RWJF Scholar examines neighborhood-based death rates from opiate-based painkiller overdoses, compared with heroin overdose deaths.
Between 1997 and 2006, staff from the national program office of the Robert Wood Johnson Foundation (RWJF) program Reach Out: Physicians' Initiative to Expand Care to Underserved Americans established and operated a technical resource center. The center, called Volunteers in Health Care, helped physicians, dentists and other providers meet local health care needs through their volunteer efforts.
After the Grants
Because it could not generate adequate funding, the resource center no longer exists, although the RxAssist Web site remains active.
RWJF supported Volunteers in Health Care with one solicited grant (ID# 030114) and three unsolicited grants (ID#s 035301, 040746 and 053639), totaling $8,353,238, to Memorial Hospital of Rhode Island, the site of the Reach Out national program office.
The number of Americans without health insurance grew steadily during the 1990s, reaching 41.7 million (15.6 percent of the population) in 1996 the year before the start of this project according to the U.S. Census Bureau. One journal article, written by the project director, noted these consequences:
Studies have demonstrated that the uninsured have difficulty getting medical care, that when they are hospitalized their illnesses and injuries are far more acute and advanced than those of people with insurance and that the mortality rate is higher for uninsured than for insured persons. ("Physicians Helping the Underserved: The Reach Out Program," Journal of the American Medical Association, January 5, 2000).
In 1992, RWJF launched a national program, Reach Out: Physicians' Initiative to Expand Care to Underserved Americans, to promote the creation of physician-led systems of indigent care and expand the private sector's capacity to care for the medically underserved.
Based at the Center for Primary Care and Prevention of the Brown University School of Medicine/Memorial Hospital of Rhode Island, Reach Out was intended to complement publicly funded safety-net providers. Some 11,252 physicians participated in volunteer initiatives, and almost 200,000 patients were enrolled at the conclusion of the four-year program, according to the JAMA article cited above.
Many Reach Out projects used the patient assistance programs of pharmaceutical companies, which provide medications at reduced or no cost to some low-income people who lack prescription drug coverage. This is not always easy for patients, however, since each company's program operates individually and changes frequently, with differing application processes and eligibility criteria. Patients must apply separately to each company and may be required to reapply after only a short term of medication.
Reach Out's Accomplishments
In the view of the national program staff, Reach Out's single most important accomplishment was its documentation of physicians' capacity and willingness to lead communitywide efforts to provide care to the medically underserved. The program also showed that communities can develop and run programs for the medically underserved that suit their local needs and resources.
The Reach Out experience further demonstrated that volunteer physicians need help both in local organizational development and marketing, and in securing assistance from managed care organizations, organized delivery systems and the pharmaceutical industry. According to RWJF program officer Susan Hassmiller, "there was still more work to be done, and RWJF decided to continue the technical assistance."
With four RWJF grants running from July 1997 through March 2006, staff of the Reach Out national program office established a technical resource center, called Volunteers in Health Care, to help physicians, dentists and other providers meet the health care needs of underserved populations through their volunteer efforts.
Under grant ID#s 030114, 035301 and 040746, Reach Out staff and additional, newly hired personnel implemented and operated the new resource center. Under grant ID# 053639, staff redesigned the RxAssist Web site, which assists clinicians in accessing free medications for uninsured patients (see Results). H. Denman Scott, M.D., M.P.H., Reach Out's national program director, served as project director of Volunteers in Health Care.
Project staff conducted the following activities.
Project staff gathered data to guide its work with volunteer providers throughout the country by:
Project staff distributed requests for proposals to more than 1,600 organizations, seeking new strategies to address health care access issues.
A separate request for proposals offered grants specifically for projects to expand access to oral health services. Volunteers in Health Care partnered with the American Dental Association on this effort.
See Results for information on grants awarded.
During the grant period, project staff:
Project staff did a limited amount of work to develop a business plan with benchmarks and action steps for moving Volunteers in Health Care toward sustainability; it was unable to reach that goal.
Staff considered a variety of options for generating ongoing revenue, including seeking grants from foundations and corporations, charging fees for selected products and services and seeking subcontractor arrangements with other organizations and government agencies. Eventually, Volunteers in Health Care imposed charges for some of its products and established small contractual relationships with the American Dental Association (see Results), Systemetrics (see Results) and Express Scripts (see After the Grant), but these generated only limited revenue.
