Pastoral Counseling & Education

Center

anCillary serviCes

suPPort

4 Better Sleep

American Health Imaging

Med Provider

North Central Surgery Center

Park Central Surgery Center

Patient’s Comprehensive Cancer

Center in Carrollton

Pediatric Surgery Center

Prime Diagnostic

Quest Diagnostic

Sam’s Club Hearing Centers

Southwest Diagnostic

Imaging Center

Texas Institute for Surgery

Two Forest Imaging

laBoratory serviCes

suPPort

Clinical Pathology Laboratories

Laboratory Corporation of America

Project Access DAllAs PArtners

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enrollment:

PAD finished 2011 with a 12-month average of 3,178 active enrollees.

Enrollments have remained active (~116 new patients per month) from

11 community clinics and hundreds of private physicians, maintaining

the total patient enrollment at approximately 3,000.

specialty care referrals:

PAD completed 1,947 specialty care physician referrals (73% of all 2011

specialty requests). This helped ensure that PAD enrollees received

timely specialty physician consultations and care, decreasing their

need for hospital utilization to stabilize their chronic diseases. This

was accomplished by a concerted effort to recruit additional physician

volunteers; PAD added 240 physician volunteers (152 primary care

and 88 specialty care) in 2011. With the assistance of private specialty

physicians and the continued support of the University of Texas

Southwestern Medical Center and Parkland physicians, we have reduced

the average wait time for a specialty care appointment to 50 days, with

urgent appointments made within 2 weeks.

Pharmacy:

During the first half of 2011, PAD experienced a 30% increase in

pharmaceutical costs (to $23.41 per patient per month). The number of

prescriptions per patient increased 21%, with the costs per prescription

rising 7%. As a result, PAD made major changes to its pharmacy

benefit, helping to bring spending under sustainable budgetary control.

Additionally, we added a Pharmaceutical Assistance Program Navigator

(PAP-N) in September 2011 to help patients obtain free brand-name

medications from pharmaceutical companies. The PAP-N has assisted

149 patients obtain 240 unique brand-name prescriptions, saving PAD

more than $22,350 in annual prescription costs for these patients. These

changes have helped reduce PAD’s monthly pharmaceutical costs by

69% and stabilized the program’s budget.

care navigation:

PAD has seen a 14% increase in the number of enrollees needing care

navigation, particularly transportation. Providing this service helped

reduce specialty physician visit “no-show” rates by 40% (12% no-shows

in 2011; 20% in 2010).

Quality in Diabetes care:

Since 2009, PAD has collaborated with the Diabetes Equity Project* to

improve diabetes care management for PAD enrollees. Combined with

PAD’s pharmacy support, care navigation, and primary and specialty care

physician access, diabetic patients have realized a 15% improvement in

average HgbA1c control (8.7% baseline; 7.4% after 12 months).** Further,

the DEP’s surveillance data reveals a 53% increase in the percentage

of diabetic patients experiencing good (HgbA1c < 7%) diabetes control

(32.7% at baseline; 50.2% after 12 months).

Donations in care:

PAD’s volunteer provider network donated a record $9.7 million in care to

PAD enrollees during 2011:

• $4.5 million from local physicians

• $5.2 million from local hospitals and ancillary partners

As this report demonstrates, we have made tremendous progress

over the last nine years and look forward to 2012 and our 10th year of

operation.

Working together with you,

Jim Walton, do, MBa

Medical Director, Project Access Dallas

*Diabetes Equity Project — Funded by the Merck Co. Foundation’s Alliance to Reduce Disparities in Diabetes

**Walton JW, Snead C, Collingsworth A, Schmidt K. Reducing Diabetes Disparities Through the Implementation of a Community Health Worker-led Diabetes Self-Management Education Program. Fam Comm Health, 2012; 35 (2): 161-171.

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140 E. 12th Street | P.O. Box 4680

Dallas, Texas 75208

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A patient’s story best describes the value of Project Access

Dallas. Imagine a local hospital leader faced with a friend’s

request to help an uninsured relative. The relative just

received a cardiac diagnosis made during a recent ED

visit for chest pain. The condition wasn’t serious enough to

require admission, but the patient was told it was urgent

enough to deserve attention by a physician within the next

1 to 2 weeks.

