"I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm."
From the modern Hippocratic Oath

For Wichita, Kansas, it all began back in 1998 with Paul Uhlig, M.D.

Who is Paul Uhlig?

He’s a fourth generation Kansas physician, a cardiothoracic surgeon, and the founding president of the Central Plains Regional Health Care Foundation.

He’s also a man with insight and determination, who set the wheels in motion to provide access to health care for the uninsured of Wichita.

And that’s no small feat.

The community had been trying here and there, in bits and pieces, to help the uninsured get the care they needed. But their efforts were haphazard and unorganized. As a consequence, indigent care services already provided by the area’s dedicated health care professionals were uncoordinated and not seen as making a significant impact.

So, through the Central Plains Regional Health Care Foundation, a non-profit organization that he established, Dr. Uhlig led discussions with various health care and government leaders, exploring what existed in the community — particularly the organizations that were already engaged in indigent health care: the SCAMU clinics. (SCAMU, for the uninitiated, is short for the Sedgwick County Association for the Medically Uninsured.)

At that time, each of these clinics had a private list of physicians whom they could contact when one of their indigent patients needed specialty care. Basically, the clinic would call the physician who provided the needed service — and would beg for help. It was only natural, then, that each clinic fiercely protected its list. Certainly, none of the clinics would share with any of the others. To do so would mean jeopardizing their vital contacts in the medical community. After all, there weren’t that many physicians to go around who would volunteer their services.

It was a situation in need of a remedy.

After all, it seemed that providing accessible, quality health care to the working poor shouldn’t be an impossible dream. But to make that a reality would require a few changes to the normal course of day-to-day business. One of the first things that Dr. Uhlig understood was that all the diverse elements of the community needed to come together: the doctors, the hospitals, the funders, the County Commissioners, the City Council, the Mayor, the pharmacists, the clinics, the county health department, and, last but not least, a government organization that everyone loved to hate: the state Medicaid Agency — the office of Social and Rehabilitation Services (SRS).

The inspiration for this vision was found in a successful health care model being run out of Asheville, North Carolina: Project Access. It was a program based upon creating a closer relationship between primary care clinics and specialty care providers on behalf of the uninsured. Asheville’s program began with a one-year health-planning grant and continued with a three-year implementation grant — both from the Robert Wood Johnson (RWJ) Foundation — as well as grants from other organizations. And it was winning recognition and awards — such as the Innovations in American Government Award — along the way.

This was clearly an idea worth exploring.

"We kept telling the community that we were looking for a better coordination of health care delivery and this project just fell into our laps," remembers Carolyn Earnest, Nurse Practioner, assistant to Dr. Uhlig and co-chair of the program’s Operations Council. "We changed our focus from health care within the hospitals to looking at Project Access and replicating it for our community. It was going to be only the first of several things that we’d thought about and planned to do."

The reaction of the community, however, was not one of automatic trust. It was going to take a great deal of effort to bring about a collaboration that would realize this vision.

To that end, Dr. Uhlig compiled a list of key local leaders in health care and education, as well as city and county managers. Then, in September 1998, he arranged for eight of them to be flown to Asheville to see what this Project Access was all about. The group consisted of Wichita city manager Chris Cherches; University of Kansas School of Medicine-Wichita (KUSM-W) dean, Joe Meek, M.D.; Max Bleck, chairman of the board of Hunter Health Clinic; Ed Dismuke, M.D., chair of the Department of Preventive Medicine, KUSM-W; David Grainger; M.D., board member of the Central Plains Regional Health Care Foundation; Suzette Schwartz, CEO of Hunter Health Clinic;

