Two Philly school-based clinics seeking insurance payments for effective, low-cost care

The ideas behind two school-based health clinics in Philadelphia are gaining wider attention — and support from at least one city politician.

A group of nonprofit agencies partly funds the clinics at Pan American Academy Charter School and Belmont Charter School. Each site has a dedicated nurse practitioner, a step up from the level of care that most school nurses can provide.

After two years of success — better attendance and fewer emergency room visits — project leaders want insurance companies to reimburse the school clinics when kids come in for a visit.

Many children at Pan American and Belmont are eligible for Medicaid. Right now, however, a visit to the school health clinics is not covered by insurance.

Molly Porth, program and development coordinator at Education Plus Inc., says the health clinics have benefited  especially children with chronic conditions. About one-third of the kids at Belmont and Pan American have asthma, she said. The average is about 23 percent citywide.

“When they do have issues, instead of leaving, going home, they are able to stay in school and work with the (nurse practitioners) in the office,” Porth said. “And it’s huge for the parents not to have to leave work, pick up kids that are suffering from stomachaches or cuts on the playground.”

Easing the need for expensive ER care

Tine Hansen-Turton is chief strategy officer for Public Health Management Corporation and CEO of National Nursing Centers Consortium, which back the health clinics.

“The traditional student would have ended up in an emergency room, where the average cost starts at $350,” Hansen-Turton said. “So the fact that we are alleviating the burden on the emergency room, we think that’s a good thing.”

Hansen-Turton and her team are now shopping those cost savings — and their success story — to insurance companies, especially those with a large number of Medicaid members.

Under the proposal, insurers would pay the schools $60 for each visit to the school clinic.

In making the case for reimbursement, Hansen-Turton described the schools and their care needs.

“Located in the ZIP codes 19133 and 19104 respectively, the neighborhoods in which the schools are located face greater rates of poverty and health challenges than citywide averages,” she said.

The plan to seek reimbursement and make the clinics “sustainable” –- less reliant on year-to-year charitable funding — was solidified this spring during a roundtable at the Philadelphia Social Innovation’s Lab at University of Pennsylvania Fels Institute.

Soon after that meeting, Tom Knox contacted Hansen-Turton’s team at PHMC to discuss how the model could apply to the entire Philadelphia School District. Last month, Knox began talking with the media about his ideas.

Helping to coordinate child’s care

Dale Ayton, nurse practitioner at Belmont School, says her school-based clinic facilitates “holistic” care and is a hub for kids who need care coordination.

“The school communicates with primary-care providers, teachers, parents,” Ayton said.

Most of Ayton’s students have an outside primary-care doctor.

“However is if the parent can’t get to the doctor, or relies on the emergency room because of transportation or scheduling problems, the nurse practitioner can step in with the written consent of the parent,” Ayton said. “For instance ringworm, burns, wound care, X-rays.”

“The corresponding act to that would be to contact the primary-care provider and let them know what’s going on,” she said.

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Disclosure: The Public Health Management Corporation supports WHYY’s health desk.