Project staff noted that the major external challenges to the long-term sustainability of Volunteers in Health Care was generating adequate interest from government agencies or from the professional medical and dental associations it considered to be the project's "natural allies." According to a report to RWJF:
It was impossible to get either physician/dentist organizations or the U.S. Department of Health and Human Services to give it any focused attention. They did not identify clinician volunteerism as a priority issue Nor did the Volunteers in Health Care mission fall within the guidelines of national health care funders and local foundations could only fund projects in their geographic areas.
Project staff also observed that its efforts to achieve sustainability should have begun earlier.
In interviews conducted for this report, staff of Volunteers in Health Care offered the following conclusions:
In the absence of ongoing funding, the Volunteers in Health Care resource center has closed, although staff continues to answer questions from the field when contacted.
The Volunteers in Health Care Web site is no longer in operation. Project staff have preserved its content and hope eventually to move it to the RxAssist Web site or elsewhere. The pharmaceutical company Astra Zeneca has provided funding to maintain the RxAssist Web site for two years (into 2008). As of mid-December 2006, there were 60,000 registered users of the RxAssist Web site, according to the deputy project director.
Under a contractual arrangement with Express Scripts, a pharmacy benefits manager, Volunteers in Health Care helps to market Express Scripts' patient assistance program and receives a small fee for each program application downloaded from the RxAssist Web site. This contract, scheduled to last until June 2007, brings in about $48,000 per year for the RxAssist Web site. The Systemetrics contract (see Results above) provides additional, short-term funding.
Project staff is working with the federal Centers for Medicare & Medicaid Services (CMS) to ensure that pharmaceutical patient assistance program information on the CMS Web site parallels that on the RxAssist Web site.
Volunteers in Health Care
Memorial Hospital (Pawtucket, RI)
H. Denman Scott, M.D., M.P.H.
Data Collection Activities
To guide the development and expansion of the Volunteers in Health Care technical resource center, project staff:
RxAssist Web Site
The RxAssist Web site, which was redesigned and relaunched in January 2006, includes:
Links to the RxAssist Web site are included on the Web sites of the AFL-CIO, the Centers for Medicare & Medicaid and hundreds of other sites, including academic health centers, medical societies, disease-specific organizations, insurance associations, state governments and other health care entities.
In a report to RWJF, project staff called RxAssist "the best source of information for how Medicare Part D [Medicare's new prescription drug coverage launched January 1, 2006] affects eligibility in pharmaceutical company patient-assistance programs. We were the first organization to post information on this topic and have been the only organization to regularly contact programs for updates."
As part of its efforts to provide an array of technical assistance and promotional materials available, project staff:
Volunteers in Health Care published seven issues of Rx for Access before ending the relationship in June 2005. Medpin published four additional issues through December 2005. Archived copies are available at RxforAccess. See the Bibliography for details.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Geller S, Taylor BM and Scott HD. "Free Clinics Helping to Patch the Safety Net." Journal of Health Care for the Poor and Underserved, 15(1): 4251, 2004. Abstract available to subscribing libraries online.
Scott HD, Bell J, Geller S and Thomas M. "Physicians Helping the Underserved: The Reach Out Program." Journal of the American Medical Association, 283(1): 99104, 2000. Abstract available online.
Hattis PA, Staton S and Walton J. Understanding Charitable Immunity Legislation: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2000, 2001, 2001, 2003 and 2004.
How to Start a Free Clinic: Basic Starter Kit. Pawtucket, R.I.: Volunteers in Health Care, 2000.
Volunteer Retention and Recruitment Manual. Pawtucket, R.I.: Volunteers in Health Care, 2000.
Volunteers in Health Care. (Newsletter). Pawtucket, R.I.: Volunteers in Health Care, 2000 (one issue), 2001 (one issue), 2002 (two issues), 2003 (one issue).
A Comprehensive Resource on Pharmaceutical Patient Assistance Programs. (RxAssist information packet). Pawtucket, R.I.: Volunteers in Health Care, 1999.
Locate Free Medications Online at www.rxassist.org (RxAssist Web Site promotion brochure). Pawtucket, R.I.: Volunteers in Health Care, 1999.
What Makes Volunteers in Health Care One of a Kind? (Volunteers in Health Care Web site promotion brochure). Pawtucket, R.I.: Volunteers in Health Care, 1998.
