The Robert Wood Johnson Foundation (RWJF) launched Reach Out: Physicians' Initiative to Expand Care to Underserved Americans in 1992. The program's aim was to:

• Complement publicly funded safety net providers, such as community health centers.
• Expand the private sector's capacity to care for the medically underserved.
• Promote the creation of physician-led systems of indigent care supported by partnerships with local providers and other community-based organizations working with the poor.

RWJF authorized $15 million in funding for the program, to begin in March 1993, later (1995) reducing the amount to $12 million.

The Program
During 1993–1994 Reach Out received over 400 project proposals from doctors' groups. Of these, the national program office selected 40, representing a variety of proposed site models. All sites selected had a commitment to increasing access to care, leadership by practicing physicians and evidence of community support. Reach Out placed particular emphasis on selecting sites that relied on voluntarism. Sites were variously located: from large metropolitan areas to remote locations in Maine and Montana, and five projects were statewide.

The selected projects received funding in two stages. In a planning stage, RWJF provided each project site a one-year development grant of up to $100,000. At the end of this development period, grantees were eligible for three-year implementation grants of $200,000. One site dropped out after 12 months.

Each of the 39 implementation grantees established partnerships with primary care providers, hospitals, health departments, state agencies and others. Under the direction of H. Denman Scott, M.D., M.P.H., the national program office at Memorial Hospital in Pawtucket, R.I., provided ongoing administrative direction and technical assistance to these projects.

The 39 implemented projects fell into seven model categories. The two most common models, the free clinic (10) and the referral network (16), accounted for two-thirds of the total number of projects. Other projects were modeled as combined clinic/referral networks, rural primary care networks, public health private partnerships, managed care look-alikes, and insurance look-alikes. Many projects had elements of two or more models.

Key Results
As cited in the Journal of the American Medical Society (JAMA) in January 2000, 11,252 physicians participated in Reach Out, providing care to the underserved via their community's site. Some 199,584 people received medical care through Reach Out. Not all patients were uninsured; some were enrolled in Medicaid and the care provided was not on a volunteer basis.

Put differently, approximately 2 percent of U.S. physicians volunteered to treat 0.5 percent of the nation's uninsured, under Reach Out. Service to these nearly 200,000 patients cost about $60 per patient (based on the total $12 million RWJF program cost). A significant number of these patients were provided ongoing medical homes throughout the three-year implementation phase of the program, while others received specialized care such as surgery or costly tests.

In the view of the national program office, perhaps the single most important accomplishment of Reach Out was its documentation of physicians' capacity and willingness to lead community-wide efforts for the medically underserved.

The program also demonstrated the capacity of communities to develop and run programs for the medically underserved that suit their local needs and resources.

According to the national program office, there were two unexpected discoveries:

1. The universal difficulty, among the underserved in Reach Out projects, of maintaining oral health.
2. The difficulties, mainly financial, of these underserved in securing needed pharmaceuticals.

At the conclusion of Reach Out in the fall of 1999, the national program office judged that 21 of 39 implemented projects were "stable," that is, expected to exist for at least two years beyond RWJF funding. Another 14 were classified as semi-stable, or coping with problems but with some chance of continuation beyond RWJF funding.

In a 1999 analysis, the national program office concluded that collaboration with safety net agencies was a key ingredient of project sustainability.

This report provides more comprehensive details about 10 sites (see the Project List). These 10 sites were selected by RWJF, the project evaluator and the national program office to highlight the variety of operating structures by which community based care models can be made to work.

Evaluation
Irene M. Wielawski, a former investigative reporter for the Los Angeles Times, conducted an evaluation of the Reach Out program for RWJF. Her conclusions, listed in more detail in the body of this report (see Evaluation as well as Lessons Learned), included the following:

• The willingness of health care professionals to help people regardless of their ability to pay is alive and well, particularly with community backing—for example administrative or case management support.
• Health care systems and health care improvements for the medically underserved must have strong local input.
• In providing community based care for the medically underserved, there is no one-size-fits-all model.
• Not only local leadership and local chemistry, but also local history appears far more predictive of success of a community health care effort than the actual architecture of the model being used.
• The quality of the project manager is critical to the success of any volunteer program to aid the medically underserved.

Writing in the January 2000 article in the Journal of the American Medical Association (JAMA) cited above, Reach Out's national program director, Scott, concluded that:

• "The Reach Out experience illustrates a variety of approaches to care for the underserved. All of these models can work. Success has been most difficult in urban centers, where the numbers of underserved were vast."
• "Which model a community might choose to pursue depends on local circumstances, including the background and inclination of local physician leadership and the availability of other services in the community."
• "Programs need a funded administrative structure. The tasks of recruitment, scheduling, marketing, information management and case management require paid staff. The staff need not be large to be effective."
• For a more comprehensive summary of findings about Reach Out, from JAMA and other sources, see Lessons Learned.

Communications
Media coverage of Reach Out included, an extended commentary appearing in the Los Angeles Times, the Houston Chronicle and Newsday, in 1994, and a feature article in the Boston Globe Magazine, in 1995. (See the Bibliography for further details.)

After the Program
Upon the close of Reach Out, RWJF established Volunteers in Health Care, a national, nonprofit resource center to make use of the lessons learned under Reach Out, and thus aimed at assisting volunteer-led health care initiatives serving the uninsured. Volunteers in Health Care makes available specialized products such as patient tracking software, as well as "field reports," short compendiums of advice, some written by former Reach Out site volunteers and many others written by non-Reach Out sites, outlining the "how to's" critical to starting or expanding programs for the uninsured. A valuable tool developed under Reach Out and available through Volunteers in Health Care is "RxAssist", a continually updated, searchable database detailing more than 100 pharmaceutical companies' patient assistance programs. Available at www.rxassist.org, it is already in wide use helping address the difficulty of obtaining affordable drugs for patients who cannot afford them. RxAssist has grown from 150,000 hits per month in 2000 to 2.6 million hits per month in 2005. RWJF has contined support for RxAssist through December 2005 (ID# 053639). The project has established a business plan and program generated income is expected to support approximately 50 percent of continuing operations in 2006.