NORTHPORT, Maine — Doctor and health care activist Michael Fine of Rhode Island has a dream — and a plan to make that dream a reality.
Fine can imagine doctors banding together to subvert the current health insurance system by providing good, primary health care to people without insurance for a reasonable, prepaid price. He’s doing that already at Health Access RI, which bills itself as the first organization in the nation to try the approach.
As he spoke about his experiences Tuesday morning at Point Lookout during the TouchstoneMaine Conference on the Patient Centered Medical Home, the 30 or so doctors in the room sat up and took notice.
“We build a health care system from the ground up,” he said to applause and shouts of approval from his audience.
One of those cheering was Damariscotta doctor Michael Clark, who said after the speech that he moved home to Maine to design a new type of practice that would serve his area’s working, uninsured people.
He said that he crunched the numbers and figured that he could provide primary health care for $25 per person per month, with a reasonable fee per visit.
“We had big ideas. A lot of people fantasize about getting out of the rat race of the insurance companies,” he said. “It felt scary to consider an alternate funding model.”
Ultimately, he was concerned that he could run afoul of insurance or Medicare regulations, and so regretfully didn’t go down that route. But listening to Fine describe his successful experience in Rhode Island was inspirational.
“I’d do this tomorrow,” Clark said. “The promise of this, to be able to deliver care to my lobstermen, and carpenters and all the small-business men … The big excitement is not to get a few more bucks per person. It’s to deliver care that aligns with my values and conscience, and that is the care that our patients want.”
One of the most striking elements of Health Access RI is its simplicity. Although nationally, health care is famously and painfully expensive, primary care doctors are a third of the medical work force and do a majority of the work — but earn only $150 to $200 each year per patient they see in their practices, a fraction of the $1,000 he said insurance companies earn. And much of the doctors’ time is spent filling out the companies’ paperwork rather than actually practicing medicine.
Primary care physicians, or family doctors, provide a variety of medical care to their patients and take continued responsibility for that care.
Although Health Access RI provides its patients with affordable primary care, it should best be combined with low-cost, high-deductible insurance to protect against catastrophic expenses, Fine said. The company has partnered with a broker that offers short-term medical insurance, and encourages its patients to use a Health Savings Account to pay for medical expenses that fall in between primary care and catastrophic expenses.
At Health Access RI, they figured that charging patients about $30 a month for primary care, including acute care and nighttime medical calls, would benefit both the practice and the uninsured. The network has grown slowly since it began in 2002, and now includes a dozen family practices in Rhode Island and has 500 patients as members. Fine said that the company has been able to negotiate “incredible discounts,” and now pays about what Medicare pays for services such as laboratory tests and X-rays.
“It’s concierge medicine at Target prices,” Fine said.
The health care reform that’s slowly making its way through Washington, D.C., if it’s passed, likely will not provide care to all of the country’s uninsured, Fine said, and also may make the business environment more difficult for private primary care practices.
He envisions this type of population-based primary care as one solution, and hopes to expand to 20,000 patients and to other states. The untapped market is very large, and growing, Fine said. Rhode Island has 150,000 people without medical insurance, and Maine had 118,000 as of 2007. Plenty of those people have incomes that are higher than the federal poverty level and so likely would be able to purchase primary medical care for themselves and their families at this kind of pricing, he said.
Plenty of primary care physicians in Maine might like to jump on board, too, said Clark.
“This is about improving access,” he said, adding that it’s “gut-wrenching” not to be able to provide care for the uninsured the way he would like.
“This will be a chance to make some changes,” he said.