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