Western New Yorkers without health insurance can now get discounted health services at five regional hospitals and urgent-care centers throughout the region that participate in a new electronic network.
The long-awaited program started by electronic-transactions entrepreneur Joseph Wolfson came to life last week with the launch of low-cost basic services at each health-care facility, and a new identification card to link them together.
Through the new Health Transaction Network, consumers can now access routine physical examinations, eye care, dental exams, mammograms, blood pressure screenings, prescription drugs and other services that might otherwise be out of their reach. Services are provided on a pay-as-you-go basis, with no billing or insurance.
The initiative, under development for sixteen months since its announcement, is aimed at uninsured or underinsured Western New Yorkers, who can't afford coverage for even primary medical care. The goal is to enable them to get wellness services so they can prevent more serious conditions.
"We're really focusing on that. If people do that, they don't end up with a lot of costly care later," Wolfson said. "If you're a young mom without the money, this is an opportunity to take your young baby to the pediatrician. And it's affordable."
So far, participating hospitals include TLC Health Network's Lake Shore Health Center in Irving and Tri-County Memorial Hospital in Gowanda, Niagara Falls Memorial Medical Center, Medina Memorial Health Care System and MedFirst Urgent Care in Amherst. Sharma Family Medicine and Lake Shore Eyecare, both in Irving, are also signed on. In all, the institutions have 21 locations.
Additionally, Bertrand Chaffee, Brooks Memorial and Western New York ImmediateCare are expected to join shortly, along with five pediatric practices, one dental practice and an occupational health group.
Officials are also talking to most other area hospitals and practices -- including Catholic Health System, Erie County Medical Center, Buffalo Medical Group and Lifetime Health Medical Group -- to sign them up as well. Only Kaleida Health, the area's biggest hospital system, remains a holdout, Wolfson said.
Costs vary depending on the provider, with a routine physical exam for illness costing $45 at TLC but $62 at Niagara Falls and $90 at MedFirst. A woman's annual physical is $88 to $90, while mammograms are $76 or $85. X-rays are as low as $40 at TLC's sites. Flu vaccines are free at the hospitals, and $15.50 at MedFirst.
TLC also has a $20 dental exam and $40 cleaning, and a $25 basic eye exam and $69 eyeglasses.
The only other cost is $10 to first get the ID card, and $10 a year to renew it. The card can be obtained at any of the hospitals, and is good at any of the facilities. Prices are posted online at www.htnnet.com.
"We are excited about the benefit the new Health Card will provide the under and uninsured citizens of our community," said Kendrick Betham, vice president of marketing and community relations at TLC. "The program will provide individuals without adequate health insurance the ability to address small health problems before they become bigger ones which many times can become a prescription for disaster."
Even consumers with insurance can benefit, Wolfson said, noting that some plans require a consumer to pay a high deductible before major coverage kicks in. Also, not all plans include dental, vision or drug coverage.
The launch of the new system marks the culmination of a five-year odyssey for Wolfson, an ATM industry veteran known for previously launching the MetroTeller and Cartel card networks before shifting gears in 2003. That's when he saw a chance to modernize the health insurance business, which has remained a time-consuming and paper-driven business.
His plans for Health Transaction Network initially called for automating insurance verifications, referrals, and claims processing using "smart cards" with microchips to identify patients at a provider's office, confirm their eligibility for coverage, and begin seeking reimbursement from insurers. But the idea didn't catch on.
The new idea, unveiled in October 2007, bypasses the insurers, and proved attractive to area hospitals, especially in outlying areas. That's because they get paid right away, by cash, check, or credit or debit card. There's no billing or paperwork, and no claims processing, eliminating the delay and administrative costs that typically account for 20 to 30 percent of the cost of a medical transaction.
"This is all cash, on the spot," Wolfson said. "There's no paper. They get paid right away."
Additionally, the providers benefit from increased business, seeing patients that might not normally even come in for treatment. And it could lessen the burden on emergency rooms, as people getting wellness or basic sick care don't need to go to the ER for such treatment.
"Primary and preventative care is the key to reducing healthcare costs," said Joseph A. Ruffolo, CEO of Niagara Falls Memorial. "Hopefully cardholders will now be able to seek primary care providers that will enable them to get the preventative care they deserve."
About 45.7 million Americans were uninsured in 2007, including 8.1 million children, according to the federal government. At least 25 million more are "underinsured," according to the Commonwealth Fund.
"We're in a position now where we can help people," Wolfson said. "This gives people hope."
To join, consumers must go to one of the hospitals or urgent-care sites, where they will receive what looks like a gold credit card, with their photo on the upper right corner.
More importantly, though, the "smart" card features both a magnetic stripe on the back and a microchip in the front. The stripe has the person's network account number, so that their treatments among the various hospitals are linked. The chip will contain a digitized version of the person's fingerprint, encoded when they sign up.
The digital image is used to verify their identity when they obtain services, and is compared against the person's actual fingerprint when they press down on a finger scanner. It can only be read with a special card reader and computer program set up at the respective medical offices, but is not retained.
Besides the basic system, the company also offers "stored-value" small business and gift cards that are "reloadable." A small business that can't afford full insurance premiums for its workers could instead provide a lower-cost catastrophic plan and then give employees the HTN card, with money "loaded" on it every pay period. Stored-value accounts are managed by Lake Shore Savings Bank.
"Many employers are eliminating the coverage as an employee benefit. With the HTN, local businesses are provided with another option," said Niagara Falls Memorial Chief Operating Officer Anthony F. Zito. "It's a win-win for the patients and the hospital."