CARELINK MARKS 20 YEARS OF MAKING AFFORDABLE CARE AVAILABLE TO THOSE IN NEED
The idea 20 years ago was to provide better care to those who couldn’t find affordable health coverage, while being good stewards of University Health System’s finances.
That idea led to the creation of CareLink, a financial assistance program for qualified Bexar County residents — one that has been cited in national journals for its innovative and compassionate approach to providing low-cost healthcare to the uninsured, and praised by those on both sides of the political divide.
University Health System’s CareLink program celebrated its 20th anniversary this year. The program gives low-income families — the vast majority of them headed by working adults — affordable access to a family doctor, specialty and hospital care when needed, preventive care and medications. Members pay for services they use based on family size and income.
“CareLink provided a discipline in the way we provided care to the indigent,” said George B. Hernández Jr., president and chief executive officer of University Health System, who was one of the architects of the program. “People ask, is it insurance? No, it’s not insurance. But people think it’s insurance because of the way we provide care to them.”
CareLink is available to Bexar County residents earning 200 percent or less of the federal poverty level — currently $49,200 a year for a family of four — who don’t qualify for or can’t afford coverage elsewhere.
Throughout its 100-year history, University Health System has offered care to the sick, regardless of their ability to pay. But from its launch in 1997, CareLink created a model that starts with connecting the patient to a nearby medical home. A family doctor manages the patient’s care with the aim of preventing illness and avoiding unnecessary and expensive emergency department visits.
The program created a schedule of benefits and requires that patients contribute a monthly payment for the care they receive according to their ability to pay — even if it’s only a few dollars. And because CareLink documents its patients’ incomes and residency, the program is able to work easily with the pharmaceutical industry to qualify patients for special discount programs, making expensive drugs available to those who need them.
Mark A. Hall, director of health law and policy at Wake Forest University School of Law, who has studied and written about CareLink, wrote in an analysis for the Robert Wood Johnson Foundation: “CareLink has succeeded in providing low-income, uninsured residents good access to a full range of medical services based in primary care medical homes, regardless of citizenship. Impressively, its costs to the county and its hospital system are half that of comprehensive insurance.”
As a result, CareLink has provided a consistent level of care in good economic times and bad. Dr. Roberto Villarreal, senior vice president for research and information management, who oversees the program with executive director Virginia Mika, notes that the number of CareLink members rose from about 40,000 members in 2004 to more than 70,000 at the peak of the Great Recession four years later. It fell again as the economy improved.
With the Affordable Care Act, the number has dropped to about 25,000, with those earning enough to receive subsidies now able to buy insurance on the federal exchange. But because Texas did not expand Medicaid as the law intended, those earning 100 percent or less of the federal poverty level remain uninsured — with CareLink as a vital lifeline.