New Health Care Model Makes Doctors Visits/ Prescriptions Affordable for Uninsured
Co-operative that strives for low costs comes to Portland
By Helen Silvis Of The Skanner News
February 13, 2012
Morgan Butler, at left, and Tony McCormick attended an Occupy Health day in Northeast Portland. They hope to
sign up 300 people or more with their low cost health care co-operative.
“We’re not waiting for political things to happen,” says Morgan Butler, membership services community organizer for Patient Physician Cooperatives Portland. “We’re creating our own thing, which seems to work a lot better and a lot faster.
“We want people to know they can have a primary care provider right now. And they won’t have to wait months for an appointment.”
Patient Physician Cooperatives Portland (PPCPdx) is not an insurance policy. It is a nonprofit that brings together physicians and patients outside of the traditional insurance model. To join the co-operative, patients pay $18 a month.
That basic $18 membership fee allows members to see any participating medical provider at discounted Medicare rates. Members can call and speak to a doctor by phone or webcam at any time, through the co-op’s TeleDoc service. Yes, that’s 24/7.
Membership also brings a prescription drug discount of around 54 percent. And it covers medical advocacy. If you need surgery, for example, advocates will work with you to help you get a discounted rate. They will go over your bills and challenge any questionable charges.
On top of basic membership, you can also choose a primary care doctor and agree to pay that person a fixed monthly fee for a year. The fee, which varies from doctor to doctor, pays for a number of no-pay visits during that year. Doctors all set their own rates, which cover several no-pay visits.
Kirsten Carr M.D. charges her patients $45 a month. For this, she offers up to seven no-pay visits in the first year, four in the second year, and five every following year. Why those numbers?
“It covers most needs for most people,” Carr says. “For most adults, a physical and four sick visits a year should be sufficient to meet their needs. Even my patients with diabetes or heart problems, I see about once every three months.”
Carr’s practice is based at the Multnomah Family Care Clinic in West Portland. The Co-op does have a few providers in most areas of the city, with six on the Eastside. North Portland-based family nurse practitioner Shelda Holmes is a provider. (Holmes’ husband, Rep. Chip Shields, and her clinic manager, is the state representative for North and Northeast Portland. )
The highest provider fee is $77 a month, with most falling around $40.
“We’re not here to make money,” says Butler, who worked for the homeless nonprofit Transition Projects for 12 years before landing at PPCPdx. “We’re here to hook up human beings with healthcare resources, and not just healthcare, but wellness care.”
Just seven months old, PPCPdx is up and running with 30 health care providers and 80 members. On the providers list, so far, are two medical doctors and two family nurse practitioners, along with chiropractors and naturopathic doctors, acupuncturists and massage therapists.
Carr says most doctors haven’t yet heard about the co-op; word is just beginning to spread in medical circles. She was keen to sign up as a provider because she already sees many patients who have no insurance and pay cash for services.
“It made a lot of sense to me to sign up with this plan,” she says. “It’s a pretty reasonable model of care. When I was starting out I thought a lot about how I wanted to practice, and this fits nicely with giving providers work and giving patients a good opportunity for access to health care.”
Former health industry executive Don McCormick launched Patient Physicians Cooperatives in Houston, Texas, 8 years ago. After working with physicians groups for 40 years, he agreed to help a clinic reorganize, and came up with the idea of a co-op. The Houston co-op now offers services from 49 diverse doctors. And in Hickory, N.C., the Apollo Healthcare Cooperative, opened in 2009, has grown to 600 members and offers a seven-day a week urgent care clinic.
Andrew Watkins, a
Houston-area pastor says the co-operative is helpful to
families who can't afford conventional health insurance.
“I love it: I’m an advocate for it,” Watkins told The Skanner in a telephone interview. “It allows people to go see a doctor even if they don’t have insurance, and not fear the cost. It allows you to focus on getting well.”
Watkins says many members of his church are working but still can’t afford insurance. He gave the example of a family with five children who joined the co-op and were able to take care of their medical needs.
“Nine out of 10 things can be taken care of right there in the doctor’s office, and the kids get to see the same primary care doctor,” he says.
Size matters, however, when it comes to what the co-ops can offer. The Houston co-op has partnered with hospitals, an imaging center and specialists, as well as with individual doctors. It also offers a low cost insurance that covers hospital care.
Portland’s co-op needs to add members so it can offer these kinds of valuable extra benefits, Butler says.
Low-cost legal services are available now, and other optional extras can be added, as the number of members grows.
“I’d like to have 300 members signed up, because at that point we can do a whole lot more,” he said. “We have a lot more buying power and people will start coming to us.”
Butler says he gets a lot of questions about how co-ops work, when people get a serious illness such as cancer.
“If you do get cancer, we will advocate for you to get Medicare rates for your treatment,” he says. “We can help you apply to state of the art cancer centers, like the Anderson Clinic in Houston. And if you are signed up with a primary care provider, you will have a far more personal care experience.”
Jenny McCormick, daughter of co-op founder Don McCormick, co-ordinates between the three cities. She is also a breast cancer survivor. She started out with insurance through her job, she says, but had to switch to her husband’s insurance when she was unable to work.
“We still ended up with big bills. That’s how people spend all their life savings and go bankrupt. It was a rude awakening,” she says.
Insurance companies usually put a cap on the amount they will pay and patients have to pay for everything beyond that, she said.
“What the coops do is help patients negotiate with doctors, cancer treatment centers, labs and pharmacies, to get an affordable price – usually the Medicare rate. It works because most doctors and clinics are willing to help. Many of them are simply writing off bills for uninsured patients, already.
“Sometimes the cost is less than you would pay if you had insurance, once you add in the medication bills and the co-pays,” she said.
“Even with insurance, cancer patients still end up paying a lot. If you know about chemo treatments, you know they are very expensive and most patients pay a percentage of that.”
Jenny McCormick said she currently runs a group for cancer survivors and finds many suffer from nerve pain, orthopedic problems, and other after-effects of treatment. The co-op model offers an affordable way to continue recovery, she says.
“We can’t fix all the problems through the co-op, but we can make the cost very transparent. And you have that security from having a group behind you who can advocate for you and remove that stress.”
Butler said co-op members are highly aware of the large numbers of families who have no insurance, no job and can’t afford their services. Co-ops can’t fix that problem, he said, but its Portland providers try to do a little by volunteering 20-25 hours a month at FISH emergency services.
Butler sees the co-op as a good step toward making medical care available to everyone. “Some people say they won’t get involved with anything less than a single-payer system, he said. “But anyone who knows how health care is set up, knows that we couldn’t put in a single-payer system tomorrow if we wanted to. Patient/Physician Cooperatives can be part of that transition. We are definitely part of the solution.”
To sign up or to find out more, call Morgan Butler at 971 313 8354 or visit PPCPdx online at ppcpdxcoop.org