- Ascension Wisconsin

Ascension Wisconsin, 2025 Community Benefits

Charity Care/Free Clinics
Hospital-Supported Initiatives

Access to Specialty Care for the Uninsured – A Coordinated Approach

Securing access to specialty care for low-income, uninsured individuals is a complex and intractable issue. There are many barriers to receiving specialty care in a timely and coordinated manner, even for those with an established medical home and health insurance coverage. With approximately 7% of Milwaukee County residents uninsured at any point in time, Milwaukee’s health systems have sponsored free clinics and worked closely with FQHCs and other community clinics to weave a stronger safety net of care for low-income and vulnerable individuals. While these safety net clinics can provide primary care to uninsured patients, access to specialty care remained a challenge.

Through the Milwaukee Health Care Partnership, the four Milwaukee health systems – Aurora Health Care, Ascension Wisconsin, Children’s Wisconsin, and Froedtert ThedaCare Health - established the Specialty Access for Uninsured Program (SAUP) to create a barrier-free, coordinated process to provide specialty testing and treatment for uninsured patients.

SAUP improves the efficiency and effectiveness of care between health partners and offers timely, managed, and clinically appropriate access to specialty care for uninsured patients who are established in a primary care medical home at one of Milwaukee’s eleven participating safety-net clinics. The result? In 2024 alone, the three adult health systems have guided more than 1,000 referrals for specialty services – from cancer treatment to vascular surgery!

Sarah (Name changed for patient privacy) is one of these patients. Sarah does not have insurance and has been a long-time patient at Aurora Walker’s Point Community Clinic (Walker’s Point). In recent months, she experienced ongoing abdominal pain and communicated this with her doctor at a routine visit. After obtaining various labs and ultrasounds at Walker’s Point, the provider determined specialty care was needed. A SAUP referral was placed for her to see a specialist at Aurora St. Luke’s Medical Center (Aurora).

This patient saw the gynecologist who performed an exam and biopsy. Sarah received a diagnosis of metastatic cervical adenocarcinoma, gastric type. A PET scan showed uptake of the cancer at the head of the pancreas. Sarah is now actively receiving cancer care with Aurora.

Sarah described her journey from diagnosis to treatment as smooth and is eager to share her gratitude. She particularly praised her providers, noting, “I am thankful to my PCP at Walker’s Point for connecting me to the care I need, and the team at St. Luke’s has been terrific. My oncologist is a great provider, and I’m receiving excellent care.”

An Emergency Room Crisis Protocol Supports Coordinated Care for Multi-System Involved Youth

In February 2022, the Milwaukee Health Care Partnership (MHCP) Youth Behavioral Health (YBH) Committee convened a workgroup to address gaps in care for youth with complex, multi-system needs who were presenting to emergency rooms (ER) in behavioral health crisis. These youth were experiencing extended ER stays, delayed discharge, and/or boarding in medical hospitals without medical need. This reflected challenges in coordinating care across multiple systems and accessing the right care at the right time.

One youth, for example, arrived in the ER for the fifth time in a month with suicidal ideation, aggressive behaviors, and unmanaged chronic health conditions. The foster parent could no longer provide care, and local facilities were unable to meet the youth’s needs. Though medically stable, the youth remained hospitalized for months while hospital staff, child protective services (CPS), Wraparound, and others searched for an appropriate care setting. This scenario highlighted systemic gaps and the urgent need for standardized, cross-sector processes.

A cross-system data review and listening sessions with Wisconsin residential care providers confirmed these challenges: youth residential beds had been declining for more than a decade, facilities struggled to serve youth with complex needs, and Psychiatric Residential Treatment Facility (PRTF) care was not available in-state. While efforts to establish PRTFs are ongoing, the workgroup identified an immediate opportunity to improve care through a standardized ER crisis protocol.

Co-designed by the Milwaukee health systems, DMCPS, Wraparound, Care4Kids, Children’s Long-Term Support (CLTS), and others, the protocol clarifies roles and order of operations, streamlines communication, and ensures accountability during a crisis. Implemented at Children’s Wisconsin in Q1 2023 and the Mental Health Emergency Center in Q3 2023, it establishes six core steps: social work/RN triage; CPS case manager notification; stakeholder and treatment team notification; discharge planning; ongoing communication until youth are stable; and coordination of transfer or discharge. It also provides guiding principles for cross-agency care, centralized contact information, escalation paths, agreed-upon timelines, and increased transparency regarding feasible discharge options.

Early indicators of success include reduced ER length of stay, lower readmission rates, avoidance of unnecessary inpatient admissions, improved access to appropriate care, and enhanced experiences for youth, families, and providers. While tracking this small population (11 youth identified in a 1.5-year lookback) is challenging, the protocol establishes a structured, collaborative approach to ER crisis management for multi-system involved youth with complex needs.

This effort demonstrates the power of cross-sector collaboration in addressing systemic gaps, improving immediate care coordination, and laying the groundwork for future innovations and continuous improvement. The ER Protocol provides a common language and shared accountability, helping ensure that youth in crisis receive timely and appropriate care, even as longer-term solutions in the continuum of services continue to be developed.

The Milwaukee Health Care Partnership is comprised of the four Milwaukee health systems – Aurora Health Care, Ascension Wisconsin, Children’s Wisconsin, and Froedtert ThedaCare Health.