Support for this program is provided by the Weldon F Osborne Foundation.

The Schillhahn-Huskey Foundation.

And viewers like you.

Thank you.

On today's show will feature two nonprofits dedicated to healthy outcomes for our community.

One exists to support our community through health services and education.

And the other offers free birth control and education.

We are stronger together.

Chattanooga State.

And to learn more.

Welcome to Chattanooga.

Stronger together.

I'm Barbara martyr.

With us today is Ray bond, executive director of the Medical Foundation.

This organization serves our community with specialty health care services, promoting a greater quality of life.

We are thrilled to have Ray with us.

Welcome, Ray.

So glad that you're here with us today.

Having me.

So, I want to know what is the medical foundation and how did you get involved in it?

So the Medical Foundation is a nonprofit organization that's affiliated with the Chattanooga Hamilton County Medical Society.

And, the society has been around since 1883.

Oh my gosh.

In in 1986, the medical society created the foundation to serve as the charitable arm for all of the work that physicians do in our community.

I moved to Chattanooga from Washington, DC in 1994, and then in 1995, I went to work for the society and directed all of their programs, including the foundation.

so part of my journey, I worked for, locally for a couple of years with another nonprofit.

Then I worked in Nashville and headed a statewide, government association for a couple of years, worked with the legislature, and then I realized I was a Chattanooga, TN at heart.

And so I came back and, started helping the physicians form their project access initiatives.

So I have been back with them since 2001 working in various programs.

Well, welcome back to Chattanooga.

I'm glad you called it home.

I never really left.

I know you just took a hiatus and then came back.

I know, I love that.

So.

So what are some of the programs that, that the foundation does?

Sure.

Well, the both of our organizations have two goals.

One is to advocate on behalf of physician and healthy medical practices, all the things that help with medical practice do well in our community so they can serve patients.

But the biggest goal or the secondary goal has always been to improve community health.

So we do that in a variety of ways.

Project access, which we'll talk about in a minute, is our biggest program.

But we're also concerned about the future workforce in health care.

So we have yout leadership programs to encourage outstanding young student to consider careers in medicine.

And some of the kids have gone through that program since we started about 14 years ago.

Now our doctors in medical school and doctoral programs.

So it's been a wonderful success and one of my favorite things that we do.

We also have a physician well-being, program called Life Bridge because we want to take care of the physician who take care of us every day.

So the project access is our largest program and the one we're probably best known for.

And so, how does how does project access actually work?

Project access is really a clinic without walls.

When we started it, we talke about forming a health center, a clinic.

But we realized the gap in health care system was really specialty care and hospital care.

So we partner with area health centers and clinics.

We actually coordinate some specialty care for 28 different community health centers in our region.

And those health centers could refer patients to u when they need specialty care.

The neat thing about that is long term studies demonstrated that when a primary care home has access to specialty care, it actually increases their capacity.

Instead of having to see people multiple times until in the old days, they were sick enough to get care through the emergency room, they can refer them up front to us, will coordinate the specialist, the hospital care the anesthesiology, pathology, all the services they need and that opens up those extra positions for the clinic to actually see more patients.

And so the doctors, through project access, the patient comes in for the specialty surgery or whatever like that.

And these doctors see them for free in their office, perform surgeries and procedures.

The hospitals, all the Chi Memorial, Erlanger, Park Ridge have participated since the beginning.

And a year and a half ago to Nova and Cleveland joined our network.

So all area hospitals participate in this program, and all the services are provide at no cost to eligible patients.

Now, what's the eligibility on this?

The eligibility level is 150% of poverty and that changes every year.

So right now that's about 22,000 for an individual a year, or it's about 38,000 for a family of three.

And if you know what the cost of living has been, you know, lately, these folks don't qualify for any other program.

They don't qualify for TennCare.

They don't qualify for financial assistance to get health insurance.

And a lot of them work sometimes two part time jobs and they never qualify for benefit.

So it's really designed for th working poor in our community.

And to give them a leg up, restore them to health so they can keep on working and supporting their family.

To us, that's what it's all about.

Well, it's really filling that gap.

Exactly.

And so that they actually now have.

So when they're going to say a clinic, a local clinic or whatever like that, that clinic clinician, that doctor, whoever's out there, they're the ones that determine the necessity to contact project Access and say okay, we've got a patient here.

This is what's going on.

and then do your eligible qualification and then get the right doctor to connect with them.

And then then the doctor takes over.

Exactly.

It's like, I like to tell people it's like a huge insurance company where nobody gets paid.

No.

Well, you don't get pai in dollars that you get paid in doing the right thing.

Exactly.

And I doctors get paid and saving lives.

