Access to Healthcare Network
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Transcript of Access to Healthcare Network
Access to Healthcare Network
A membership based, non-profit medical discount plan for under and
uninsured Nevada residents.
Access to Healthcare Network
Mission
Access to Healthcare Network’s mission is to increase access to primary and specialty health care services for the under and uninsured, working poor, Nevada residents, through shared responsibility and community wide partnerships.
AHN History
• Developed through Healthy Community Access Program (HCAP) grant.
• AHN received 501(C)3 status in August of 2007• AHN is registered with the Nevada Division of
Insurance
AHN – Target Population
• The estimated 400,000 under and uninsured Nevada residents between 100% and 250% of the Federal Poverty Level
• The working poor• Children• Single mothers• Self-Employed• Part-time workers• Recently Unemployed
receiving unemployment benefits
Shared Responsibility Model
PROGRAM STRUCTURE
HospitalsHealthcare Providers
MembersCommunity
Hospitals
• In Patient Rate: $400 per day $3000 cap• Out Patient Rate:
35% of Medicaid or 50% of Medicare$13,000 hernia surgery AHN Rate: $350$19,000 ankle surgery AHN Rate: $320$20,000 hysterectomy AHN Rate: $700
Healthcare Providers
A Network of over 700 healthcare providers:
• Primary• Specialty• Ancillary• Dentists• Optometrists• Pharmacists
All providing services at greatly reduced rates.
AHN Members
• Must not be insured or eligible for Medicaid, Medicare, or S-CHIP
• Earned income within 100% and 250% of the Federal Poverty Level
• Must Pay Cash at the time of service
Membership Fee
Time Frame
3 Months 6 Months 1 year
Individual $120 $180 $288
Individual+ 1 child
$195 $300 $530
Entire Family
$270 $420 $770
Employer Based Membership
• Small Business owners • Employers with part-time workers• Employers who cannot afford high premiums
• Employer pays half the cost of membership for the member
AHN Program BenefitsIntegrated Healthcare Delivery System• Primary Care
Physician (Medical Home)
• Access to Specialty, Ancillary, Dental, Vision and Pharmacy
• Discounted Rates
• Care Coordination
• Patient Care Fund
Patient Care Fund
• State and Local Governments subsidize cost of AHN membership
• Foundations designate funds for specific illness or population of people
Susan G. Komen for the Cure
Health Service• Primary Care Visit• Oncologist Consult• Mammogram• Biopsy• Mastectomy• Chemotherapy• Radiation Therapy
Actual Cost AHN Rate$80 $40$130 $65$296 $75$1650 $96$5000 $400$137,000 $6700$87,000 $4200
AHN Programs
• Statewide Help Line – 1.877.385.2345• Covering Kids and Families• State of Nevada Health Insurance Program• State of Nevada Health Assistance Program• Maternal Care Program• Health Savings Program
AHN Health Savings Program
Charles Schwab BankFederal Home Loan Bank of San Francisco
AHEAD GrantWells Fargo Bank
Pilot Project of 40 AHN Members
Health Savings Program
• For AHN members wanting to save for their healthcare needs.
• Must attend 3 -2 hour Financial Education Sessions and 1-1hour Credit Report Review Session
• Two Financial Education Workshops during course of the saving period
• AHN Program Orientation
Health Savings Program
• Must save a minimum of $25 per month• Can only be used for health related costs• Savings will be matched dollar for dollar up to
$500• Deposits are made at AHN• Savings are monitored by Care Coordinator• Members will receive a monthly statement
Shared Responsibility Model
Hospitals
Seed money for network startup
Reduced fee for service
Hospitals
Seed money for network startup
Reduced fee for service
Members
Pay cash at the time services are provided
Pay monthly membership fee (individual and family)
Members
Pay cash at the time services are provided
Pay monthly membership fee (individual and family)
Providers
Primary Care Providers, Specialists, Hospitals, Pharmacy, Mental Health and Ancillary Services
Offer services for a reduced fee
Providers
Primary Care Providers, Specialists, Hospitals, Pharmacy, Mental Health and Ancillary Services
Offer services for a reduced fee
EmployersPay monthly fee for uninsured employees and family members to access reduced fee Network
Receive tax incentive
Employee pays portion of monthly membership fee
EmployersPay monthly fee for uninsured employees and family members to access reduced fee Network
Receive tax incentive
Employee pays portion of monthly membership fee
Insurance IndustryFirst Membership based, Non Profit Medical Discount Plan in Nevada registered with the Division of Insurance
Partnering with Brokers
Marketing to employers
•Transition our members into Insurance products
Insurance IndustryFirst Membership based, Non Profit Medical Discount Plan in Nevada registered with the Division of Insurance
Partnering with Brokers
Marketing to employers
•Transition our members into Insurance products
Banking Industry Funding for development of AHN- Health Savings Program
Funding for match portion of Health Savings Program
Community Reinvestment Act activity
Banking Industry Funding for development of AHN- Health Savings Program
Funding for match portion of Health Savings Program
Community Reinvestment Act activity
GovernmentCounty and State
Grant funding for operating costs
Tax incentives for employers
Annual contribution for network sustainability funding and Patient Care Fund
GovernmentCounty and State
Grant funding for operating costs
Tax incentives for employers
Annual contribution for network sustainability funding and Patient Care Fund
AdministrationProviding services Statewide
• Sustainability Funding• Annual operation budget• AHN services offered :
•Washoe County•Northern Nevada•Southern Nevada (Las Vegas)
AdministrationProviding services Statewide
• Sustainability Funding• Annual operation budget• AHN services offered :
•Washoe County•Northern Nevada•Southern Nevada (Las Vegas)
Patient Care Fund
Funding provided by local Foundations to provide financial assistance to AHN members for specific illnesses or member populations.
Patient Care Fund
Funding provided by local Foundations to provide financial assistance to AHN members for specific illnesses or member populations.
Community
Medical Society
Foundations, corporations, businesses, individual donations
Supports Network sustainability and Patient Care Fund
Community
Medical Society
Foundations, corporations, businesses, individual donations
Supports Network sustainability and Patient Care Fund
Why it Works
HOSPITALS/PROVIDERS
• Reduced rate of ER usage among the uninsured
• Receive payment for services up front• AHN puts a structure to a structure-less
population
Why it Works
MEMBERS• Have access to affordable healthcare• Have a Primary Care (Medical Home)• Have access to Specialty Care• Have access to Dental and Vision• Have assistance navigating the healthcare
system
Why It Works
Community• State and local government hands that are
ordinarily tied can use AHN to provide services allowing their budgets to go farther
• Local Foundations can serve a designated illness or population and their contributions go three times farther
Why It Works
• AHN’s shared responsibility, integrated health care delivery model, can work anywhere:– Small rural area of 50,000 or less
• (Northern Nevada)
– Midsize Urban area of 500,000 • (Washoe County – Reno/Sparks , Nevada)
– Large Urban area of 2,000,000 +• (Las Vegas, Nevada)
Beyond 2014
• AHN model prompted Congress to include non-profits in the Insurance Exchange
• AHN model will be implemented within 10 states
• AHN will be there for those in need of access to healthcare