UPDAte from the meDicAl Director

Jim Walton, do, MBa

With no health insurance, the patient turned for help to a relative involved in

healthcare administration. A few phone calls later, the patient had an appointment

with a local PAD charity clinic’s primary care physician. That physician deemed the

condition urgent, and the patient was scheduled to see a volunteer PAD cardiologist,

who performed a stress test and echocardiogram in the office. Within 2 weeks the

patient went from an ED visit to cardiac catheterization and a diagnosis of coronary

artery disease needing bypass surgery. Amazing as it seems, the final chapter of the

story has the patient receiving bypass surgery at Parkland Hospital, without having

had a heart attack. As you will see in this annual report, the value of hundreds of

similar stories is measurable. The value to the patients and their families is priceless!

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0 1,000 2,000 3,000 4,000

1,

06

2

1,

55

9

3

,9

84

2

,8

47

2008 2009 2010 2011

ACTIVE ENROLLEES

The decrease in number of PAD enrollees reflects efforts to align the number of active patients with the capacity of the physician volunteer network.

Project Access Dallas gained 240 physician volunteers in 2011 and improved

communication with volunteers through a monthly e-mail newsletter.* The decrease in number of referrals reflects efforts to align the number of active patients with the capacity of the physician volunteer network.

The rise in number of prescriptions filled is consistent with our focus on enrolling patients who have comorbidities, in conjunction with a higher first-quarter patient enrollment and a larger annual pharmacy allowance.

Diabetes Equity Project: Diabetic PAD Enrollees participating in DEP had a 15% INCREASE in disease control. (Average HgbA1c 2009-2011) Operating expense per patient increased in 2011. This is consistent with

resizing the program to meet network supply, and providing new services and staff to assist with patient care.

The increase is a result of improved data collection and reporting by all PAD partners. Services included office visits, diagnostic procedures and surgeries.

The number of navigated enrollees increased after PAD added pharmacy navigation for patients of private physicians (0 in 2010 vs. 145 in 2011).**

0 625 1,250 1,875 2,500

738

1,913

2,081

2,227

2008 2009 2010 2011

PHYSICIAN VOLUNTEERS

0 1,125 2,250 3,375 4,500 2,027 2,894 4,046 3,279 2008 2009 2010 2011

ANCILLARY & SPECIALTY

REFERRALS

0 400 800 1,200 1,600 238 743 1,334 1,521 2008 2009 2010 2011

COMMUNITY HEALTH

NAVIGATED ENROLLEES

0 8,000 16,000 24,000 32,000 11,206 11,250 25,551 31,926 2008 2009 2010 2011

PRESCRIPTIONS FILLED

0 6.0% 7.0% 8.0% 9.0% 8.7% 7.4%

Baseline After 12 Months

DIABETES CARE

MANAGEMENT

0 500 1,000 1,500 2,000 723 1,301 1,087 1,966 2008 2009 2010 2011

OPERATING EXPENSES PER PATIENT

0 2,500,000 5,000,000 7,500,000 10,000,000 4,474,528 3,742,087 5,512,044 9,760,967 2008 2009 2010 2011

DONATED SERVICES

HgbA1c

In 2010, Omar Jackson was on vacation in the Dominican Republic. Although he recently

had been laid off from his job of 25 years in the telecommunications industry, he was

hopeful that a new job was on the horizon. He had solid work experience, an education

from Cornell University, and the desire to work. Surely, he’d be fine, he thought.

Jackson’s trip and life changed in an instant.

At 48, he suffered a stroke during his vacation. He immediately got on a plane back to Dallas, but he doesn’t

know how he had the presence of mind to get to the airport, book a flight home, and then go straight from

the airport to a hospital. His insurance coverage from his previous job expired when he’d been in the hospital

for 2 weeks. Then his savings ran out. Although he wasn’t physically ready to leave the hospital, he was out

of money and saw no alternative.

That was until the hospital enrollment coordinator for Project Access Dallas came into Jackson’s room to tell

him about the program. But he was wary; he had been in the hospital for 3 weeks and was looking for options,

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0 1,000 2,000 3,000 4,000

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2008 2009 2010 2011

ACTIVE ENROLLEES

The decrease in number of PAD enrollees reflects efforts to align the number of active patients with the capacity of the physician volunteer network.