And we've had a number of patients who were losing their sight an their vision has been restored.

We had people who were o the verge of losing everything because they couldn't get a medical procedure.

And we've got some extraordinary, stories of patients who have really been restored to wholeness.

And really, you know doctors got involved in medicine because they wanted to help people.

And project access is a non bureaucratic, easy way for them to do that.

So they're not just a handful of doctors.

How many doctors do you actually have that are a part of the program.

We have we grow our panel in the early years for a couple of years, bu we have pretty much had steady at a little over 1100 physicians.

It's, it's a it's a miracle.

And I think it is a testimony to the heart of the physicians in our community.

It really is.

And the fact that they're willing to give of their time and their talent for this, because sometimes you get frustrated with your doctor when you go in because you don't feel like they are literally listening to you.

And that could be that they are stressed out and they're overburdened, burdened and overworked and just really can't give that quality time.

Yeah, to that patient at that particular time.

and so I could see why you would have the, the psychological services to really help those doctors to, you know, de-stress and whatever.

Like that.

So that's amazing.

But the other thin that I think is interesting is you also have an employment.

Yes.

I was like, what all else do you not do?

Well, the medical society also has a staffing agency.

So, we provide, clinical and clerical temporary and permanent employment services for medical practices in our area.

We started that in 1989.

And so we've been doing that.

And we also, helped start the physician quality of education organization that does all the credentialing for doctors in our region.

And that's now a statewide organization that actually started at the medical society, about 30 years ago.

So, how many clinics I know you have the local hospitals you mentioned, but how many clinics do you actually work with?

Well, two years ago, we actually started expanding project access.

We are now southeas Tennessee project access.

And last this last year, we provided some services to people in 31 countie in and around Hamilton County.

And, we actually coordinate care and work with 28 different health centers.

Those are the health department, health centers, federally qualified health centers.

we get referrals from primary care doctors who are providing care for uninsured patients.

so we actually have a pretty, pretty big network.

And, I'm also really just proud to say that we were the first project access in Tennessee, and we actually provided technical assistanc to start the other programs in, Tri-Cities, Knoxville, Nashville and Memphis.

So now there's a project access network that's spreading statewide.

But it all started right her in our hometown of Chattanooga.

Good.

A lot of things start here at it, actually.

Do I really like the famous for that?

so do you do, like continuum care and transportation or anything like that?

We have some transportation resources.

We help people with bus passes.

We, we we try to provid comprehensive care coordination.

So we try to figure out what everything that patient needs is transportation issue, what resources are available, do they need food?

Where can they go to get some nutritional resources?

We do follow up phone calls t remind people of their visits.

We do follow up if they need help getting prescriptions.

We help direct them to prescription assistance programs.

So we try to provide a real, care coordination and health care navigation.

Even if you have health insurance, the health system can be confusing.

So we try to walk hand in han with people through the duration of their care.

So, kind of give m you talked about, you know, the, example of someone with blindness and other.

So what is the gamut of different surgeries and services and things like that?

we have access to most specialists.

now, that said, we have a few specialties in Chattanoog that we have huge shortages of.

So if you have insurance and it takes you six months to see a certain specialty, it will probably take us almost that long to get somebody in just because we don't have enough doctors.

In some specialties we do ortho.

We work with the Colon Cancer Foundation to do preventive screening for colon cancer.

we provide we have a wide variety of surgery.

We have some cancer patients, that we've helped coordinate care long term with some of them.

So really, one way or another we can find most resources for folks.

And so it's just getting those referrals from those clinics that you already have a working relationship with.

Yes.

And they kind of know what your, criteria is.

Yes.

And then work with you and then you can take it and get it with the doctors and get the appointments or whatever.

So then we also try to refer yo our referrals for when we know somebody needs a specialist.

So for instance, we can help do a preliminary orthopedic screening for somebody to be sure that if they need to go to, to, physical therapy, we'd rather direct them to physical therapy than use a specialist appointment for that.

So we do some screening.

Our specialists have developed criteria.

So we also try to educate primary care before you make a referral.

What kind of testing is needed.

You know, how do we, how do we, to make that referral referral process really efficient?

So I can't believe you doing so much.

This this has been so informative to me.

I thought I knew what project access and what the foundation was, but this has just been so much more.

So.

Right.

Thank you so much for coming in.

And I just I can't wait.

to this airs and our viewers get to learn more about it.

And I'd love to direct them to your website so that they can learn more about the programs.

and, and get the help that they need.

That'd be wonderful.

Thank you so much, Barbara.

Thank you.

Up next, we'll have Mandy Cowley, executive director of A Step Ahead.

So stay tuned.

