A Penn program helps uninsured patients get surgeries. They just received funding to expand.

Nearly 1,000 Penn Medicine patients have undergone surgery that they had put off — from gallbladder removal to hysterectomies to wound treatments — through a program that pairs patients with “navigators” who help them plan and prepare for a surgery.

Penn Medicine’s Center for Surgical Health works with patients who lack insurance or have other issues that prevent them from getting necessary surgery. Now, a $310,000 grant from the Independence Blue Cross Foundation will help the center to expand its reach by hiring a new full-time staff member and growing its network of doctors, lawyers, and community organizations who refer patients to the center.

The center was launched in 2020 after two residents at Penn noticed that many of their patients were visiting emergency rooms for serious pain but never following up with doctors. The residents, Matthew Goldshore and Carrie Morales, proposed bringing in a navigator to help patients who had difficulty scheduling and paying for surgery.

Those patients often didn’t have insurance and couldn’t pay for follow-up appointments. Some were undocumented immigrants. Others were overwhelmed by Penn’s vast health-care system and unsure how to schedule appointments. Some patients would receive surgery only when their conditions worsened to the point that they couldn’t keep up daily routines.

A team at Penn worked to train volunteer “patient navigators” — mostly medical students at Penn — who could help patients obtain insurance and schedule surgery. The navigators coordinate transportation to hospitals, attend doctor’s appointments with patients, and encourage them to ask questions about their care.

They also connect patients with such services as food and housing assistance that can improve their health.

Getting patients to surgery before their conditions become more serious can make their care less expensive. Patients in the program also had shorter hospital stays.

“It’s cheap, it’s effective, and it’s just the right thing to do,” Goldshore said.

The first Center for Surgical Health (CSH) patient was a woman who had serious pain from gallstones. Because she was undocumented, she had no insurance. She visited Penn’s emergency room twice in one summer, where she was told to make a follow-up appointment with a surgeon.

On her third visit, she met Goldshore. “She was scared,” he said. “She had nowhere to go.”

Goldshore and Morales helped the woman find insurance coverage and scheduled a surgery to remove her gallbladder. The woman recovered from her surgery and within three weeks, she had returned to work.

“We believed we were on to something,” Goldshore said.

Patient navigators say their work has given them new insight into the difficulties that some patients experience trying to access health care.

“Applying for insurance for the first time for a patient is overwhelming,” said Manisha Banala, a patient navigator at CSH and a second-year medical student at Penn. “But as you continue to go through the process, you get more familiar with it and you get more confident in what it takes.”

The navigators work to build relationships with their patients as they move through the Penn system, helping patients ask questions and advocate for themselves as they consider treatment options.

A patient who needed a major surgery once came with a navigator to a medical appointment with Jon Morris, vice chair of education at Penn’s surgery department and CSH’s co-founder and director. He recalled outlining the risks and benefits of the procedure, then asking whether the patient had any questions.

“The patient looked right at the navigator and said, ‘What should I do?’” he said. “I think that tells you how important the navigators are to this process.”

It’s fulfilling, navigators say, to provide ongoing support for patients.

“You can say, ‘I’ve been with you this whole time. You know me. I come to your appointments, I come to your surgery,“ said Caitlin Cavarocchi, who has been a patient navigator for two years. “I’m a familiar face in a new setting.”