Portico is a program based in St. Paul, MN that works to help low-income uninsured people in two ways.  First, they do outreach into these communities to see who is eligible for publicly funded healthcare coverage and they help them apply.  For those who aren’t eligible they offer a free program that provides primary care.  This component is about the second service, the first service is covered in “HMO Funded Outreach to the Uncovered but Eligible for Government Programs:  Portico Healthnet I.”

For individuals not eligible for one of Minnesota's public healthcare programs, Portico Healthnet sees if they qualify for the Portico Healthnet Program which offers access to a number of health care services through a network of providers.  This service is mainly funded by large providers in the region and provides the following services at no or low cost: 

Portico Healthnet employees steer patients the most appropriate, usually lower cost option, when they need services.

Providers make grants to Portico Healthnet to pay for this program.  Providers “get their money back” in a number of ways.  First, approximately 33% of funds go back to the donors by using doctors in their networks for pay.  The rest of the money is used to buy medicines, to pay for specialty care outside the provider’s network, etc.

Second, participants in the program have one third fewer emergency room visits and 27% less hospital visits than if they weren’t in the program.  Most of these visits would have just been written off as charity care or been otherwise uncollectible for the provider.  Finally, Portico Healthnet’s efforts to enroll eligible people in publicly funded healthcare leads to providers getting paid to provide care to these people who otherwise wouldn’t have been able to pay their bills.  This year they expect to enroll 2,500 people in the government program and 1,200 in their program.

Portico Healthnet’s research shows that for every dollar they give to Portico Healthnet they get at least a dollar back in direct payments and savings.

Deb Holmgren, the Executive Director, stresses the importance of the social workers and translators who help individuals reach out to doctors in more appropriate settings than the emergency room.

More importantly than the financial savings, perhaps, is the fact that this population now has access to better healthcare helping providers achieve their mission of providing quality and appropriate healthcare.

Business Model: 

Providers grant money to a non-profit to help individuals access lower cost primary care in settings more appropriate than the emergency room.  They “get their money back” in saved charity care, direct payments to doctors within their network, and by enrolling eligible individuals in public healthcare.

Assumptions:

• Getting the uninsured to use primary care outside the emergency room saves money.
• A non-profit can be a better intermediary between providers and parts of their community.

• Optimizing intermediation between patients and providers