We want to know how you serve your community.

Send us photos or videos of you or your family volunteering, and we may feature it on a future episode.

Email stronger@wtcitv.org or use the hashtag STRONGERWTCI on social media.

Welcome back.

We're happy to have Mandy Cowley with us.

Mandy is executive director of A Step Ahead.

Their mission is to remove barriers to contraception through education, outreach and access to free preventative birth control.

Welcome, Mandy.

It's so good to have you here with us today.

So when did Step Ahead get started and what is its purpose?

Yeah, we were founded in 2013 and initially only served Hamilton County.

since that time, we have expanded to 17 additional counties spannin Tennessee, Georgia and Alabama.

So we serve an 18 county region.

we really exist, as you said, to remove barriers to contraception.

birth control is really important in people's lives.

first and foremost, to time pregnancies for if and when they are ready.

Here in Tennessee, 1 in 3 pregnancies are unintended, and an unintended pregnancy can really shift the trajectory of someone's life.

the most effective way to time a pregnancy for if and when you're ready is to use birth control.

birt control is also really important to help manage medical conditions like endometriosis or polycystic ovary syndrome, also known as PCOS.

Those conditions affect 10% of women of reproductive age, and they can cause really painful symptoms that prevent someon from living their fullest life.

and hormonal birth contro can help treat those symptoms.

Unfortunately, birth control is not always easy to access.

It's very expensive and it can be very confusing.

And that's why we exist.

For the educational purposes, and I do know I've had several friends that that had endometriosis, excruciating pain.

And so they had to go on the birth control pills even while they were during those childbearing years.

and that was interesting to m that, you know, birth control, birth control can stop that or reduce the severity of it and everything.

that was interesting for me to learn that through friends and stuff like that.

what is the age group that you're seeing the most?

The majority of the wome that are coming into you.

Yeah.

Most of the women that we provide access to free birt control are in their early 20s.

So they're either in college or they're starting their career paths, or they're really just getting their feet under them.

Right?

and so that's primarily who we reach and serve.

who reach out to us for our clinical services.

Yeah.

Because you kind of notice that women are waiting late in life to start their families because it is very education and career oriented and then stabilize.

And they're also waiting later in life to get married and do anythin so that choose their time.

Yes.

Yeah.

but when we talk about birth control, it's, it's very expensive.

those long acting forms of birth control, things like IUDs and implants can cost over $1,200 out of pocket just for the device.

That doesn' include any of the related care.

and so those are for folks who are uninsured, paying out of pocket.

Even when we think about the more affordable forms of birth control, things like birth control pills, those can cost $1,000 a year between your clinic visit and then picking u that pack of pills every month.

that means that birth control is out of reach for many in our community just because of cost.

so over half of the people we serve are completely uninsured and over half liv below the federal poverty line.

So if you're choosing between paying rent or getting the birth control method that's right for you, there's not really a choice to be made.

You're going to pay rent.

so really, birth control is truly out of reach for many of the folks that we serve.

So, what types of birth control?

and I know there's the pills, but there's also, different types to what all do you provide?

That's right.

We currently cover the IU implant and birth control pills.

We hope to expand to the ring, the patch and the injectable form of contraception sometime in the future.

so that's kind of the range of reversible methods.

are your services free?

They are.

They're 100% free.

if you live or go to school in our 18 county region, you qualify for our services.

We don't have insurance requirements, income requirements, any of that.

If you live or go to school in our region, you qualify.

so it's 100% free.

What happens on the clinical end, when folks learn about our services, they call our appointment line.

We do a brief intake, and then we refer the to a partner medical provider.

We're not a clinic.

Okay.

we partner with existin clinics throughout our region.

we provide transportation support to and from that appointment if they need it.

Gas money should not be the reason you don't get birth control.

They go for their visit.

They get the birth control method that's right for them.

And then we pay for everything that is not covered by other means.

So if they have insurance, we pay copay deductible.

They're uninsured.

We pay for everything.

And when I say everything, I mean the method, the visit, any necessary testin like STI or pap smear, follow up care, their contraceptive care should be 100% free if they come through a step ahead.

Okay, so they could either go to you directly or they can go to a clinic and then the clinic can refer them to you.

Due to the fact that they may not have the finances to pay for it.

That's right, that's right.

About half of the folks we serve call our appointment line, and then we connect them to a provider.

About half of the folks we serve are in one of those partner providers already, and they need financial assistance accessing birth contro so our clinic partners can sign those folks up right there in their office and then bill us for their services.

So tri state, Tennessee.

Georgia.

Alabama.

Correct.

Wow.

Yes, correct.

