Lessons Learned: Developing a Volunteer Health Care Program for the Underserved

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164 Brief communication LESSONS LEARNED: DEVELOPING A VOLUNTEER HEALTH CARE PROGRAM FOR THE UNDERSERVED In 1994, one in nine people in Ohio (1.23 million, 11.1 percent of the population ) were without health insurance.1 The uninsured face multiple barriers to health care access, and in response, many communities in the United States have established programs to address access barriers. Development of volunteer free clinics to improve health access is an important part of communities' responses to the dire needs of the uninsured. Montgomery County, Ohio (population approximately 574,000), has experienced problems in the provision of health care to its underserved community similar to those of other counties in Ohio. Development of Reach Out of Montgomery County, detailed elsewhere,2 is an example of a community-academic partnership to address the issue of health care access. In 1993, the partnership was formed among leading health care institutions in Montgomery County, including the Wright State University School of Medicine (WSU-SOM), the Combined Health District of Montgomery County (CHDMC), and the Montgomery County Medical Society (MCMS). Awarded a grant from the Robert Wood Johnson Foundation (RWJF), Reach Out began in 1994. Reach Out established two model sites at neighborhood health centers in underserved areas of east and west Dayton. Each clinic is staffed by volunteer family physicians, medical residents, nurses, and front office staff and is open in the evening. Subspecialists see Reach Out patients in their own offices. A paid nurse manager coordinates Reach Out clinics with support of a part-time social worker, a community health advocate, and a secretary. Over the years, Reach Out has developed collaborative relationships with numerous organizations in Dayton. These collaborations have contributed to Reach Out's success as a community-based organization. With the help of pro bono legal counsel from Miami Valley Hospital, Reach Out became a 501c(3) nonprofit organization to address concerns about potential liability voiced by one of the funding partners. The decision to become a 501 c(3) organization also proved wise in that it helped Reach Out's fund-raising. Reach Out works with two committees (operational and funding) and has an 18-member working board that provides direction and makes final decisions on significant issues or policies. The operational committee is in charge of solving problems related to the daily operation of the program. The funding Received October 6,1999; revised December 20, 2000; accepted May 30, 2001. Journal of Health Care for the Poor and Underserved · Vol. 13,No. 2 · 2002 Ahmed et al. 165 committee is responsible for developing funds for the long-term sustenance of the program. Reach Out generates funding by conducting an annual letterwriting campaign, participating in United Way, and writing grants. For three years, it also raised funds by holding an exhibition basketball game between physicians and lawyers. Reach Out's main funding sources at present are local hospitals and Wright State University. Miami Valley and Good Samaritan Hospitals have been major supporters of this program from its inception. Wright State University also provides strong support by encouraging a large number of its faculty to provide volunteer health care at Reach Out. In 19992000 , approximately 250 volunteers (including physicians) donated almost 3,200 hours to take care of 1,630 patient visits to the clinics. The cornerstone of a free health care program is skilled people who are willing and able to make a long-term volunteer commitment. The core planning group for Reach Out decided to seek a small but reliable core of physicians who would not only provide quality services but would, by their example and positions in the community as opinion leaders, encourage other physicians to participate. Physician recruitment proved one of the most formidable early challenges. Physician input was invited in the first stages of planning to help in anticipating physician needs and encouraging their involvement. The MCMS was invited to be one of the founding partners in the Reach Out initiative. With MCMS leadership, a focus group of physician leaders representing various medical specialties was conducted. Facilitators of the focus group provided information about the proposal, asked for suggestions, and explored concerns . Responses ranged from "There is no need for a program like...

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