West Virginia passes bill to create preventive care pilot program

The state medical association supported the bill, which also would raise eligibility for the state's SCHIP.

By Mike Norbut — Posted April 10, 2006

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West Virginia legislators unanimously approved a bill to create a pilot program tailored after a physician's retainer practice model.

The bill, which West Virginia Gov. Joe Manchin is expected to sign in the coming weeks, completed the circle for Vic Wood, DO, who specializes in ambulatory medicine and runs Doctors Care, a clinic in Wheeling, W.Va.

In 2004, Dr. Wood started offering unlimited appointments and x-ray services to patients in typical retainer medicine style and directed patients to an insurance company for an individual policy covering services such as hospitalization and specialty visits. But the West Virginia Insurance Commission ordered Dr. Wood to stop offering the service, so it could investigate whether he was selling insurance in violation of state law. The bill authorizing the pilot program, however, opens the door again for Dr. Wood's innovation.

The program created by the bill in many ways follows the structure of Dr. Wood's model. It includes a "preventive care plan" component, where subscribing patients can receive primary care appointments, x-rays and lab tests for one monthly fee. It also calls for an "individual limited benefits plan" component, where families could pay as little as $100 per month for portable insurance that also covers mostly primary care services.

The bill includes a provision to raise eligibility for the state's SCHIP, or children's health insurance program, from 200% to 300% of the federal poverty level, which would grant insurance coverage for most children in the state.

While Dr. Wood points to his model as a way for anyone to save dramatically on health care, legislators see it as a way to provide a safety net for the state's uninsured. Both bill provisions are geared to help the same population, said state Sen. Evan Jenkins, executive director of the West Virginia State Medical Assn. Catastrophic insurance plans are permitted under different legislation, he said.

"This is intended to give them options," said Jenkins. "The same person would not use both, but they would target people from the same category."

The three-year program, slated to start no later than July 2007, was the result of work by the state's Affordable Insurance Workgroup, a committee in which Dr. Wood took part.

He also provided a description of his model to legislators through committee hearing testimony, which drew comparisons to coal mining camps years ago, when miners would pay a set fee for care from the company's physician.

The bill's passage is "a huge victory for doctors and patients," Dr. Wood said. "It's a way to wrestle health care away from the insurance companies and put it in the hands of patients. That's why insurance companies were fighting it."

The state medical association also supported the bill, especially after it was strengthened for physicians during the legislative session.

Jenkins said he added a provision to the bill stipulating doctors who contract with the new plans would be reimbursed at their current contracted network rate. In the past, bills have mandated that only commercial companies that offer similar insurance plans reimburse at the equivalent of a government pay rate, such as Medicaid, he said.

Dr. Wood expects his clinic to be one of eight sites accepted under the pilot program. The bill allows each clinic involved in the program to include two satellite offices, for a total of 24 pilot locations.

"In addition to helping ensure that West Virginians who are currently without any health care coverage get critical primary and preventive health services, these two bold programs also are very cost-effective and require no state subsidies, demonstrating the positive impact that can be achieved when government and the private sector work together," Manchin wrote in a recent weekly communication column.

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