There's nothing really comparabl to what we do, in those areas, until you go as far south as, say, Atlanta or Birmingham.

Now, are you duplicating a step ahead in anywhere, like in Nashville or Memphis or any place like that?

Yeah, they're we're an interesting model.

They're actually six a step ahea across the state of Tennessee.

we are all independent nonprofits.

We all have our own governance structures, funding streams, all that good stuff.

We work under the common name, a step ahead, and we are all working to expand access to contraception.

So we currently cove 85 of the 95 Tennessee counties.

Wow.

Yeah.

It's amazing.

Yeah.

It's fantastic.

Yeah, it's a lot of work.

Yeah.

So s what are some of the barriers?

That's right.

Apart from cost, we've talked a little bit about knowledge as well.

so knowledge is a significant barrier, that we see all the time.

So we have health educators on staf who provide medically accurate information about a broad rang of reproductive health topics.

we believe everyone has a right to know how their body works.

And so our hope is that folks who participate in our programing have a better understanding of themselves.

They know what contraceptive methods are available, and they know how to use those methods correctly.

That's really important.

so we provide education for both youth and adults.

and we do that both in person and virtually.

So in person, a lot of our education happens in partnership with other organizations.

So think churches, nonprofits, community centers, places like that.

and then we also have a video platform on our websit that folks can access for free, and they can log in and watch some of that educational programing from the comfort of their own home as well.

Wow.

and that's good to know too.

But the fact that your, your education is not just for the women that are going to be, you know, using these services or, but the fact that you could also work with the parents in educating them, on how to navigate.

That's right.

This journey with their daughter.

That's right.

Our hope always is that a parent or caregiver is a trusted source of information, so that when that young person feels like they need access to birth control, they can go to that parent or caregiver and have that important conversation.

a lot of my staff are parents themselves, including me, have a 12 year old.

So gosh, we're right in the thick of it, right?

Oh, you're the tween.

Yeah.

We know firsthand what it feels like to have those awkward conversations, and that's why a core part of our educational programing is aimed at parents and caregivers.

We want them to feel equipped and empowered to hav these important conversations.

We want them to be a trusted source for the teens in their lives.

50% of teens say they are no comfortable talking to a parent or a caregiver about birth control.

So even just opening the conversation and knowing how to do that is a really important skill.

And we are so grateful to be able to help parents and caregivers do that.

Yeah, that is so important.

That conversation.

Yes.

because you're right, at 50%, they don't feel comfortable.

But not only they don't feel comfortable.

The mother doesn't feel comfortable there.

And talk because she doesn't know what questions to ask o how to start the conversation.

And then once the conversation is started, where do we take this?

What do we do?

Don't be judgmental.

Right.

But be an advocate to try to help your daughter think through all the possibilities and how to take care of her, her body, her health.

That's right.

So many of our parents and caregivers didn't have these conversations with their parents, and so they don't know how.

It was never modeled.

Right.

So, being able to practice tha and know you're talking points before the the topic comes up is so important.

and exactly what you said.

Our shared goal is alway that the youth in our community are making good, smart decisions, and parents and caregivers can help them do that around their reproductive health.

Yeah.

Do s during a typical year, how many women would you provide services to you, would you think?

Yeah, that's a great question.

So since we started serving in 2014, as when we started serving, the community, we launched in 2013 and got our feet under us.

We've connected 80, 200 wome with access free birth control, and we've covered $2.25 million in medical expenses on their behalf.

last year, in 2023, we connected about 1300 women with access to free birth control and covered just over $200,000 in medical expenses for those folks.

on the educational programing to date, we have educated over 10,000 people.

There are in-person educational opportunities.

and on an average basis, every year, about 2000, 2500 peopl participate in that programing.

Wow.

Yeah.

That's amazing.

It's great.

Do you have volunteer opportunities?

We sure do.

So the primary way volunteers help us currentl is through our appointment line.

It can be answered anywhere that you have internet and a phone.

We of course, trai those volunteers and equip them with all the tools and resources they need.

of course folks assist with outreach and events as well.

and so yeah, anyone can visit our website and learn more about those opportunities.

That's awesome.

Mandy, thank you so much for coming in today.

Thank you to us.

More on, what you're doing at the step ahead.

Thank you so much for having me.

It was a pleasure.

Okay.

We hope Chattanooga Stronger Together provides a new perspective for viewers like you who are looking to make a difference.

So let us know what you think.

Email us at stronger@tv.org or use the hashtag stronger Wtcr on social media.

I'm Barbara Marder and I'll see you next time.

Support for this program is provided by the Weldon F Osborne Foundation.

The Schillhahn-Huskey Foundation.

And viewers like you.