VIH Leadership Institute brochure. Pawtucket, R.I.: Volunteers in Health Care, 1998.
Volunteers in Health Care: Community, Commitment. (Volunteers in Health Care promotion brochure). Pawtucket, R.I.: Volunteers in Health Care, 1999.
Goldin GL. Sample Policy and Procedure Manuals: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2001 and 2004.
Richardson K and Walton J. Managing Medication Samples: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2001 and 2004.
Goldin GL and Hanson SH. Recruiting and Retaining Medical Volunteers: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2002 and 2004.
Goldin GL and Hanson SH. Starting a Dental Project for the Uninsured: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2002.
Goldin GL and Hanson SH. Starting a Free Clinic: A Volunteers in Health Care Guide. Pawtucket, Rhode Island: Volunteers in Health Care, 2002.
Hanson SH and Goldin GL. Recruiting and Retaining Dental Volunteers: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2002 and 2004.
Jacobs EA and Goldin GL. Overcoming Language Barriers: Part 1 for Clinicians: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2002.
Walton JM. Starting a Pharmaceutical Access Program: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2002 and 2004.
Bancroft MA and Goldin GL. Overcoming Language Barriers: Part 2 for Administrators: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2003.
Geller S. Understanding the Health Insurance Portability & Accountability Act: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2003.
Richardson K and Geller S. Using Pharmaceutical Company Patient Assistance Programs: A Volunteers in Health Care Guide. Pawtucket, R.I.: Volunteers in Health Care, 2004.
RxAsssist Plus, Version 1.0, medication and patient tracking program on CD-ROM. Pawtucket, R.I.: Volunteers in Health Care, 2001.
RxAssist Plus, Version 2.3, medication and patient tracking software on CD-ROM. Pawtucket, R.I.: Volunteers in Health Care, 2001.
RxAssist Plus, Version 3.0, medication and patient tracking software on CD-ROM. Pawtucket, R.I.: Volunteers in Health Care, 2003.
RxAssist Plus, Version 3.2, a web-linked program providing a searchable database of pharmaceutical company patient assistance program information that allows for patient and medication tracking on CD-ROM. Pawtucket, R.I.: Volunteers in Health Care, 2004.
"Volunteers in Health Care Physician Volunteer Focus Group Study," Volunteers in Health Care and National Research Corporation, fielded September 1998March 1999.
"Physician Survey," Volunteers in Health Care, fielded October 1998March 1999.
"Indigent Drug Program Survey," Volunteers in Health Care, fielded OctoberNovember 1998.
"Pharmaceutical Access Monitoring Study." Volunteers in Health Care, fielded MarchMay 1999.
"Assessing the Impact of the Free Clinics of the Great Lakes Region," Volunteers in Health Care and Free Clinics of the Great Lakes Region, fielded JuneNovember 1999.
"VIH Mailing List Telephone Survey," Volunteers in Health Care, fielded June 2000.
"Assessing the Impact of the Free Clinics of the Great Lakes Region," Volunteers in Health Care and Free Clinics of the Great Lakes Region, fielded JuneSeptember 2000.
"National Survey of Programs Using Dental Volunteers," Volunteers in Health Care, fielded SeptemberOctober 2004.
www.volunteersinhealthcare.org (no longer operative as of January 2007). Provided information about Volunteers in Health Care; guides on many topics, such as starting a free clinic and overcoming language barriers; resource tips; field reports from free clinics throughout the nation; and other relevant materials. Pawtucket, R.I.: Volunteers in Health Care, Spring 1998.
www.rxassist.org. Provides an informational database on pharmaceutical manufacturers' patient assistance programs as well as pharmaceutical news and information on issues of interest to health care providers and consumers. Also includes a packet for patients on obtaining free/low cost medications. Pawtucket, R.I.: Volunteers in Health Care, Spring 1999. Redesigned site launched January 3, 2006.
www.rxforaccess.org. Provides access to the 11 published issues of Rx for Access (seven issues published with Volunteers in Health Care), which offered information to safety net providers delivering pharmaceutical services between July 2004 and December 2005. Created in conjunction with Medicine for People in Need. Pawtucket, R.I.: Volunteers in Health Care and Oakland, Calif.: Medicine for People in Need, 2004.
Report prepared by: Mary B. Geisz
Reviewed by: Karyn Feiden
Reviewed by: Molly McKaughan
Program Officer: Susan B. Hassmiller
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