No longer should a Nevadan have to see their child suffer with another painful sore throat and worry about how they will pay for the streptococcal-screen and needed medicine.
A nonprofit organization — working together with community stakeholders — is making sure that more individuals and families receive healthcare coverage, filling in the cost gap between traditional health insurance premiums and Medicaid or Medicare eligibility. The Access to Healthcare Network (AHN) has been around since 2006, and yet many still don’t know about AHN and its innovative medical discount program.
AHN serves Nevadans from three locations. There are close to 80 employees at the headquarters location at Reno Town Mall in Reno, about 35 staff members working at the satellite location in Las Vegas, and three who are running the Elko office.
“I get to come to work every day and know we’re a mission-driven organization whose entire point and purpose of existence is to help people to become and stay well in any shape, way or form that we can,” said Trevor Rice, Chief Operating Officer.
Trevor worked as a care coordinator when he first joined AHN. One family’s story especially inspires him. Though he can’t give any identifying details because of patient privacy, he can talk about the story in very general terms. It showed him how AHN can boost the state’s health care system with dramatic results.
Trevor shares that a young girl was experiencing worsening symptoms of an illness. Her parents worked several jobs to make ends meet, and they had no health insurance. She was starting to miss school and becoming much sicker. She needed a specific procedure by a specialist, and it was urgent. There was only one provider in town who could perform the needed surgery. Rice was able to convince this physician’s practice group to try out the AHN program. At the same time, another outside funder provided a donation that helped with the providers’ service fees, and the girl received her life-saving procedure.
What is a Medical Discount Program?
AHN is just about one of its kind — the only licensed medical discount program in the state, and the only licensed nonprofit medical discount program in the country.
It is a leading-edge idea that is working well in Nevada. Most of AHN’s client members live above the income level that triggers Medicaid coverage — too much income for Medicaid, and too little for typical insurance premiums.
Members join for a monthly fee — $45 for adults and $10 for children — less expensive than traditional insurance, and they receive care at a considerable savings compared to what they would pay if going it alone in the largely expensive health care system.
AHN provides its members with holistic services that range from diagnostic tests to lab work, from primary care to specialists, pharmaceuticals to physical therapy and additional benefits. More than 2,000 statewide providers have joined the network; including physicians, diagnostic and laboratory facilities, therapists including massage and acupuncture, mental health specialists, pharmacies, vision providers, and dentists. Gyms and companies offering life-alert bracelets also provide discounts to members.
Access was founded in 2006 by Sherri Rice, currently CEO, on the principle that no one should fall through the cracks of the system.
“It’s kind of a big city, small town mentality; where partnerships, relationships still matter here, and this wouldn’t have worked without building partnerships and building relationships where everyone was in the same boat,” Trevor explained. “So Sherri came to the idea of shared responsibility, which is the idea that caring for the uninsured is not the responsibility of just one organization, one entity. It’s not just the government’s responsibility, it’s not just the hospitals, it’s not just the providers, it’s not just the organizations, it’s not just the client. Everyone has to come together. And we’re all in the same boat and move toward the same goal to make this successful. And if they didn’t do that, this wouldn’t have happened.”
AHN operates with a comprehensive model of three funding sources; federal and state grants, charitable foundation donations, and the monthly membership fees of its client subscribers, currently numbering about 6,000.
This diversification makes AHN sustainable.
“We’ve proven hand-over-fist that this program works; it works extremely well,” Trevor said.
Partnerships With Community Stakeholders are Underway
Community partnerships have begun as well. Partnering organizations fund the special programs they set up with AHN. For example, Saint Mary’s Regional Medical Center has established a Care Management Program and Health Education Program with AHN.
These programs are not just for uninsured individuals, they are for anyone with identified risk factors, referred to the program by medical personnel.
In the Care Management Program, high-risk hospital inpatients who will soon be released, receive follow-up care coordinated by AHN. Patients are referred if they have a risk factor such as a chronic disease they have trouble managing, no primary care physician, or are under-resourced in either income, transportation, or housing.
“And when they’re discharged, our job is to set them up to be successful, to help prevent them from having to go back into the hospital,” Trevor explained. “So, we help them gain access to primary care and specialty care providers. If they have transportation issues, we resolve those. If they have food insecurity issues, we resolve that.”
An AHN staff member is introduced to the patient before discharge and asks about their needs. A patient may need resources to better understand their diagnosis and learn more about strategies for living with a chronic disease. Health coaching may include topics such as how physical activity can be enjoyable, as in just getting outdoors and walking, or how to reduce stress.
The Health Education Program comprises classes in diabetes self-management and diabetes prevention, along with classes in healthy cooking for those who are suffering from a chronic disease.