The Stone Soup Story (Excerpt adapted from the book “Stone Soup” by Marcia Brown.) Three soldiers trudged down a road in a strange country. Suddenly, ahead of them they saw the lights of a village. “Maybe we’ll find a bite to eat there,” said the first. The soldiers stopped first at the house of Paul and Françoise. “Good evening to you,” they said. “Could you spare a bit of food for three hungry soldiers?” “We have had no food for ourselves for three days,” said Paul. At Vincent and Marie’s the answer was the same. It had been a poor harvest and the grain must be kept for seed. So it went all through the village. Then the first soldier called out, “Good people! We are three hungry soldiers in a strange land. We have asked you for food, and you have no food. Well then, we’ll have to make stone soup.” The peasants stared. “First we’ll need a large iron pot,” the soldiers said. The peasants brought the largest pot they could find. A fire was built on the village square and the pot was set to boil. “And now, if you please, three round, smooth stones.” The peasants’ eyes grew round as they watched the soldiers drop the stones into the pot. “Any soup needs salt and pepper,” said the soldiers, as they began to stir. Children ran to fetch salt and pepper. “Stones like these generally make good soup. But oh, if there were carrots, it would be much better.” “Why, I think I have a carrot or two,” said Françoise, and off she ran. She came back with her apron full of carrots. “A good stone soup should have cabbage,” said the soldiers as they sliced the carrots into the pot. “I think I can find a cabbage somewhere,” said Marie, and she hurried home. Back she came with three cabbages. “If we only had a bit of beef and a few potatoes, this soup would be good enough for a rich man’s table.” The peasants thought that over. They ran to fetch them. “Ah,” sighed the soldiers as they stirred in the beef and potatoes, “if we only had a little barley and a cup of milk! This soup would be fit for the king himself. The peasants brought their barley from the lofts, they brought their milk from the wells. At last the soup was ready. Never had the peasants tasted such soup. In the morning the whole village gathered in the square to give them a send-off. “Many thanks for what you have taught us,” the peasants said to the soldiers. “We shall never go hungry, now that we know how to make soup from stones.”

Dwight Allen, executive director of Medical Society of Sedgwick County (MSSC); and Michael Bates, M.D., president of MSCC.

Over the course of several trips, the group learned all the details of the Asheville model. When they returned, each conveyed to their Wichita/Sedgwick County peers what they discovered about the success of Asheville’s Project Access.

Communities, of course, are very different. Asheville, for instance, was half the size of Wichita/Sedgwick County, whose population stands at about 550,000. But Wichita/Sedgwick County had several elements in its favor with respect to adopting the Asheville project and taking it to the next level.

To begin with, it’s more diverse in terms of industry. And the culture is one that prides itself on its entrepreneurial spirit. There’s an interest in being independent; in building new innovative ideas. Which is why many companies began as start-ups here. There’s also a community spirit among health providers that’s essential in developing a coordinated approach to health care. “It’s not a splintered group, and not a lot of flow of people moving in and out,” affirmed Dr. Meek. It therefore seemed like a natural that the many ostensibly divergent interests here could come together under a single banner.

STONE SOUP: GOOD FOR THE COMMUNITY

The whole idea behind Project Access is one of collaboration — everybody brings something tangible to the table to make it work. As Wesley Medical Center’s CEO, 022603 5 David Nevill, offered, “Project Access is kind of like the children’s tale of Stone Soup.” (See inset.) The result being that there’s a greater positive effect for everyone as a result of each self-interested party giving just a little:

When Dr. Uhlig first approached his fellow physicians through the Medical Society, he presented the idea to its board of directors. The board was immediately responsive and, in turn, presented the idea to the physician membership.

The physicians were naturally skeptical. But Dr. Uhlig was persistent and, by showing a great enthusiasm for a well-defined vision, he was able to turn his peers around quickly. “We thought we should have a unanimous decision of the board, which we obtained. It wouldn’t make sense to go to the hospitals with support from only 50% of the board,” relayed Dwight Allen. It was at this time, in 1999, that the Medical Society, with the agreement of the board of directors, took over the Central Plains Regional Health Care Foundation, making it part of the Medical Society. The foundation’s board changed in the process, with physicians subsequently comprising more of its membership.

Next came the clinics, who were hesitant because they thought they were already doing good work. They thought nobody else had been out there getting the job done. And they felt that they already had a connection to the University of Kansas School of Medicine- Wichita (KUSM-W) and to the Sedgwick County Health Department. It’s also important to point out that, because each of the clinics were operating under a tremendous amount of stress, there existed an atmosphere of mistrust between them.

