street roots
7
Jan. 20, 2012
Patient Physician Cooperative seeks to remodel health care
BY DEVAN SCHWARTZ
your visit,” McCormick adds. “PPC attracts
the kind of providers who want a connection
n Nov. 19, demonstrators rallied in
with their patients.”
Pioneer Courthouse Square calling
Naturopathic Doctor Leslie Nicholas
for health care reform and coverage
serves as one such primary care provider.
for all. Speakers stepped to the microphone
“The co-op is a beautiful thing,” she says.
and called out “I’m mad as hell because...”
“There’s no issues with pre-existing
The crowd then responded to their
illnesses. You get to choose your primary
narratives of medical inequity with a chorus
care provider. It’s a relationship.”
of “unacceptable!”
Nicholas, also the medical director at
A desire for affordable, reliable medical
Mercy and Wisdom Healing Center and the
care united those in attendance - a
attending physician at Northwest College of
universal desire for a universal solution. The Natural Medicine, saw a need for the co-op
rally was supported by the Patient Physician since the beginning.
Cooperatives (PPC), a nonprofit, insurance-
“My question is: why is everything so
free model of health care in Portland.
expensive? Why not do things at cost for
Modeled after chapters in North Carolina
what’s really being provided? I just wonder
and Houston, Texas, the local PPC was
if medical insurances aren’t to blame for the
founded last spring.
high cost of medical care.”
“Portland is very comfortable with the
Nicholas aims her critique also at the
idea of a co-op,” says Tony McCormick, a
Oregon Health Plan. “It’s really good in
medical software writer who founded the
theory, taking Medicaid dollars and figuring
Portland PPC. Compared to traditional
out who should have that money. But only
insurance companies, the PPC also
so many people can get on the plan. And it’s
emphasizes alternative medicine
a lot of finagling to make it work for the
practitioners, a seemingly perfect fit in
patient.”
naturopathic Portland.
The Oregon Health Plan, running since
“How it works is quite simple,” says
1994, is the state’s Medicaid program and
McCormick. “An individual pays 15 dollars a was developed jointly by Gov. John
month for co-op membership. This is
Kitzhaber and Dr. Ralph Crenshaw.
considered Plan A.”
The organization bills itself as ideal for
Plan A provides access to non primary-
people who do not qualify for free health
care specialists, a pharmacy discount card
care through Medicaid or assistance
and co-op advocacy for finding urgent and
programs such as the Oregon Health Plan;
catastrophic care.
people who can pay a for basic health care
Plan B is for members who want to
but can’t afford health insurance. This
choose a primary care provider. Monthly
includes people with lower pay, the
fees range from $22 to $77, depending on
unemployed, the self-employed, or part-time
employees or persons who work for small
the provider, and the shopping list of
businesses who cannot offer health benefits,
services are listed on the organization’s
the organization claims.
Web site. Each provider offers a number of
While the cooperatives in North Carolina
no co-pay visits, encouraging preventative
and Texas include many medical doctors,
care.
“When you see your provider through
Kirstin Carr is the first M.D. serving in
Portland’s chapter. Carr was attracted to the
PPC, you will see them for the entirety of
S T A F F W R IT E R
O
CASUALTY, fro m page 1
in support of the ban. “It’s bad policy,”
Oliver says. “The data is in, in terms of the
effect [of clinics].”
Outside In will lose around $6,250 in
federal funding because of the ban. Oliver
says the inability for local clinics to apply for
federal support puts more pressure on local
governments to fund the clinics. “Local
money is more critical than ever,” Oliver
says.
The city is early in the 2012-13 budget
cycle, with each department asked to
present budget cut packages of between 4
and 8 percent. Outside In’s funding is a
special appropriation, which are due until
the end of January. The mayor, who
included the funding last year as a special
appropriation, will not be presenting his
budget until later in April.
The threat to funding is coming at a time
when Multnomah County’s four clinics and
Outside In’s exchange program are
experiencing record levels in both the
number of individuals coming to the clinics
and the number of syringes exchanged.
Toevs says the number of needles
exchanged at the five clinics has increased,
on average, by 15 percent each year since
2008. In 2011, a little over 1.5 million
needles were exchanged at the clinic’s four
sites and Outside In.
Toevs attributes the rise in numbers to
the increasingly popularity of heroin among
young people. She also says that the
recession may drive people who usually buy
syringes at a pharmacy to needle
exchanges, where they can get clean
needles for free.
Public health officials tout the programs
as an effective and proven method of
reducing the spread of infectious diseases
among injection drug users, particularly
HIV, by getting drug users to use clean
needles and not share needles with other
people. According to the Centers for
Disease Control and Prevention, 36 percent
of HIV infections are the result of injection
drug use.
“It’s ridiculous,” said Michael Kaplan,
executive director of Cascade AIDS Project.
“At a time when we just got the ban
removed, when we know that access to
clean needles makes a difference in HIV
co-op’s affordability for patients, and its
ability to sidestep pre-existing conditions
and byzantine insurance coverage networks.
“Going forward, as the co-op grows, I’m
excited by the possibility of streamlining
staff, vaccines and overhead costs that
would make my ability to see patients even
better,” Carr says.
Carr says the co-op couples well with
catastrophic insurance coverage. This way,
patients can see primary care providers
with few hurdles and still have peace of
mind were they to receive a catastrophic
disease diagnosis, such as cancer.
“Being part of a system that explains your
options can be very helpful,” says Carr.
“The co-op advocates for its members and
helps them find their proper level of
coverage.”
As with any organization, it’s important to
bear in mind their financial picture. Tony
McCormick says the PPC gets 15 dollars
per member each month for member
administration, support and provider
marketing. Three to five dollars of that goes
the to 501(c)3 charity, he says, and PPC
keeps 1 percent of the provider fees for
administration. The rest goes directly to
care givers.”
One objective in the organization’s
development is seeking recognition from
the federal government to qualify for 2014’s
personal mandate providership, as outlined
in the Patient Protection and Affordable
Care Act (HR 3590).
“The Patient Physician Cooperative has
been an easy thing to get started,”
McCormick said. “And I think it will grow
dramatically.”
More information about the Patient
Physician Cooperatives can be fo u n d at
www.patientphysiciancoop.com.
P H O T O B Y K R IS T IN A W R IG H T
Used needles for disposal.
prevention, when we know that it does not
increase substance abuse, and despite what
surgeon generals and people throughout
government have argued for many years, the
House has gone — counter to good public
health — and said, ‘We’re not going to fund
access to clean needles.’”
Toevs says needle exchange clinics can
also be the gateway to drug treatment and
other services that drug users would not
normally be willing to think of accessing.
“We’re pretty neutral in terms of meeting
people where they’re at,” Toevs says. “If
they are interested in reducing their use or
exploring or engaging in treatment, we are
like a first step to getting them into the
system.”
The clinics Multnomah County operates
also provides information and teaches
individuals about how to identify an
overdose and what to do, as well as how to
prevent overdoses, abscesses, and other
health-related risks.
Oliver says Outside In’s clinic frequently
sees individuals who do not use any other
type of social services, but clinic staffers are
typically successful at convincing individuals
to go to Outside In’s medical clinic if they
have abscesses or other basic, preventable,
and treatable health needs. “It helps keep
them safe,” she says.