Proposed clinic-based
health care model would help people who can't afford, don't
The Associated Press, July 22, 2005
Providing health coverage through community-based centers or private physicians' offices are among proposals being considered by West Virginia's Affordable Insurance Workgroup as it works to find ways to help the uninsured. “The cost of insurance now is getting so high . . . that the average person can't afford it," said Dr. Vic Wood, who developed a clinic-based health care model in Wheeling.
The workgroup, which met Thursday, is considering ideas for a pilot program based on Wood's model and a similar proposal called the Community Care Prevention Program, which would help people who cannot afford health insurance or do not qualify for health insurance through their employers or the government. People who have seasonal or part-time jobs are among those who could benefit from such a plan, workgroup members said. "This could maybe be a patch-through for that person," said Dr. Sarah Chouinard, who works at Clay Primary Care.
The program could be similar to those at coal camps years ago, when everything was set up at a doctor's office in the camp, said Tom Susman, a health care lobbyist and former state administration secretary. "You pay so much per paycheck per month," Susman said.
On any given day in 2003, 21.9 percent of West Virginia adults ages 19-64 and 7.6 percent of children ages 18 and under were uninsured, according to West Virginia University's Institute for Health Policy Research. While the programs would not offer full or catastrophic health coverage, they would provide primary and urgent care services for a monthly fee. They would also provide patients with a medical home.
"A lot of uninsured people use the ER as their medical home . . . rather than a physician," said Scott Brown, West Virginia's pharmaceutical advocate.
However, workgroup members are addressing several questions, including defining eligibility and determining how much patients should pay, if fees should be consistent at all participating clinics and if those fees should be flat or tailored to patients based on risk factors.
Workgroup members discussed an option in the Community Care Prevention Program of setting a $35 monthly fee for patients with no risk factors such as tobacco use, uncontrolled diabetes, cancer and vascular disease. That fee would increase to $45 if the patient has one risk factor, $55 for two risk factors and a maximum of $75 for three or more, under the proposal.
The higher fees would factor in the extra care patients with risk factors would need, Chouinard said. "It's not really a penalty for having these problems," she said.
Caring for a cancer survivor is much more involved than caring for someone who is healthier, Chouinard said.
But Health Care Authority board member Marilyn White questioned the fairness of charging extra fees for patients with certain conditions because they would be treated by specialists. "How can you justify charging someone more for a disease you're not going to treat?" White said.
Another concern was preparing for the possibility that after a few years, the group will find the pilot program cannot continue. "An exit strategy needs to be addressed," said Bill Kenny, deputy commissioner at the state Office of the Insurance Commissioner.
The workgroup plans to continue working on the proposal, which it hopes to present to Gov. Joe Manchin before a special legislative session this fall.
"Hopefully, this will get people into care early, before they've gotten very sick," Health Care Authority Chairwoman Sonia Chambers said.