Project Access Dallas gained 240 physician volunteers in 2011 and improved

communication with volunteers through a monthly e-mail newsletter.* The decrease in number of referrals reflects efforts to align the number of active patients with the capacity of the physician volunteer network.

The rise in number of prescriptions filled is consistent with our focus on enrolling patients who have comorbidities, in conjunction with a higher first-quarter patient enrollment and a larger annual pharmacy allowance.

Diabetes Equity Project: Diabetic PAD Enrollees participating in DEP had a 15% INCREASE in disease control. (Average HgbA1c 2009-2011) Operating expense per patient increased in 2011. This is consistent with

resizing the program to meet network supply, and providing new services and staff to assist with patient care.

The increase is a result of improved data collection and reporting by all PAD partners. Services included office visits, diagnostic procedures and surgeries.

The number of navigated enrollees increased after PAD added pharmacy navigation for patients of private physicians (0 in 2010 vs. 145 in 2011).**

0 625 1,250 1,875 2,500

738

1,913

2,081

2,227

2008 2009 2010 2011

PHYSICIAN VOLUNTEERS

0 1,125 2,250 3,375 4,500 2,027 2,894 4,046 3,279 2008 2009 2010 2011

ANCILLARY & SPECIALTY

REFERRALS

0 400 800 1,200 1,600 238 743 1,334 1,521 2008 2009 2010 2011

COMMUNITY HEALTH

NAVIGATED ENROLLEES

0 8,000 16,000 24,000 32,000 11,206 11,250 25,551 31,926 2008 2009 2010 2011

PRESCRIPTIONS FILLED

0 6.0% 7.0% 8.0% 9.0% 8.7% 7.4%

Baseline After 12 Months

DIABETES CARE

MANAGEMENT

0 500 1,000 1,500 2,000 723 1,301 1,087 1,966 2008 2009 2010 2011

OPERATING EXPENSES PER PATIENT

0 2,500,000 5,000,000 7,500,000 10,000,000 4,474,528 3,742,087 5,512,044 9,760,967 2008 2009 2010 2011

DONATED SERVICES

HgbA1c

but not like this. He didn’t need or want a handout.

Eventually, he conceded that he needed help, and

he enrolled in the program.

“I didn’t realize how down and out I was,” he

says, recalling his initial hesitation about enrolling

in PAD. “But, now I can’t imagine where I’d be

without it.”

When he was released from the hospital after a

2-month stay, he spent some time in outpatient

rehab, but he couldn’t drive, he couldn’t cook

and he couldn’t get up the stairs to his second-

floor apartment. He needed help in every facet of

his life, and PAD came through. PAD helped him

change apartments, provided access to food, and

drove him to all his doctor’s appointments —

including a few rehab appointments in Euless.

“I would never be able to do it without PAD,”

Jackson says. “They have done everything for me.

They even helped me apply for disability income; I

had no idea I could get something like that.”

Jackson grew up in New York City and moved

to Dallas in 1999. He says, “It was 77 degrees

here in December. I’ve only been back to New

York once.”

While he’s enjoyed his time in Dallas, his family

and most of his friends still are in New York.

“PAD is my family and support

system here,” he says.

A lot of that feeling of familial support comes from

the staff at Healing Hands Clinic. He describes

his experiences with the clinic as “great, very

attentive and very thorough.” He says that the

clinic’s physician, Mary Beth Felty, MD, called him

one evening at home, just to check on him.

“I couldn’t believe it. No one calls me at night!

And she just wanted to give me some feedback,”

he says.

Jackson has been back to the emergency room

only once since his initial visit — after he suffered

a fall and needed stitches on his head. He’s getting

the medical attention and the care that he needs

from PAD and his medical home to get back on his

feet and return to his normal life. He’s applying for

jobs and again looking forward to the future. From

here, the future looks pretty bright.

