(Editor’s Note: This is the ninth and final article in a series on the Athens uninsured initiative, produced by graduate students in the Health and Medical Journalism Program at the University of Georgia.)
Betting on RenoIn a few months, Allie Chambers and Tracy Thompson will begin paying visits to physicians in the Athens area. They’ll be trying to sell an idea.
They will be asking family doctors, internists, ob/gyns and a host of specialists to join a bold effort aimed at making health care affordable for some of Clarke County’s 22,000 uninsured residents.
Chambers and Thompson are leaders of the Athens Health Network, a coalition of clinics, hospitals and health care providers who want to change the status quo in this northeast Georgia city.
They’ll be asking local physicians to become part of a new, nonprofit, cash-for-care medical discount plan modeled on one that has worked well for the past seven years in Nevada.
The Access to Healthcare Network (AHN) began in the city of Reno, and is still based there, but it has gradually expanded and now has members throughout Nevada. But until now, such a plan has never been tried outside the Silver State. Athens will be the first such place.
“There is no program like this anywhere in the country,” said Lise Mousel, director of provider and community development for AHN in Reno.
The health plan works on the same general principle as a warehouse club, such as Costco. People pay a modest, income-based monthly membership fee that entitles them to purchase primary care, surgery and other specialty care at significantly discounted prices. Membership is limited to uninsured people who earn too much to qualify for Medicaid and are not old enough for Medicare.
The Athens version of Nevada’s approach will be called the Health Assurance Program, or HAP. Chambers, executive director of Athens Health Network, said the organizers hope to have about 60 physicians on board when the plan launches.
About 700 physicians practice in the Athens area, according to the Coalition of Athens Area Physicians (CAAP).
Appealing to patients and providers
“We would like to begin recruiting doctors this summer,” said Chambers, who learned about the nonprofit, medical discount model when she was a public health graduate student at UGA and an intern for the Athens Health Network.
When doctors, clinics and hospitals agree to be part of the network, their contracts will spell out exactly how much patients will pay for office visits, tests, procedures, rehab services and the like. When people enroll in the plan, they’ll be given a handbook and access to a website where they can look up prices for whatever they need, according to Chambers.
Caps are also negotiated. So patients can see the maximum they’ll be required to pay if additional care — such as a stay in the hospital — turns out to be necessary.
In Nevada, individuals who earn $11,170 to $22,439 per year pay $35 a month for AHN membership. They pay $40 for each primary care visit.
For people who earn a little more, monthly membership costs $40 each month, and a visit to the primary care doctor is $45. At both membership levels, charges for inpatient hospital care are capped at $400 per day.
The most important thing to understand about the program, Mousel said, is that it is not standard health insurance, which spreads costs among large populations of insured people and requires modest co-pays from individuals who get care.
Under the “shared responsibility” plan pioneered in Reno, members pay cash to providers at the time they receive services. But the amounts they pay are dramatically lower than typical charges.
Nevada family doctor Andy Pasternak has been part of AHN for six years. He is enthusiastic about the plan in part because it gives him an organized way to help low-income people in his community.
He enjoys dealing with AHN members, many of whom are excited to have some type of health care coverage. “It’s been really rewarding taking care of a lot of those patients,” he said.
The plan has benefits for his office staff, too, because it reduces their workload by cutting down on paperwork needed for regular insurance claims.
Other health providers like the fact that the plan is not a giveaway: Patients pay for their own care on the day it’s provided. This means that AHN members have “skin in the game,” said Jeff Snyder, administrator for OB/GYN Associates in Reno, a practice with 12 doctors.
Network participants tend to come back for recommended follow-up visits, perhaps because they know exactly what these will cost, Snyder said.
This is not always true for people with conventional insurance plans. “Some people with high deductibles are not following up,” he said.
Help with mental health and substance abuse issues is also available to network members. Some AHN participants have needed these services for a long time, but found them financially out of reach, said Jolene Dalluhn, admissions director of Quest Counseling and Consulting in Reno.
In Nevada, the medical discount model works because rates are within reach for patients and because the emphasis on upfront payment is appealing to doctors. The organizers of the new network in Athens are working to develop an arrangement that expands access to essential health care for underserved people and cuts uncompensated care and claims processing for doctors and their staffs.
“[Patients] are here because they want to be, and the rate is low enough that they can access the services, but not so low that we can’t stay in business,” said Dalluhn.
Katie Ball is currently pursuing a master’s degree in health and medical journalism from the University of Georgia. Her reporting interests include research in medical technology and ustainable environmental practices.