A local group cut deals with health care providers to get care to the uninsured
A local group cut deals with health care providers to get treatment for the uninsured
“I’d see homeless people limping down the street and break down in tears,” Cliff Lewis says. He’s sitting in an easy chair in his North Valley home, wearing tan khaki pants and a dark turtleneck over a thin frame. His mind is on the fear of medical bankruptcy.
Lewis and his wife, Jeannie, are two of the 55,000 Washoe County uninsured. Both work full-time jobs at small businesses where health care plans are very expensive for small numbers of participants. They’ve worked in Reno for 30 years and remember better times when benefits were affordable.
They priced insurance policies. United American Health offered major medical coverage for $550 per month with a $3,000 deductible due for each of them before they could use it. That wasn’t a price they could afford.
“I knew something was seriously wrong, but with no insurance, what do you do?” Lewis asks.
Weekly, debilitating, “knock down, drag-out” headaches forced Lewis to go to urgent care, where they ran tests and referred him for an MRI. His vertebrae had grown into his spinal cord. After the MRI, Lewis was directed to neurosurgeon Michael Song.
“We were scared to death,” Lewis says. “Dr. Song said if I fell down or hit a wall it could potentially kill me.”
Dr. Song sent him home with a neck brace, told him to sit down and do nothing. Spinal surgery was the only option.
For two years, Lewis put off medical attention because he had no insurance. During that time, he had two spinal cord strokes after slipping into warm water. “It felt like somebody slammed the base of my skull with a baseball bat,” Lewis says. “When I came out of the water, I was paralyzed.”
These strokes were rare and the symptoms went away. With no insurance, Lewis ignored precursors to a serious problem.
With surgery looming in a few weeks, at a cost of $16,000, the Lewis’ began seeking assistance from social services to stave off medical bankruptcy. An apologetic worker informed the couple that they made too much money and had too many assets to meet the pre-determined guidelines for assistance.
Co-workers at the small design company where Lewis works began an Internet search that led them to Access to Healthcare Network. The Lewises were among the first to enroll in July 2007, prior to surgery in August.
Search for a solution
Five years ago, a community group gathered to address the growing number of uninsured in the area. Hospitals, health department officials, businesses and doctors gathered to discuss the downward-trending cycle. A strategy was agreed upon.
Sherri Rice, a tall, driven redhead who knows how to build successful non-profits from the ground up, accepted an offer to build the Access to Healthcare Network. “We are one of the most important things to happen for the state of Nevada,” Rice says. “It’s the right thing to do, and nobody’s making any money.”
An application to the federal government for a Healthy Community Grant was approved. But more important was that hospitals agreed to cut their rates if Access members would agree in writing to go to urgent care and stay out of the emergency room—except for genuine emergencies—which sharply cuts hospital costs.
Renown and St. Mary’s offer Access members discount rates of $400 per day for in-patient hospital stays. This rate includes all imaging and medicines with a $3,000 cap on costs, no matter how long patients need to stay. Intensive care is $600 per day with a $3,000 cap. Emergency room visits are not reduced unless members are admitted. If admitted, in-patient rates apply.
“Hospitals and doctors are the total base of the program,” Rice says. “These providers are everything to us. They’re the ones who deserve all the accolades.
Providers benefit from payments upfront, albeit deeply discounted, and no costs for billing or collections. All members sign an arbitration clause with providers, reducing litigation expenses. Membership also reduces emergency room expenses and traffic for all parties.
Basically, members agree to pay discounted rates upfront. A $13,000 hernia operation costs $300 through Access. A $12,000 breast biopsy costs $165. Lewis’s $16,000 spinal surgery cost $1600.
“These discounted rates are a privilege for our members,” Rice says. “They need to follow the rules.” Members must pay for services at the time of service. This is non-negotiable. Two no-calls/no-shows and members are kicked out with no chance of coming back.
Scolari’s and Safeway offer reduced pharmacy for members. Urgent care rates are $70 per visit, all inclusive. Members are encouraged to use urgent care and not the emergency room. Over 400 providers offer primary care, mental health, dental, vision, specialty care, surgery, diagnostic and ancillary services.
This network isn’t insurance. Members are not denied services due to pre-existing conditions. Rice describes Access as “a community partnership based on shared responsibility.”
Big benefits for a small fee
“What they [members] ask for is to pay what they can offer according to their income and their dignity,” Rice says. “We give them both. When they show their card and pay cash, they are treated like any person with insurance.”
Monthly fees are $40 per individual with an additional $25 for one additional family member and $50 for unlimited family members. Every member receives a care coordinator to help navigate his or her care.
Employers can join and receive tax incentives for assisting members with monthly costs.
The hospitals benefit and save money not just because patients are steered away from the emergency rooms, but also because when people get treatment, they can be treated at less cost than if their conditions continue to worsen. Many emergency room visits result in treatment that would have been far less expensive if handled earlier.
The small amounts members pay is more than nothing, which is what hospitals and physicians were getting from some patients, accompanied by costly searches for patients or collection agency costs.
In nine months, 1,200 members enrolled. Access has no enrollment limitation in place. Rice says they want the part-time people, those not eligible for Medicaid/Medicare or Nevada Check-Up (children’s insurance) and people waiting to get insurance who meet the income guidelines. Applicants must have photo identification, verification of monthly or annual income and live in Nevada to apply.
Rice says the working poor are often wrongly stigmatized. She hasn’t had one member ask to receive benefits for free. Access asks the uninsured to be accountable and includes them in the partnership. Members, like Lewis, are happy to pay the premiums.
Lewis is grateful for Access providers making spinal surgery affordable. Although Dr. Song isn’t an Access provider, he agreed to perform the surgery at the Access price. “Two hours after surgery I was up walking the hallways,” Lewis says. “It was amazing.”
Since the spinal surgery, Lewis has been diagnosed with Dupuytren’s Disease, an abnormal thickening of tissue between the skin and tendons in hand palms and feet soles. He’s had surgeries for his right hand and foot through Access. He’ll undergo the “whole regime” for the left side soon.
“Without Access, I’d be dead,” Lewis says. “I don’t want to be disabled. I want to be fixed. I love my job.” He’s told everyone he knows about Access. Some people are in disbelief about the benefits. Others have a problem because patients must have cash ahead of time.
“I feel very respected and don’t feel like a second class citizen,” Lewis says. “Access is the prefect name—the user has actual access to their health plan.”