Healing the uninsured

By Ret Boney

When the Alliance Medical Ministry opened its doors almost two years ago, it closed a health-care gap for Wake County’s uninsured workers.

In that time, the full-service primary health-care provider has handled about 8,400 patient visits for some 2,700 working adults who have no insurance, either because they make too much to qualify for state assistance or too little to afford premiums on their own.

“Proper health and health education is the core of everything that happens in a community,” says David Wilson, board member and co-founder of the ministry.  “If we get it going on the right track, then it can have a huge and positive ripple effect on the larger community.”

In North Carolina, roughly one in five adults is uninsured, with that number rising for African Americans and Hispanics, says Wilson, meaning most of this population forego wellness and health education visits and use local emergency rooms for non-urgent problems.

The Alliance Medical Ministry clinic was designed to function like a high-quality private practice, providing patients ages 15 and older with their own physician and quality medical care, including lab tests, referrals to associated specialists and access to free or discounted medicines when possible.

“We’re set up like a private practice,” says Susan Weaver, the ministry’s medical director and one of its doctors.  “Whoever you see initially will be your physician and a doctor is on call 24/7, 365 days per year.”

The clinic employs three physicians, who together account for one-and-a-half full-time positions, and two nurses, one of whom speaks Spanish to accommodate the clinic’s growing Hispanic population.

The clinic charges a nominal fee based on a patient’s household income and number of dependents, and the complexity of the visit, with 97 percent of patients making less than $25,000 per year and 98 percent qualifying for the lowest fee of $10, Weaver says.

And as long as one person in the family is working, access to the clinic and its services is available to all adults in the household, including extended relatives.

About half the clinic’s patients are Hispanic, about a third are African American, 5 percent are Asian American and the remainder are white, and Weaver estimates about half the patients arrive with undiagnosed or untreated chronic illnesses like hypertension, diabetes and asthma.

“Imagine having diabetes with no treatment,” says Wilson.  “These working uninsured go totally untreated.  Here, not only are they treated, they are educated as to what’s driving the illness.”

The clinic occupies a building adjacent to WakeMed hospital in southeast Raleigh it was able to renovate for about $2,000 by using volunteer labor and donated materials, and now has eight exam rooms, enough space to host monthly on-site clinics with an obstetrician/gynecologist, an ear, nose and throat specialist and an ophthalmologist.

Area hospitals provide labs, x-rays and in-patient services for the clinic, and almost all the clinic’s equipment has been donated by local hospitals, physicians or individuals donors, Weaver says, part of the volunteer network that includes some 250 who provide their time and resources to allow the clinic to operate affordably.

About 20 percent of the clinic’s $669,000 budget for this year is covered by grants from local hospitals and hospital foundations, which find the clinic is able to serve uninsured workers more efficiently and effectively than can emergency rooms.

Weaver estimates it costs hospital emergency rooms several hundred dollars to serve an uninsured patient with a non-urgent problem, compared to about $80 a patient at the clinic, a difference she says is one of the reasons WakeMed refers about 600 patients to the clinic each month.

Patient fees cover about 5 percent of the clinic’s budget, with the remainder from fundraising efforts, including about 20 percent from congregations, more than 40 percent from individuals, a quarter from foundations and 5 percent from corporations, says Weaver.

“My hope is that we continue to grow so that we provide an option for everybody to have quality health care,” says Weaver.  “Of course, one day I hope everyone has insurance.”

The idea for the ministry started with Dr. Charles Mann, a Cary ear, nose and throat physician and member of First United Methodist Church in Cary, who heard about a similar program and wanted to pursue the idea in Wake County.

He brought the idea back to Cary, catching the attention of three fellow church members, including Wilson, and after confirming the local need, they formed a board in 2000 and pooled their personal funds to hire a small staff and begin planning.

“We wanted to find a real need that wasn’t being served,” says Wilson.  “To bring our startup and business skills to an unmet community need.”

After planning, fundraising and hiring Weaver, the group rented a building and began serving patients in early 2003, and expects about 10,000 patient visits next year, Wilson says.

The group plans to grow the clinic in Wake County to serve the unmet need, which Wilson estimates is at least 10 times the number the clinic is currently serving, while looking for opportunities to help other needy communities.

“There’s a lot of capacity in the medical system,” says Wilson.  “But there’s not an efficient way to tap into that.  I’m hopeful that as this model continues to build, it will be an efficient way to impact this need.”

Ret Boney is the Assistant Editor of the Philanthropy Journal.

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