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0 1,000 2,000 3,000 4,000

1,

06

2

1,

55

9

3

,9

84

2

,8

47

2008 2009 2010 2011

ACTIVE ENROLLEES

The decrease in number of PAD enrollees reflects efforts to align the number of active patients with the capacity of the physician volunteer network.

Project Access Dallas gained 240 physician volunteers in 2011 and improved

communication with volunteers through a monthly e-mail newsletter.* The decrease in number of referrals reflects efforts to align the number of active patients with the capacity of the physician volunteer network.

The rise in number of prescriptions filled is consistent with our focus on enrolling patients who have comorbidities, in conjunction with a higher first-quarter patient enrollment and a larger annual pharmacy allowance.

Diabetes Equity Project: Diabetic PAD Enrollees participating in DEP had a 15% INCREASE in disease control. (Average HgbA1c 2009-2011) Operating expense per patient increased in 2011. This is consistent with

resizing the program to meet network supply, and providing new services and staff to assist with patient care.

The increase is a result of improved data collection and reporting by all PAD partners. Services included office visits, diagnostic procedures and surgeries.

The number of navigated enrollees increased after PAD added pharmacy navigation for patients of private physicians (0 in 2010 vs. 145 in 2011).**

0 625 1,250 1,875 2,500

738

1,913

2,081

2,227

2008 2009 2010 2011

PHYSICIAN VOLUNTEERS

0 1,125 2,250 3,375 4,500 2,027 2,894 4,046 3,279 2008 2009 2010 2011

ANCILLARY & SPECIALTY

REFERRALS

0 400 800 1,200 1,600 238 743 1,334 1,521 2008 2009 2010 2011

COMMUNITY HEALTH

NAVIGATED ENROLLEES

0 8,000 16,000 24,000 32,000 11,206 11,250 25,551 31,926 2008 2009 2010 2011

PRESCRIPTIONS FILLED

0 6.0% 7.0% 8.0% 9.0% 8.7% 7.4%

Baseline After 12 Months

DIABETES CARE

MANAGEMENT

0 500 1,000 1,500 2,000 723 1,301 1,087 1,966 2008 2009 2010 2011

OPERATING EXPENSES PER PATIENT

0 2,500,000 5,000,000 7,500,000 10,000,000 4,474,528 3,742,087 5,512,044 9,760,967 2008 2009 2010 2011

DONATED SERVICES

HgbA1c

* PAD also began contacting physician offices that had seen a PAD patient within the previous 30 days to answer any questions and to obtain feedback. We successfully encouraged peer-to-peer recruitment with a contest focusing on a top-needed specialty. ** We experienced a significant increase in episodic referral patients (537 in 2010 vs. 892 in 2011), despite a significant drop in the number of full-time navigated patients (797 in 2010 vs. 484 in 2011). Primarily, the large increase in episodic patients served resulted from increases in the capacity of our Community Health Navigation program (addition of a donated van, increased capability of our CHN staff due to CHW training and certification, and increased capacity to provide certain types of durable medical equipment, such as CPAP and oxygen therapies). We transported almost twice as many patients in 2011 as in 2010 (675 vs. 343) and provided several kinds of durable medical equipment to more than 150 patients in 2011, compared to fewer than 20 patients in 2010.

PhYsiciAn VolUnteers of the YeAr

PRIMARY CARE

Sarah Helfand, MD – Pediatrics

Sarah Helfand, MD, a PAD volunteer since 2002, works tirelessly

at Healing Hands Ministry. According to her peers, she inspires

others to volunteer to serve the working poor of Dallas County. Dr.

Helfand serves on the PAD Leadership Committee at Methodist

Medical Center and on the DCMS board of directors. She

participates in DCMS community events, such as doing physicals

at health fairs, answering questions in the “Ask the Doctor” booth,

and volunteering on Medical Missions Day.

SPECIALTY CARE

Howard Weiner, MD – Gastroenterology

Howard Weiner, MD, has volunteered with PAD since 2002. He has

offered unlimited appointments in PAD’s most needed specialty

this year, seeing as many patients as PAD could send. Since the

inception of Project Access Dallas, Dr. Weiner has been influential

in getting support from the leadership at Presbyterian Hospital of

Dallas. He is an exceptional volunteer and a great leader for Project

Access Dallas.

Figure

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