Cheri Brown had walked a tightrope for years, going without health insurance to pay other expenses. Then she fell off. She could afford her well-woman exams and even medication for her diabetes. But about 18 months ago, she needed a hysterectomy. Five months later, she learned she had breast cancer.
Both were beyond the means of Brown, a 40-year-old single hairdresser.
But Brown is back at work and feeling blessed these days, having landed in a medical safety net — one celebrating its 10th anniversary this year.
Project Access accepted its first patient on Sept. 1, 1999. Since the beginning, it has provided medical care through a wide-ranging volunteer network of physicians, hospitals, government and business.
It has had a significant impact on Sedgwick County residents such as Brown, providing nearly $86 million in care for 9,049 patients since its inception through the end of June.
Even more significantly, say some of those involved, it has shown what can be accomplished when people work together in ways they hadn't before.
"It was really the first effort in our local community that coordinated care for patients without health insurance," said Christopher Moeller, a dermatologist who recently stepped down as president of the Central Plains Regional Health Care Foundation. Project Access is a project of the foundation, in conjunction with the Medical Society of Sedgwick County.
Physicians, hospitals and others had provided donated care all along, said physician Paul Uhlig, who brought the Project Access idea to Wichita. But they had done so in an uncoordinated way and sometimes at cross purposes, though unintentionally.
Project Access works to make sure the efforts are coordinated.
In Brown's case, for example, it meant referrals to a gynecologist, an oncologist, a surgeon and a radiologist, as well as hospital stays.
Project Access is for people in Sedgwick County who don't have health insurance and aren't eligible for programs such as Medicare or Medicaid.
Family income can't exceed 200 percent of the federal poverty level. For a single person like Brown, that amounts to $21,660 annually.
Kansas has an estimated 337,000 residents without health insurance, according to the latest numbers from the U.S. Census Bureau. The Sedgwick County Health Department estimates nearly 46,000 people locally are without insurance.
They are people such as Jan Brown, who has worked for most of her life but lost her job and her health insurance a couple of years ago. A widow, she has lung disease, diabetes, arthritis and other problems.
At 63, she's not old enough for Medicare and draws too much Social Security from her husband — $800 a month — to qualify for Medicaid.
Her physician was a Project Access provider and agreed to keep her as a patient, even though she could no longer pay.
"He's really gone out of his way to help me," she said.
Almost 600 Sedgwick County physicians participate in Project Access, as do Via Christi Regional Medical Center, Wesley Medical Center and several other health care facilities.
Project Access gets funding from United Way of the Plains, the city of Wichita (through federal Community Development Block Grants) and Sedgwick County. That covers some prescriptions and pays for five full-time staff members who connect patients and providers.
The majority of funding is by contribution — the donated services of the caregivers, medications from pharmaceutical companies' patient assistance programs and in-kind staff time from the Kansas Department of Social and Rehabilitation Services.
Patients must be referred to Project Access, usually through one of Wichita's low-cost clinics. Some are referred by their own physicians, as Jan Brown was, or through the primary care residency clinics of the University of Kansas School of Medicine-Wichita, as Cheri Brown was.
Moeller said Project Access works as a medical home model, something that's been talked about at the national level with health care reform. In a medical home model, one health care provider is responsible for coordinating all of a patient's care.
Outcomes include less emergency room use and better health overall, he said.
"Project Access is kind of a prototype of bringing the parts of the system together.... The amount of good and the quality of care that we were able to provide was just infinitely better, significantly better," Uhlig said.
What Jan Brown and Cheri Brown know is that it worked.
"Without them, and without the doctors being a part of that program, I don't really know what I would do," Cheri Brown said.