Community insurance co-ops, medical homes offer models for reform

Communities with nonprofit health insurance co-ops or a system of patients having "medical homes' could be useful models in a national health care overhaul.

The United Agricultural Benefit Trust, is "cooperative based in Irvine that provides insurance to about 15,000 Californians and Arizonans mostly working in agriculture," The Los Angeles Times reports. The small co-op "has found itself in the national spotlight as a model for a proposed co-op option consumers could consider along with private insurers." The Trust "works like a commercial insurer, negotiating rates with a network of doctors and hospitals, but it is owned by its members." Proponents of the model "say co-ops offer better service and are cheaper because they don't have to turn a profit. But critics say co-ops, which are not as tightly regulated as other insurance providers, are susceptible to insolvency and would not work on a large scale" (Hennigan and Linthicum, 8/6).

The "medical home" model has been cited as a way to "reinvent primary care medicine and reward doctors who practice preventive care," NPR reports. Dr. Jay Fathi, director of primary care at the Swedish Medical Center in Seattle," says, "under the current health care system, doctors 'see as many patients as you humanly can in a day and charge the insurance company as much as you can per patient.'" But in a medical home, doctors "see fewer patients in a day and focus on keeping them healthy — even bonding with them — and in return," are paid more. Patients who have no insurance can pay a flat monthly fee at the Seattle clinic, which covers everything that can be done in this office, including most basic tests. ... Being accessible during off hours, via phone or e-mail, may also reduce the number of emergency room visits. If it does, it'll save money for the insurance companies, so they'll pay doctors a bonus the following year. Insurers will also pay bonuses for keeping patients healthy" (Seinfeld, 8/5).