Last fall, members of the Athens Health Network invited the founders of an unusual alternative to conventional health insurance to visit this northeast Georgia college town and explain how their system works.
The Athens group members, who include hospital and clinic executives as well as public health officials and physicians, were so impressed that they vowed to try and copy the model founded more than 2,400 miles away, in Reno, Nev.
Access to Healthcare Network (AHN) is the first and only nonprofit medical discount plan in Nevada. Now with a network of 1,350 providers, it lowers the cost of primary and specialty care for 8,000 Nevada residents.
People are eligible to join AHN if they lack employer-provided 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 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.
Like Reno, Athens is home to large numbers of people who have jobs but no health insurance. While free and low-cost clinics provide a partial safety net for such people, and doctors and hospitals provide some care without payment, there is still a serious need.
In Reno, each patient is assigned to one of AHN’s seven care coordinators, who keeps track of the member’s health status and helps the person obtain appropriate care – including referrals. Coordinators 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, where Reno is located. “You can get everything you need from us so you can get healthy.”
Helping providers as well as patients
The services provided by care coordinators, and AHN’s pre-arranged fee schedule, are 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 pay by cash or credit card when they are treated.
“Every new member pays $130 for the first doctor visit,” said Cole. “The following visit for primary care is $40, and specialty care is $65.”
One of the clinics in the Reno network is Health Access Washoe County (HAWC), a federally 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 members. The partnership has also expanded the types of services that patients can receive.
“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 for HAWC.
“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.”
The clinic and the medical discount network work closely together 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 problem of specialty care
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,’’ he said.
The situation may be even worse in Athens, a smaller city than Reno but one with a higher poverty level.
“In Athens-Clarke County, many uninsured people cannot get health care, whether it is specialty care, mental health or just primary care,” said Tracy Thompson, director of a free clinic called Mercy Health Center.
Thompson also chairs the board of directors for Athens Health Network, which has been working for the past several years to strengthen the safety net for people with no health coverage.
An adapted form of the Nevada model will be the signature program for the Athens Health Network. It’s expected to begin enrolling members in 2014.
“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.”