The fact is, yes, the clinics were already doing a wonderful job. But their efforts were going unseen by most of the community.

And so, on April 15th, 1999, before an audience of 75 key local leaders at a community forum, Dr. Uhlig introduced Asheville’s Project Access. At the invitation of Dr. Uhlig, Alan McKenzie, director of the Medical Society in Asheville, presented the Asheville model to the audience, relaying the steps they took to bring the project to fruition as well as their discovery of who’s participation was necessary to make it all work. With this model as a guide, many of the community’s fears were allayed.

“If we would have gone to the community without Asheville as an example and say we want to bring you guys all together, people would have said ‘who are you? We’re already together’ and ‘we’ve already created some major connections,’ ” Carolyn Earnest proffered. But she added that while it was true that the community was making some connections, it wasn’t doing it efficiently. Dr. Uhlig, however, was “taking something that was already successfully formed and transforming it” to the needs of Wichita and Sedgwick County.

In Wichita/Sedgwick County the pieces were already there, each developed and mature. But they needed real coordination. Walls needed to come down. And everyone’s competitive natures needed to be checked. (One of the Operations Council’s ongoing tasks is the constant struggle to balance all the myriad relationships.) According to Dr. Michael Bates, then-MSSC president, “This is a simple solution in which everyone helps a little and everyone wins — our community becomes healthier and, most of all, patients who need help receive the care many of us take for granted.”

After the Asheville trip, there were a number of strategy meetings between Dr. Uhlig and the county manager. They agreed that the best way to get the city and the county to support this idea was to make a presentation to both governing bodies. So a meeting was set for the 1st of June, 1999. A team of people, including Dr. Uhlig, would do the presentation.

At that meeting, the City Council and the County Commission were introduced to Project Access. Asheville’s Alan McKenzie and his county manager, Wanda Green, both described what their roles were, how Project Access evolved, and the subsequent changes they saw in the community. Ms. Green also shared with the audience that Asheville’s uninsured “became a healthier part of the community.” Indeed, Project Access created a stronger workforce which, in turn, increased the number of small businesses in the community. Because of Project Access, they saw a turnaround in their community’s economic base.

All the key players were there at the meeting. It was one of the first times one could see the city and county managers, the hospital CEOs, the newspaper publisher — all together in one room — along with the Medical Society and the United Way. The pharmacists were also represented.

Because Dr. Uhlig laid the groundwork and prepared both governing bodies for what was to come, the meeting went smoothly, with very few questions, taking up very little time. Sedgwick County manager Bill Buchanan and city manager Chris Cherches clearly illustrated how the funding could work. In the end, it took less than an hour to approve $500,000 of support for the prescription medication portion of Project Access. According to Dr. Joe Meek, “It fell on fertile ground and so it took off easily. From then on it was a matter of hiring superb personnel to run it.”

“The whole project, the whole concept itself, was one of those that every City Council and County Commission member could relate to. It was something they understood, it was something they supported,” observed Chris Cherches. He added, “when the medical community showed support — which sometimes isn’t that easy — when they showed they were behind this, it just kind of fell into place.”

After this historic June 1st meeting, the Operations Council, under a newly appointed interim director, Betsy Bloxham, met once a week in intense meetings. They now faced an actual deadline. Dr. Uhlig had set the date on which Project Access would handle its first patient: September 1, 1999. This was done to create a specific, foreseeable goal and to assertively push the community towards a realization of that goal. Likewise, a monthly newsletter was created to keep all the key players informed of breaking news. It was also important to keep the media attuned to what the Council was doing because they were a resource, not only for PR but to keep the Council informed as to what was going on in the community.

Then on September 1, 1999, under newly-hired permanent program director Anne Nelson, Project Access officially “opened its doors” starting with the smallest clinic — Guadalupe Clinic — and, as part of a deliberate, measured pace, continued the process of adding one clinic a month to avoid overwhelming any of the participants. Project Access was off and running and heading in the right direction.

And everyone in Wichita is better off because of it.