Insurance mandates aside, organization still busy filling gap in healthcare access

By John Townes

Berkshire Trade & Commerce

Much has changed in the decade since Volunteers in Medicine (VIM) Berkshires was established in Great Barrington to provide free healthcare services to area residents who are uninsured or underinsured. First, in 2006, Massachusetts initiated its statewide health reform policy, the Massachusetts Health Care Law (Commonwealth Care), which mandated health insurance and established new systems to provide coverage for those who could not afford it from the private market. Then the federal government passed the Patient Protection and Affordable Care Act (ACA) in 2010, which was closely modeled on Massachusetts’ law.

While both state and federal initiatives have made progress in reducing the ranks of uninsured or underinsured residents, the role played by VIM Berkshires remains as vital – and necessary – as when it was launched in 2004, according to Arthur Peisner, chairman of the nonprofit organization’s board of trustees.

“The pool of people in the category of uninsured or underinsured may be smaller, but there is still  gap, and that is not likely to change in the foreseeable future,” said Peisner, who estimated that as many of 20 percent of the population are without insurance for at least part of the year. “We’re here to help fill that gap.”

He explained that, while both the state and federal versions of healthcare reform have provided increased access to insurance and coverage, there continue to be many people who lack insurance, or have inadequate coverage, for a variety of reasons.

The profile of the populations served by VIM is diverse. It includes working people and entrepreneurs, as well as those who are unemployed. There are people who do not have coverage because they don’t qualify for subsidized coverage but cannot afford private market insurance.

There are also those exempted from the state and federal healthcare mandates due to income and other circumstances.

In another category are people who are temporarily without coverage because of a change in their employment, or who are waiting for coverage applications to be processed, or are in transition for other reasons. “They may have had coverage but lost it, or they are between different insurance programs, and their new coverage hasn’t started yet,” Peisner said.

It also includes uninsured people who have moved to Massachusetts from other states.

Another segment of the population without coverage is the increasing population of immigrants from other countries who move to the area, including those who are here legally but have not yet obtained insurance, or those who are undocumented and are not here legally.

VIM (413-528-4014 or vimberkshires. org) operates from its offices and clinic at 777 Main St., Suite 4 in Great Barrington. It includes three exam rooms and two dental rooms.

Volunteer driven
As its name implies, VIM is based on the concept of volunteerism. Practicing or retired medical professionals provide totally free care for those who meet its eligibility requirements.

The organization serves patients throughout Berkshire County and in adjacent communities in New York and Connecticut.

VIM’s services include primary care, optometry, mental health and dental services, acupuncture and nutritional counseling.

These are provided by approximately 40 clinical volunteers, including physicians, nurses, dentists, optometrists, medical assistants, mental health counsellors and other healthcare professionals. Other volunteers provide various nonmedical support services, such as office help and business expertise.

In addition, VIM has arrangements with as many as 50 other outside providers for more specialized care on a referral basis.

VIM also has a partnership with Berkshire Health Systems (BHS), which provides it with eligibility screening and processing services. BHS also provides access to diagnostic tests and other medical services. It also has affiliations with other social service and medical organizations, including Community Health Programs, among others.

The organization does have a paid staff of six full-time equivalents, including a nurse practitioner, clinical care and dental coordinators, and an office manager.

Peisner said the volunteers work on different levels. Some provide assistance on a very part-time or occasional basis and others work on a more frequent basis. The volunteers include currently practicing professionals, as well as those who have retired.

“The degree of participation among volunteers varies,” said Peisner, who is retired from a business career and fills his role at VIM as a volunteer. “Some do a half-day a month, and others come in more
regularly on a weekly basis. Physicians also provide care through their own practices when appropriate.”

The basic criteria for eligibility for care are that a person lives in Berkshire County or adjacent areas, is between age 19 and 64, is without insurance, and has an annual income of less than 300 percent of the federal poverty level (i.e., under $35,000 for one person, or $70,000 for a family of four).

In some instances, patients who have some insurance but are not covered for specific needs may also be eligible for VIM’s services.

All contacts, including intake and treatment, are conducted on a confidential basis, and patient information is not shared. While patients can request and receive assistance in finding and applying for coverage, that is not required.

Patients are treated on a variety of levels, said Peisner. “Some patients come in once for a specific illness or treatment,” he noted, “while for others we are their primary medical home’ and a source of regular care.”

On average, VIM serves an between 650 and 700 unique patients a year, with a total number of visits between 2,500 and 3,000. Peisner noted that there is a particularly strong demand for dental services. “There is a real need for that, because many people lack dental insurance,” he said.

Peisner said they make an effort to treat all patients who come to VIM and who meet the basic criteria.

“We try not to turn anyone away, but our ability depends on the resources available at any given time,” he said. “We have to prioritize, and a person with a non-acute condition may have to wait for three to six weeks for an appointment. But we try to make sure that everyone who qualifies receives care.”

Peisner noted that the ability to meet demand for services is influenced by the fluctuating – and, to a certain degree, unpredictable – level of volunteer commitment at the organization.

“Our capacity rises or falls based on the number of volunteers we have at any given time,” he said. “Little changes make a big difference. Adding one volunteer who puts in four hours a week, for example, increases our capacity substantially.”

VIM has an annual budget of $550,000. Peisner said it receives about 15 percent of that through foundation grants, and the rest is covered by private donations from individuals and businesses, and proceeds from benefit events.

For example, the organization recently marked its 10th anniversary at its annual fund-raiser at Butternut ski area in Great Barrington on Aug. 21. The gala event featured a carnival theme with dinner, entertainment and dancing and an auction.

In-kind donations of supplies and equipment, as well as the volunteer services, also offset the cost significantly, according to Peisner. He noted, for example, that the cumulative value of contributed clinical services recently surpassed $3 million, at a current rate of about $400,000 per year.

Followed national model VIM Berkshires was started as a result of conversations in 2003 among several
friends who were second-home owners and had moved to the Berkshires.

“They started discussing healthcare in the Berkshires, and decided there was a need for this type of service,” said Peisner, who has been involved in the organization since its early days. “They started talking to medical professionals and recruited others in the community, and it grew from that.”

In looking for a model, they discovered Volunteers in Medicine, a national organization that was founded in South Carolina and is dedicated to promoting the formation of free community medical clinics. Once the organizing effort was underway, the VIM Berkshires clinic was established quickly,
and it began to serve patients in 2004.

As with other affiliates of VIM, the local organization is completely independent. “The purpose of the national organization is primarily to provide expertise and support for local efforts to open free clinics,” said Peisner, who estimated that there are approximately 100 clinics based on the VIM
model nationally. “But otherwise, they all operate on their own.”

Looking ahead, Peisner said VIM is currently developing a new strategic plan. Among the possibilities are a satellite clinic in Pittsfield, although he emphasized that specific plans have yet to be developed.

“Overall, I don’t expect to see any major changes for the organization,” he said. “There continues to be as much of a need for a free medical clinic as ever, and we’ll be around to meet that need.”

“The pool of people in the category of uninsured or underinsured may be smaller, but there is still a gap, and that is not likely to change in the foreseeable future.”

October 2014 Berkshire Trade & Commerce