To address this growing need, a 2009 Community Health Fund (CHF) grant underwrote the cost for OA to create a three-year plan of action that built on a strategic alliance among OA, local hospitals, their volunteer medical professionals, and community clinics. Today that alliance includes volunteer surgical teams at John Muir Health and Kaiser hospitals, as well as the following community clinics: La Clínica de La Raza, Lifelong Brookside Community Health Center, Planned Parenthood Shasta Pacific, and Bay Area Rotacare’s Concord and Pittsburg clinics.
Since 2009, the CHF has provided additional grants to support implementation and evaluation. A CHF-funded 2010 evaluation found that due in part to the increased organizational capacity our grant enabled, access to surgical and specialty care through OA for low-income, uninsured Contra Costa County residents increased by 250% and clinical referrals to OA increased by 144%, with patient satisfaction extremely high. And through the end of 2012, OA had made it possible for over 750 Contra Costa patients to receive specialty care services and outpatient surgeries.
In 2013, the CHF is supplying additional grant money so OA can:
- Provide specialty and surgical care services to 500-565 low-income, uninsured residents, in part by increasing the total number of available specialists from 120 in 2012 to 130 in 2013. This will decrease patient wait time and increase the capacity to serve patients locally.
- Add general surgery, vascular surgery and gynecology services at John Muir Health Aspen Surgery Center
- Implement a gastrointestinal (GI) program at John Muir Health Concord & Walnut Creek campuses.
- Increase the training of La Clínica’s staff to insure appropriate and accurate referrals to OA.
- Explore the feasibility of a specialty dental care partnership with La Clínica.
The Health Issue
Uninsured patients who can't afford surgery face overwhelming obstacles to obtaining necessary treatment. The biggest barrier is cost. Most surgeries run thousands or tens of thousands of dollars, costs that are out of reach for OA patients who, in 2012, had an average annual income of $11,100 for an individual and $20,700 for a family of four. Those who do not speak English face greater barriers to care; nearly 70 percent of OA patients need medical interpretation.
That's why many of these patients postpone treatment and experience worsening symptoms until an emergency develops. This negatively affects patients' health and quality of life, strains the resources of already overcrowded emergency departments, and drives up health care costs.
The Health Improvement Strategy
Operation Access is a nationally recognized organization, with 1,280 medical volunteers who donate care through an integrated system of 90 referring community clinics and 33 participating hospitals and medical centers in six Bay Area counties.
The OA network of volunteer surgical teams offers a wide variety of surgical procedures that include, but are not limited to breast biopsies, hernia repairs, gall bladder removal, ear/nose/throat procedures, cyst excisions, and repair of torn ligaments. A study published in the December 2009 Journal of the American College of Surgeons found that "a volunteer program providing low-risk outpatient operations using the OA model delivers safe, efficient, effective, timely, and patient-centered care."
Community clinics refer patients to OA, whose staff members screen the patient for financial and medical eligibility. OA then matches the patient with an appropriate specialist who, without charge, provides a surgical consult, outpatient surgery at a participating hospital if necessary, and one post-operative visit. Patients then return to their primary care provider, at a community clinic, for any ongoing health care needs.
To qualify for an OA procedure, patients must:
- Be uninsured and unable to obtain job-based insurance coverage
- Be ineligible for publicly sponsored coverage
- Earn less than 250 percent of the federal poverty level
- Possess less than $5,000 in savings
- Be diagnosed as needing medically necessary outpatient surgery
- Be in good overall health and lack co-morbidities.