Reina Gonzalez is a bilingual patient navigator with The Access Partnership.

Tapping into Specialty Care

The 5-year-old girl from Guatemala needs cardiac surgery. First, however, she must see an oral surgeon because all of her teeth have decay that could cause a heart infection. Moreover, her unstable hip requires treatment. Although she and her family members live close to The Johns Hopkins Hospital, they lack the knowledge and resources to obtain its services.

Fortunately, they have Reina Gonzalez to guide them.

A bilingual medical office assistant at Johns Hopkins Community Physicians - East Baltimore Medical Center (EBMC), Gonzalez has become a trusted medical compass for uninsured Spanish-speaking patients in East Baltimore. She interprets, coordinates and advocates. She makes appointments for her clients and reminds them, often, about those appointments. She motivates and engages as many as 116 patients a month who need specialty care at Johns Hopkins.

Few of the people she helps speak English. Fearful of the health care system, they don’t know what to expect. They worry that they won’t understand what they are told and that the medical staff will reject them because they do not have insurance.

The Honduran-born administrator is one of the stars in The Access Partnership (TAP), Johns Hopkins Medicine’s program for uninsured and underinsured patients who live in the communities surrounding The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center.

Celebrating its 10th anniversary this year, TAP enables qualified patients receiving primary care to be referred for diagnostic tests, imaging services and appointments with Johns Hopkins specialists. Gaining access to surgery, cancer treatment and other forms of specialty care can prevent many of these community residents from making multiple trips to the emergency room or from having treatable conditions become more serious without timely care.

To date, the program has served 7,411 patients and provided 15,636 referrals.

Before Johns Hopkins launched the program in 2009, many patients who were eligible to receive primary care through state or federal insurance could not afford to pay for the next level of tests and treatment that their physicians recommended. Patients who participate in TAP pay an advance fee of $20 every three months. There are no additional bills for services received through TAP.

The Johns Hopkins Hospital and Johns Hopkins Bayview cover the costs of tests and procedures through their charitable care program, and all Johns Hopkins specialty physicians who treat TAP patients donate their services — a fact that stuns many observers.

“When we started, I was told by multiple people: You’ll never get the doctors to do this. The fact is, nobody has ever said ‘no’ to caring for a TAP patient,” says Anne Langley, Johns Hopkins Medicine’s senior director of health planning and community engagement.

“The biggest misconception about TAP is that it’s a bucket of money that we can hand out to people,” she adds. “The truth is, we don’t have any money. Instead, what the program does is make our financial assistance policy work. Hopkins clinicians provide their services without charge, and TAP makes it easy and efficient for them to do that.”

Bridging Gaps

When tap was created a decade ago, at first, it served only  those patients at EBMC who lived in two ZIP codes. Now, the program serves patients living in 10 ZIP codes who use primary care clinics at The Johns Hopkins Hospital and Johns Hopkins Bayview, as well as at Health Care for the Homeless, Chase Brexton Health Care, the Esperanza Center and Baltimore Medical System. Nine patient navigators assist with the process.

Over time, the demographics of TAP’s population have changed. In 2009, most patients were African American. By September 2018, however, 95 percent of the patients were of Hispanic or Latino origin. Because of the additional insurance coverage now available through the Affordable Care Act and expansion of Medicaid, TAP now primarily assists uninsured immigrants. The active population stands at around 1,100, with roughly 70 percent aged 19 to 50.

Johns Hopkins physicians Rosalyn Stewart and Sarah Polk review all requests for specialty care to make sure that referring physicians have already tried standard treatments. The top five specialties seeing TAP patients are radiology, ophthalmology, cardiology, physical therapy and gynecology.

After a referral is approved, the patient is matched with a bilingual TAP navigator like Gonzalez.

“Our navigators have been the ‘secret sauce’ in the TAP program,” says Barbara Cook, TAP’s founding medical director. “They assist all of our patients with obtaining and keeping appointments, encouraging them to call with questions or concerns. It is concierge medicine for some of our most vulnerable patients.”

Not only does the program bridge a crucial health care gap for patients, but it also teaches Johns Hopkins residents how to practice primary care that is careful and cost-effective, says Lenny Feldman, director of the school of medicine’s Internal Medicine-Pediatrics Urban Health Residency Program.

“During our recruiting season, we talk about TAP a lot because this is a unique aspect of care at Johns Hopkins that is worth really emphasizing to our applicants,” Feldman says.

A New Lease on Life

Jose, who requested using only his first name, suffered frequent epileptic seizures since childhood that kept him from finishing school and finding steady work. At any time, without warning, the 36-year-old could experience a debilitating attack.

The uninsured East Baltimore resident qualified for the TAP program at the Esperanza Center, his primary care clinic. After he was hospitalized at Johns Hopkins in 2017 for seizures, Jose saw Johns Hopkins neurologist Emily Johnson.

At first, she adjusted his medication. After realizing it was not preventing his seizures, the neurologist asked TAP to approve rigorous inpatient testing to determine whether Jose’s epilepsy would benefit from a new surgical intervention. The evaluation suggested he was a good candidate for laser ablation.

Jose underwent surgery at The Johns Hopkins Hospital in December 2018. Since then, he has continued to take his medication but has not experienced any seizures. Johnson’s next step will be to decide whether he can be weaned off medication.

Now, more than six months past his last seizure, he believes he will never have another. For the first time, he is beginning to set goals. He hopes to find steady work, perhaps as a painter or laying concrete.

“Before, people were scared to give me work, but now they see I’m much better,” he says. “I lived in constant fear of where I’d have my next attack. I’m happy because I don’t have to worry anymore. The greatest gift is my peace of mind.”