The Shared Responsibility Model for Accessing Healthcare

The Challenge

The number and percentage of uninsured Nevadans continues to grow steadily. The uninsured are less likely to receive preventative health care, are more likely to be hospitalized for a condition that could have been prevented with timely outpatient care, and have higher rates of illness and mortality. This scenario results in higher health care costs for hospitals that provide the free or charity care, as well as healthcare providers left with bad debt they can't collect. Meanwhile the entire community suffers the majority of the cost of caring for the uninsured, because those with health insurance have to off-set those without health insurance, by paying higher premiums.

While the majority of Nevadans under the age of 65 receive their health insurance coverage through their own employer or the employer of a family member, the long-standing link between work and employer-sponsored insurance is weakening. Because employer-sponsored insurance is currently voluntary on the part of businesses and employees, not all Nevada firms offer health benefits, or not all workers are eligible for coverage under their employer's plan. Also, not all employees choose to participate in their employer's insurance due to the costs, or they can't afford their share of health premiums. These problems are compounded by the inability of family incomes in Nevada to keep pace with the rapid rise in the cost of health care and health insurance.

Without an innovative solution to this situation, the difficulties that uninsured workers face in accessing the current healthcare delivery system represents a persistent and costly problem for workers and their families in Nevada.

 

A Solution

Access to Healthcare Network is a community-owned, non-profit organization that develops, manages and monitors a comprehensive network of hospitals and primary, specialty and ancillary healthcare providers who have all generously committed to offering their services to the uninsured at greatly reduced fees. AHN provides uninsured Nevada residents with access to quality healthcare at reduced rates, while also providing timely compensation for the providers participating in the Network because of the way it is modeled - sharing responsibility between all participants. (AHN Members must pay cash at the time services are provided. Members of the network are uninsured Nevada residents who do not qualify for Medicaid, Nevada Check Up, or employer-sponsored insurance. Members are screened for their Nevada residency status and income eligibility.)

Modeled after several nationally recognized non-profit medical discount programs that serve the working poor, AHN has enhanced Nevada’s healthcare delivery system for physicians, hospitals, and the community-at-large.

AHN incorporates best practices and lessons learned from nationally recognized models throughout the country. Since its inception in 2007, the vision of the AHN and participating agencies is the development of a comprehensive, self-sustaining strategy to address access barriers facing working uninsured residents of Nevada, as well as the creation of a healthcare system in which the uninsured and underinsured residents of our community gain access and receive services from a more efficient, comprehensive and higher quality system of care.

 

The Shared Responsibility Model

Access to Healthcare Network embodies a Shared Responsibility Model of decision-making, accountability, and distribution of responsibility, as well as divides up the effort required to address the problems faced by providing care to the uninsured residents of our state. AHN is a community-based partnership that connects area hospitals, local and state government, community agencies, with employers, healthcare providers, and the patients who need services but are uninsured and can't afford to access services. The program offers a comprehensive solution to a complex problem by coordinating and leveraging the public and private resources that are already being expended. AHN facilitates the involvement of all partners, ensuring that each is accountable and no contributor is overburdened.

The results of the Model benefit all the parties involved:

For AHN Members

· Increased access to primary care, specialty care, pharmacy and wellness services

· Improved chronic disease management

· Improved health care literacy and tools to navigate the health care system

· More affordable care

· Establishment of a primary care medical home for all family members

· Improved continuity of care

· Improved school performance

· Access to resources and information ultimately leading to health insurance enrollment

· Improved health resulting from receiving health care when care is needed

For AHN Providers

· Cash payment at the time of service

· Reduced bad debt

· Reduced inappropriate use of emergency services

· Reduced no-shows, late shows and last-minute cancelations

· Centralized coordination of patient care and patient volume

· Guaranteed equal distribution of AHN members across participating providers

· Reduced billing, pre-authorization, or additional paperwork

For Local Employers

· Improved access to health care for employees

· Healthier and more productive workforce

· Tax incentives

· Access to a medical discount plan and health benefit for low-wage employees

· More cost-effective alternatives for covering part-time workers

· Enhanced capacity for workforce recruitment and retention

· Reduced employee turnover and absenteeism

For County and State Governments

· Reduced costs for provision of indigent medical care

· Reduced costs for eligibility screening and enrollment

For the Nevada Communities that Participate

· Improved population health and well-being

· Improved coordination of care to vulnerable populations

· More comprehensive system of care

· Reduced taxpayer burden for uninsured members of the community