Comprehensive Community Health Models

Muskegon Community Health Project

Muskegon County, Michigan (population 172,000) has a comprehensive community health model that includes a community owned health plan for small businesses, an oral health and vision programs for children, diabetes and chronic condition management programs, healthy lifestyle promotion, and many other initiatives aimed at improving the overall health of the community.

The community owned health plan, called Access Health, targets the working uninsured by offering health insurance to small businesses. Employers, employees, and health care providers designed a benefit package that offered an appropriate balance between services and cost. Muskegon County then solicited bids from HMOs, but none felt they could offer the benefit package at the proposed price. The county formed a non-profit organization to deal with providers directly.

Program financing is a “three-way shared buy-in”, or “three-share”, model. Employers and employees each contribute 30 percent of the cost of premiums ($46 per month each in 2003). The community provides the remaining 40 percent through a combination of Medicaid funds (Disproportionate Share Hospital funding), local government funds, and foundation grants. Providers also donate 10 percent of fees back to the program.

To be eligible, employers must pay a median wage of $11.50 or less (in 2003), and must not have offered health insurance in the past year. This is problematic in that it favors employers who have not provided insurance over those who have. Access Health planners report that they have not heard complaints from ineligible businesses.

Access Health has been in place since 1999. In 2003 there were 1,500 enrollees in 400 businesses. Participants are reporting high satisfaction with the program.

Alameda Alliance for Health

The Alameda Alliance for Health is a not-for-profit managed care program in Alameda County, California. It has offers two programs: Alliance Family Care, which provides coverage to low-income families on a sliding scale basis, regardless of immigration status; and Alliance Group Care, which is a subsidized health benefits package for in-home supportive services workers.

The Alliance was created to try to address disparities in access to health care for Alameda’s 167,000 low-income, uninsured residents. Many of the uninsured immigrants in the county have in their household at least one undocumented immigrant who is not eligible for MediCal or other publicly funded coverage. The county also has about 7000 in-home workers who do not have access to employer based health coverage.

Alliance Family Care is financed primarily with private money, with additional grant money from the California tobacco settlement. Alliance Group Care is financed with modest premiums ($8 per month in 2003 and $5 co-pays), county social service funds, and federal and state matching funds.

The two programs cover nearly 10,000 people. Since their inception the county has had higher use of preventative services in the county, higher child immunization rates, and higher rates of screening for diabetes.

More information:

• Muskegon Community Health Project
• Alameda Alliance for Health
• The Center for Health Care Strategies wrote an article about the Alameda Alliance for Health’s effort against asthma in February, 2005.
• Community-Based Health Coverage Programs: Models and Lessons, from the W.K. Kellogg Foundation.
• Measuring the Return on a Community’s Investment (ROIC) in Health Care Resulting from Providing Access to Affordable Health Coverage, by David Rogoff, July 2003, a publication of the Community Health Leadership Network.
• Community Benefits: The Need for Action, An Opportunity for Health Care Change. A Workbook for Grassroots Leaders and Community Organizations, a publication of the Robert Wood Johnson Foundation’s Access Project
• The Civic Renewal Project features writings on Health. Of particular interest is Health as a Civic Question, prepared for the American Civic Forum, November 1994.