The challenge of making health care available to 40 million Americans who’ve been living without health insurance has been a hot topic since last June, when the Supreme Court ruled that the Affordable Care Act could go forward.
Obviously, universal coverage will be hard to accomplish, especially in a struggling economy. The search for solutions led a group of health leaders in Athens to look 2, 446 miles west to Reno, NV. There, an unusual alternative to conventional health insurance has been in operation since 2007.
Access to Healthcare Network (AHN) is the first and only nonprofit medical discount plan in the state of Nevada. Now with a network of 1,350 providers, it lowers the cost of primary and specialty care for 8,000 Nevada residents, about 6,000 of them in Washoe County, where Reno is located.
People are eligible to join AHN if they lack employer-provided health insurance and earn too much to qualify for Medicaid but not enough to buy individual health coverage. They pay a low monthly membership fee and then pay reduced rates for the medical services they actually receive in primary care and specialty practices, hospitals and community clinics.
Both providers and patients benefit from this shared responsibility model, where no one gets anything for free and no provider goes unpaid.
The Reno Model
Last fall, members of the Athens Health Network invited the founders of the Reno plan to visit this northeast Georgia college town and explain how their system works. The Athens group, which includes hospital and clinic executives, as well as public health officials and physicians, was so impressed that they vowed to try and copy the Reno model.
Like Reno, Athens has large numbers of people who work but don’t have health insurance. And although free and low-cost clinics provide a partial safety net, and doctors and hospitals provide some care without payment, it’s not enough.
In Reno, each patient is assigned to one of seven Access to Healthcare Network’s care coordinators who keeps track of the member’s health status and helps them obtain appropriate care – including referrals. They direct members away from hospital emergency rooms and into clinics and doctors' offices, where they receive preventive care and treatment as needed.
“Our network is pretty comprehensive. We can get our clients to the next person, so they don’t sit there and go ‘I can’t see the specialist I need,’” said Josh Cole, who works with members in Washoe County. “You can get everything you need from us so you can get healthy.”
The services provided by care coordinators and AHN’s pre-arranged fee schedule is a boon for doctors and other care providers because filing insurance claims is a costly and burdensome process that often involves payment disputes. Network members hand over cash or credit card when they’re treated.
“Every new member pays $130 for the first doctor visit,” said Cole, Washoe County care coordinator supervisor. “ The following visit for primary care is $40 and specialty care is $65.”
How a Federal Center Fits In
One of the clinics in the Reno network is Health Access Washoe County, a Federal Qualified Health Center that resembles Athens Neighborhood Health Center. HAWC became part of AHN about a year ago, and with five sites in Reno it’s a medical home for many AHN members. The partnership has also expanded the types of services patients can tap.
“Some of AHN’s medical and dental services are cheaper, also there is access to other services that the clinics don’t necessarily offer,” said Joseph Mazzucotelli, director of clinical operations in HAWC clinic.
“If you need to see a dermatologist, a cardiologist, or any of those specialists, it’s very expensive. Most uninsured people suffer instead of doing it,” he said,.“But with Access to Healthcare, they have that opportunity. That opens a door for them.”
HAWC joined AHN as a provider and then invited their patients to sign up. People who chose not to become members of the network continue to receive care at the clinic, paying the same sliding scale rates they had been paying. Massucotelli said that many responded very positively towards the AHN.
The clinic and the medical discount network closely to expand certain types of specialty care. HAWC and AHN have been collaborating for the past four years to deliver women’s health services, and more recently they’ve launched a diabetes case management program.
The biggest challenge that low-income, uninsured Reno residents face is not being able to obtain specialized medical care when they need it, Mazzucotelli said “But I don’t think the problem is exclusive to Reno.
The situation may be even worse in Athens, a smaller city than Reno but one with a higher poverty level.
Challenges Unique to Athens
“In Athens-Clarke County, many uninsured people cannot get healthcare, whether it is specialty care, mental health or just primary care,” said Tracy Thompson, director of the free Mercy Health Center clinic.
Thompson also chairs the board of directors for Athens Health Network, the umbrella organization that has been working for the past several years to strengthen the health safety net for people with no health coverage.
Adapting the Nevada model will be the signature program for the Athens Health Network for the next few years. The local version will be called HAP, the Health Assurance Program, and it is expected to begin enrolling members in 2014.
First, however, the organizers must create the provider network and work out the details for services and fees.
As a member of Athens Health Network, Mercy Health Center will participate in the new program along with the Athens Nurses Clinic and the Athens Neighborhood Health Center, which is part of the same federal program as the HAWC clinic in Reno. The network will also include both local hospitals and the Clarke County Health Department, along with physicians and other health providers.
“I think we have to start slowly, we want everything to be in place so as to be successful,” Thompson said. “But I do believe this program can work in Athens-Clarke County.”