Private grants from banks such as Wells Fargo and Bank of America, N.A. are put into a fund that assists those who are having trouble paying rent after being in the hospital, due to not being able to work during that time.
Also, a patient care fund is in place to help families or individuals who sometimes cannot afford even the discounted provider fees.
“Over the past 13 years, we’ve partnered with foundations such as Susan G. Komen®, where they give us about $50,000 a year, for about the past seven years, that we then use to help pay for the care of our clients,” Trevor explained. “We partner with the Nell J. Redfield Foundation that gives us $50,000 on an ongoing basis, basically when we need it. But the premise of it is that we are able to go and raise funds not for our own operating costs, because we don’t take any dollars to administer that. It all goes to patient care.”
How Providers Are Paid
Members pay a discounted day-of fee for services at their care provider, such as $50 for a primary care visit, and $80 toward a specialist appointment.
Where the bigger savings occur is when patients need expensive imaging, procedures or surgeries. For example, an emergency room visit ranges from 30 to 80 percent less for AHN members than a self-paying patient without insurance, Trevor said.
So, why would a provider join the network if they receive reduced compensation?
“Primary care physicians went into their field because they want to help people, and they sign on with us because they simply want to help people,” he added.
The advantages for hospitals and physicians include a guaranteed prompt payment, even if it is less than from insurance programs. The providers write off the difference. Hospitals, for instance, typically only collect one percent of their costs from uninsured, self-paying patients, Trevor explained. Primary care physicians also receive AHN assistance to find specialists in the network when patients need to be referred.
Subscriber members are required to pay a day-of service fee, or they will not be able to see the provider. On the other hand, members can seek primary care or be referred to a specialist before their condition gets bad enough to need a costlier hospital visit.
How Do Nevadans Join the Access to Healthcare Network?
Potential new members apply to AHN and are screened for eligibility.
“This program was never meant to take the place of insurance — it’s meant to be a functional system for folks who cannot get access to insurance,” Trevor explained. “If you’re eligible for Medicaid, you need to go to Medicaid, because there are no co-pays. It's free. If you qualify for Medicare, you need to go to Medicare, or if you can get insurance through the Affordable Care Act, we would highly recommend that you do so. And so we’re going to screen people to see if there’s any other possibilities besides us and look to us to be the last resort for people.”
Once accepted, new members come in for a one-hour consultation — a type of health care literacy workshop on how to navigate an often complicated system.
“The health system is so complex that individuals with college degrees, with master’s degrees, have a hard time understanding exactly how the whole thing is supposed to work,” Trevor said.
A care coordinator is assigned to each member. Ten care coordinators are on staff at the Reno location.
“It’s based upon relationships; that we really care about our clients, we care about their well-being, and we want to make sure that they can be successful,” Trevor added. “When they enroll, members are handed a document that has the care coordinator’s name, telephone number, email address, and it has a picture on it, because we want them to know, ‘This is my care coordinator, Melissa, and she’s the person I go to with every issue, every question that I have.'”
A Group of Programs Offer Many Other Services for Nevadans
Federal and state grants to AHN pay for several unique programs that are available to any resident of the state, whether or not they are AHN members. For example, the diabetes self-management education classes are open to the public.
- In AHN’s State Health Insurance Assistance Program (SHIP), staff and volunteers provide free Medicare counseling for seniors.
- In the Aging and Disability Resource Centers (ADRC), AHN provides free case management assistance to seniors and individuals with disabilities, for example, to help with enrollment into Medicare or Medicaid, or to get a home modified for a wheelchair.
- The Ryan White Program offers care services to those with HIV/AIDS, such as case management, insurance, medical care and medication.
- The Women’s Health Connection and Colorectal Cancer Screening programs offer free diagnostic screenings, and AHN will care-coordinate individuals through the process; from exam to imaging, to biopsy, or further services as needed. If an individual is diagnosed with cancer, AHN will help them gain access to Medicaid, Medicare, or they may be eligible for AHN’s Medical Discount Program.
- The AHN non-emergency transportation program helps those who are low income, disabled, or more than 60 years of age to receive rides in one of its eight vans to health care providers, outpatient procedures, pharmacies, physical therapy appointments, trips home from the hospital, and other needs. Through additional programs, AHN offers bus passes, or taxi and ride-share vouchers.
AHN’s Medical Discount Program Has Not Yet Been Replicated in Any Other State
AHN is a positive success story in Nevada.
And remember the young girl who received the urgent surgery? A couple of years ago, Trevor saw her again. She was starting college and looked forward to a bright future. Also, the physician’s group that provided the life-saving procedure has stayed with AHN’s provider network to this day.
“Whatever we can do to help people be successful, knowing that for a lot of folks, it’s the difference between life and death, or the difference between a good quality of life, and a poor quality of life to get an access to these services,” Trevor said.