Oncologic services through Project Access and other safety net care coordination programs.

Abstract

126 Background: Since the 1996 formation of Project Access, a nationwide program linking uninsured, low-income, or underserved patients to specialty care, the US has experienced a growth of third-party, safety net care coordination programs that provide sub-specialty care at no or reduced cost. These programs pre-negotiate with local physicians and hospitals to offer pro bono services to patients. Little is known about the provision of oncologic services within these programs. This study evaluated the current landscape of oncologic services within US safety net care coordination programs. Methods: This study reviewed websites via an online search from 04/22/19 - 04/28/19 using keywords “Project Access”, “healthcare”, and individual state names. The websites were reviewed for information on location, services offered, and patient eligibility criteria. Where online data on oncologic services was unavailable, individual programs were called on 05/08/19 for additional information. Five programs were unreachable by phone or e-mail. Results: Websites of 29 safety net care coordination programs in 22 states were identified, serving only approximately 40 counties. Online, one program highlighted "limited" access to oncologic care, while another offered chemotherapy at a reduced cost ($5000/round). When contacted by phone, 55% offered access to oncologic services and 48% assisted with chemotherapy costs. One program provided chemotherapy only if the cancer diagnosis was made after the patient was enrolled in their system. Virtually all programs who offered chemotherapy did so through affiliated large hospital systems. A commonly reported reason for lack of oncology care was a reluctance of oncologists to commit to potential long-term agreements of free care. Online, one program offered PET scans. By phone, 89% offered some imaging. Two programs (7%) explicitly required US citizenship for care. Conclusions: Third-party care coordination centers are increasing in number and provide a novel, and potentially unrecognized, approach to increasing oncology service access. Further research should identify barriers contributing to the relative lack of oncologic services in these programs compared to other specialties.