Dr. Monique Morriseau, associate medical director at the Marillac Clinic, checks the throat of patient Gaylynn Ruiz. Marillac serves the uninsured and it has seen the number of new patients more than double as more people lose their jobs and health insurance.

Dr. Monique Morriseau, associate medical director at the Marillac Clinic, checks the throat of patient Gaylynn Ruiz. Marillac serves the uninsured and it has seen the number of new patients more than double as more people lose their jobs and health insurance. (Robert D. Tonsing / Colorado Public News)

Grand Junction is heaven for patients with no health insurance, compared to most places in America, at least according to Michael Ervin.

Patients in this Western Slope city pay as little as $7 for a visit to the doctor. They enjoy the benefits of preventive care and ready access to specialists.

Ervin was 55 when he left his job as an advertising account executive for a simpler life and shorter work hours in Grand Junction. He soon found himself with a major illness requiring neurosurgery. Recovery took a year, which cost him his new job.

Then he could no longer afford his $1,000-per-month health insurance premiums.

He considers himself extremely fortunate that he then found the Marillac Clinic, which is part of the network in Grand Junction that is being studied as a model for care, and post-health-care reform.

"It is an incredible, absolutely great situation," said Ervin, now 66. "My care was superb." Most of his office visits cost just $15 to $25, depending on his income at the time.

How it's done

Marillac's main sponsor is the Sisters of Charity of Leavenworth, which also runs St. Mary's Regional Hospital in Grand Junction. The hospital contributes $1.5 million a year to Marillac in cash, space and upkeep, and the Sisters of Charity contributes $845,000. The state of Colorado contributes $1.2 million, although that was cut by $500,000 in 2009 because of budget shortfalls. Other donations total about $300,000, and Marillac officials are hoping to boost that amount to make up for the state shortfall.

Fees collected from patients, ranging from $7 to $50 or more at a time, total $1.5 million a year.

Noticeably absent from that list: federal subsidies for clinics like this, and the federal insurance program for the poor, Medicaid.

In most places, Medicaid patients flood such clinics because they can't find a doctor willing to take its low fees.

The physicians of Grand Junction gladly serve Medicaid patients, however, because the major insurer pools private and government payments and pays the doctors the same for each patient. And that means Marillac needs only serve uninsured people who are not poor enough for Medicaid's low income limits.

It also means Marillac also avoids the mountains of paperwork, required by Medicaid and federal subsidies. That is the secret to its success, said Dr. Steve Hurd, executive director. That ominous paperwork "would impair our ability to deliver services" because it would force doctors to pigeonhole each patient into a Medicaid procedure code.

"We are about relationships and the time it takes to learn who it is we are serving," Hurd said. "We get to know them as a person and learn about their needs, not just their codes."

If a patient arrives at Marillac with a medical problem, a doctor might quickly diagnose that patient needs dental work as well, and perhaps another previously undiagnosed condition. The patient might see three different professionals that day and be signed up for continuing treatment.

"Our goal is to take the time to find out all that is going on with the patient, whether there are emotional issues, whether the children are in trouble," Hurd said.

Not simply altruism

The integrated approach pays off: A study found that Marillac cut hospitalization of its 8,000 patients from 9 percent to 4 percent in five years. Those using the emergency room dropped from 22 percent to 13 percent.

St. Mary's Regional Hospital helps pay for the clinic because it keeps the uninsured out of its emergency room for non-emergencies, saving the hospital millions of dollars annually.