N.H. expert offers health care advice

loading...

BANGOR – An ambassador from next door held the attention of Maine’s Rural Health Association on Wednesday as she described how a small New Hampshire hospital in the Lakes Region built a program that gets medical, dental and prescription drug help to the uninsured and underinsured.

Sharon A. Swanson, director of the program Healthlink, told more than 50 members of the association who had gathered for their annual meeting that, as a native of Aroostook County, she would love to see programs like hers take root in Maine.

Two similar projects are being tested in Maine.

Local solutions like Healthlink, which has received national accolades, are needed in Maine, said Dr. David Hartley, director of the Division of Rural Health at the Edmund S. Muskie School of Public Service at the University of Southern Maine in Portland.

After the Clinton health care reform debacle of the early 1990s, it became clear that health care solutions are local, Hartley said.

Healthlink, based in Laconia, N.H., was started at a time when 11 percent of the New Hampshire population was uninsured, Swanson said.

Some of the uninsured, such as a group of out-of-work professors, needed assistance for just several months, then moved out of the program.

Others, who work in the tourism industry, need help only during a portion of the year. And of course, some need help for longer periods, she said.

Helping those with inadequate service get preventive and regular health care pays, she said.

Since the program began, emergency room admissions have dropped 76 percent, patients served by the program report that their health has improved, and those getting regular care attend to smaller medical problems, resulting in an overall drop in the number of trips to the hospital and doctor, Swanson said.

The first step in building the program was to get the 110 physicians associated with the 90-bed hospital now known as LRGHealthcare in Laconia, N.H., to agree to provide free care to patients who had filled out applications and met financial requirements. After the patients agreed, 15 area pharmacies, three major hospitals, seven ambulances, as well as counselors, massage therapists and others signed onto the program.

Healthlink also lined up two partners that donate services: Blue Cross and Blue Shield of New Hampshire (now Anthem) and Compusense of Nashua, N.H. The insurer provides claims adjudication, an identification card to participants, printing of some marketing information, and data download help. The software company helps with enrollment, case management and other information systems.

The help from Anthem otherwise would cost about $100,000 a year, Swanson said.

To participate, individuals must qualify by providing detailed financial information, such as tax forms, and eight pay stubs. If the applicants qualify for other programs, Healthlink workers help them apply to those programs.

The program has helped at least 3,100 families enroll in Medicaid and 221 veterans get veterans’ benefits, she said.

If an applicant doesn’t meet qualifications for any other coverage, then Healthlink makes a deal with the patients. They may enroll if they agree to call primary care physicians before going for emergency room or walk-in care. In addition, they must commit to following the care plan developed by their primary care physician and case management worker.

This helps defeat the common problem in which the uninsured learn to skip from provider to provider as they feel guilt over small debts they haven’t paid to each provider, she said. That is counterproductive to quality care, she said.

Patients agree to play by the rules in part because of the attractive pharmaceutical drug benefit. For a $3 co-payment for generic drugs and a $5 co-payment for brand-name drugs, Healthlink members get their prescriptions covered for up to $2,500 a year, she said.

The prescription drug program is paid for from the annual proceeds of an estate that was donated to the hospital, Swanson said.

Looking at expenses as a whole, one-third of the program’s costs is pharmaceuticals, one-third is staff, and one-third is building, printing and other costs. These total about $750,000 a year to serve what is now 2,971 clients.

Clark Dumont, a spokesman for Anthem East, which includes the Blue Cross plans in Maine, New Hampshire and Connecticut, said in a separate interview Wednesday that the program has been a success in New Hampshire.

“It’s taking a public health approach,” he said. “It’s fulfilled our mission, and that is improving the health of the people – not only of the people we’re serving.”

In today’s medical system, charity care costs typically get shifted onto people paying insurance premiums, which helps drive those premiums up.

“We’re reducing the cost shifting that occurs and getting people into preventative care,” he said. Under the scenario, everyone benefits because overall health increases.

Dumont said Healthlink is also beneficial in that it teaches those who have inadequately accessed health care how to be smart consumers, how to take better care of themselves, and how to use the system more effectively.

Anthem’s positive view toward the program is reflected in a commitment it has made to Franklin Memorial Hospital in Farmington to help with its fledgling program, called Health Access.

Franklin Memorial has already been awarded a $281,240 grant from the Robert Wood Johnson Foundation for the program’s first three years of operation.

Although details are still being worked out, the insurer will donate about $100,000 in services to the hospital this year. And, Anthem is open to helping other communities with similar projects, Dumont said.

Swanson has been consulting with Maine Health in Portland, which is working on a pilot project to close insurance gaps in Cumberland, Kennebec and Lincoln counties. The program is an expansion of MaineGeneral Medical Center’s year-old MATCH pilot program.

Maine Health received a $150,000 grant from the Robert Wood Johnson Foundation to help run the pilot. It also has $233,000 from internal and foundation sources and $25,000 from MaineGeneral Health in Augusta and Waterville.