Specialty Access for the Uninsured Program (SAUP)

The Medical Society of Milwaukee County, as a collaborating partner of the Milwaukee Health Care Partnership, supports the Specialty Access for Uninsured Program (SAUP). Over 140,000 people in Milwaukee County are uninsured and without access to appropriate health care. The SAUP initiative was developed to address one of the most difficult public health issues in the community—access to physician, outpatient, and inpatient specialty care for uninsured patients.

Uninsured individuals often delay care or seek specialty care at hospital emergency departments. Even uninsured patients who are established at a primary care home in a Federally Qualified Health Center (FQHC) or free clinic experience barriers to specialty care. Further complicating the process, primary care providers at the safety net clinics often spend hours negotiating with specialists and hospitals to obtain specialty consults, tests, and procedures or resort to referring patients directly to EDs to access specialty services when a patient's disease state has advanced to a crisis state.

SAUP is intended to address these various concerns, and is being piloted by pairing five safety net clinics that serve as medical homes for uninsured patients with the four adult health systems in Milwaukee who, in turn, secure access to specialty care as needed.

SAUP's, primary goal is to ensure timely, clinically appropriate, managed access to specialty care for low-income, uninsured adults in Milwaukee County through the implementation of a primary care medical home/care management practice model. Additional program goals include:

• Improve health outcomes, care management, efficiency and effectiveness
• Reduce the total cost of care for the underserved population
• Improve clinical and care management practices among primary and specialty care providers and hospitals
• Improve the satisfaction and experience of both patients and providers

The primary target population for SAUP is a subset of the total low-income, uninsured population in Milwaukee County—the approximately 23,000 Milwaukee County residents who have incomes less than 200% of the federal poverty level, are unable to secure public or private insurance, and are established patients at a participating safety net clinic.

The clinic identifies and screens patients for eligibility in the program, then begins the specialty referral process. The hospital registers the patient and selects an appropriate specialist from its previously identified network of program volunteers.

Clinical providers and staff from safety net clinics, specialists, health systems, and volunteers have been intimately involved in project design and are actively engaged in implementation and program evaluation. This collaboration of individuals and health systems allows for:

• Effective coordination of care
• Continuous collection and analysis of data and results from interviews and focus groups
• Refinement of processes in anticipation of community-wide program implementation.