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Project Picks Up Health Costs

Posted on: Tuesday, 11 April 2006, 00:00 CDT

By Holly Auer, The Post and Courier, Charleston, S.C.

Apr. 8--In a parallel universe, Patricia Crites would have spent the last few years without any health insurance, and she'd be thousands of dollars in debt today. She got injured in a car wreck, had her appendix taken out and needed expensive injections to stave off her migraine headaches.

Tri-County Project Care picked up the tab for all but a few hundred dollars worth of co-pays, standing in for the private insurance that most small business like the one she works for can't afford to provide.

"Otherwise, I would have been saddled with some huge medical expenses that I would not have been able to afford," said Crites, a mother of four who works as the office manager at Dock and Marine on Folly Road. "Nobody needs to live their life strapped by medical bills."

Project Care, the health plan that helped some 3,200 of the Charleston area's 100,000 uninsured residents get low-cost health care over the past four years, has launched a three-year pilot program for small business owners. Instead of enrolling individuals as it did since 2002, the program will now contract with business owners to provide health care to their employees.

Crites and about 100 others are expected to be enrolled initially, for a "prepayment" cost of $85 per month per patient. The fee will be split between the business owner and their participating employees. As under the old plan, patients will make co-pays for benefits, including hospital care and doctor's visits.

Patients will have access to a network of physicians -- much like with a traditional HMO -- and hospitals throughout Charleston, Berkeley and Dorchester counties. Since $85 a month per enrollee won't cover all medical expenses for every participant, the program will tap into the cash reserves left over from its first few years, when care was paid for by a $7.5 million grant from the Medical Society of South Carolina and in-kind services from physicians and hospitals.

But that money won't last forever, so the program will next look for government support, said Dr. Casey Fitts, a Charleston surgeon who founded Tri-County Project Care. He estimates that $1,000 per year -- about the same amount South Carolina pays for each Medicaid patient -- would adequately fund the program.

To gain support from legislators, Fitts plans to point to the success of Project Care's pilot program.

Among those who participated, emergency room usage fell, hospital stays decreased and the patients' general health status improved.

Fitts thinks that's due mostly to people having access to a primary care physician who can address their needs -- diabetes, say, or high blood pressure -- before they cause other problems or become severe enough to require expensive inpatient care.

"The cornerstone of what we're doing is looking at the medical home as the entry point for care instead of going to the emergency room," Fitts said.

Small businesses with three to 50 employees are eligible for Tri-County Project Care's new plan. Participants must be between ages 19 and 64, with an income less than or equal to 200 percent of the federal poverty level. Dependent spouses also may enroll by paying the whole $85 out of pocket.

Exempted from coverage are those who have had private insurance coverage within the last six months, or those who are eligible for public programs such as Medicare and Medicaid.

Charlotte Main, who runs Prudential Kapp Lyons Realty on Edisto Island, spent the last nine months searching for a way to provide health insurance to her employees. Few of them, however, would have been able to afford the $500-per-month cost for the policies. The rates would have been even higher when fitting older people or those with pre-existing conditions into the mix.

"I worked with several insurance brokers and finally just gave up," Main said.

Under Project Care, though, she'll be able to get care for three employees in her office, and her husband's business, Main Market, has signed up another two people.

"People just don't understand how hard it is (to go without insurance)," Main said. "This is a true blessing."

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Copyright (c) 2006, The Post and Courier, Charleston, S.C.

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Source: The Post and Courier

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