Filling a Great Public Need with a Private Practice Model

OLYMPUS DIGITAL CAMERASean Harrison is the co-founder and Executive Director of Alliance Medical Ministry, a faith-led non-profit organization whose mission is to serve working uninsured adults of Wake County.

Alliance Medical Ministry opened in 2003 and began offering a primary care clinic to patients by operating on a private practice model.  The inspiration for this program came from witnessing a similar one in action.

“A friend of mine who’s an EMT doctor in Cary, Dr. Charlie Mann, saw a program at a physician conference,” explains Harrison.“It was in Memphis, Tennessee, called the Church Health Center.  Basically, it was a clinic that provided primary care and dental care.  They actually had kind of an innovative insurance type of program for very low income people, and it started out of St. Mark’s United Methodist in Memphis and has just grown and become very successful in what is a real poor city.”

Dr. Mann and Harrison liked the model and used it as a jumping-off place to start their own program for low-income, uninsured people in the Triangle area.  Working together with Charles Mann, Jack Stone, David Wilson, and many volunteers and early staff, theirdream became a reality.

The clinic began operating in 2003 at its original location on New Bern Avenue and later relocated to a fully renovated 18,000 square foot facility in 2008.  Today, Alliance Medical Ministry provides a primary care medical home to more than 8,000 low-income adults, with 98% having an annual household income of less than 200% of the Federal Poverty Guidelines.The clinic has around twenty-five paid staff members and close to two hundred active volunteers.

Harrison comes from a diverse background with over fifteen years of management experience in entrepreneurial start-ups and Fortune 500 organizations. He says his motivation to help start Alliance Medical Ministry was the call to fill a great public need, as well as meet both personal and business goals.

“I had a successful software company that I’d sold and I wanted to do something philanthropically other than just writing a check, and I think part of it is because I have an entrepreneurial background and interest, and so I felt like I had something that could aid a new non-profit.  Also, in fundraising, one of the key things is that, ultimately, to move the needle you have to do “the ask,” and Charlie made the ask to me.  He said, ‘I want to get involved and I want to do this, and he brought some relevant medical skills to the table, and I had skills from a business start-up perspective, and from just a financial perspective I was willing to invest.”

Harrison says that the biggest uninsured gap is not the very young, nor the very old, but adults ages 18 to 64 that work and either are not offered insurance, or, if it’s offered, is not affordable.  He explains that serving these kinds of patients, especially those with chronic conditions like diabetes, hypertension and asthma, is the main service of Alliance Medical Ministry.

“We would treat things like strep throat and kind of minor acute care things, but the real benefit was to keep those patients that had chronic diseases out of the emergency rooms where you get great care but it’s not a medical home.  We put them in an environment where they can see the same provider over and over again to help them get those diseases under control and continue to be productive in our community.”

Alliance Medical Ministry is not a free clinic, and Harrison says that was never the plan. All patients pay for a portion of their care, which is typically fifteen dollars and that includes time with a physician, lab testing and most medications.

“The idea is that our patients contribute, even in a way that you or I may not even think is all that significant, but it is for someone only making about eight bucks an hour and that’s got a family,” he explains.  It also means that they’re investing some of their dollars in their care and they don’t view it as free. By making even a small co-payment like this, it does make them a financial partner in their care.”

Harrison says the clinic does get some financial help from the state, with an active grant from the Department of Rural Health and Community Care.  Other help comes from individuals, congregations and foundations such as the Kate B. Reynolds Charitable Trust, Duke Endowment and Blue Cross Foundation.  Most importantly, local hospitals like WakeMed and Rex support Alliance Medical Ministry through both financial contributions and donated lab services. Last summer the clinic was also chosen as the charity partner for Band Together, a musical event which raises money for non-profits.

It’s important to Harrison that his clinic fights any preconceived ideas that go along with financially assisted healthcare.

“People, when they hear about a clinic or uninsured place like Alliance Medical Ministry, I think their mental image is kind of a dingy building that’s run down and is on the fringes and has some guy that’s retired maybe.  Or it’s not the sharpest guy any more, but he’s trying to help out and it’s a Band-Aid on a much bigger problem.”

Harrison explains that the intent is to give patients the dignity of receiving excellent healthcare in a well-appointed facility and to have the same quality experience as an insured patient.

Additionally, he points out that the medical providers at Alliance Medical Ministry are all Board Certified and could be working in more lucrative roles elsewhere if they wished.

“We pay them a competitive wage, but they could make more money by going elsewhere,” he says.  “They’re here because they like being here.  They like the population we serve, and they like the way we operate.”

Harrison explains that the “ministry” part of Alliance Medical Ministry is broad in scope.  The clinic gets financial support from synagogues and also collaborates with the Mariam Clinic, which grew out of the Muslim community.

“Our logo has a cross and a dove, so we come from the Christian tradition, but it’s not an evangelical mission,”says Harrison.  “Our mission is to say that we feel called to serve and so, we’re just trying to reflect that, and putting our faith to action if you will.  That’s what we do.”

Harrison says the biggest challenge Alliance Medical Ministry faces is that of all non-profits: sustainability.  While the objective of a business is to make money, he points out that the objective of a non-profit is to deliver some social service and that these two approaches must be balanced.

“At the end of the day, non-profits, to be successful, have to run like a business in the sense that you have to be cash flow positive and deliver a good return to the supporters and stake holders, whatever that return might look like,” he says.  “Our challenge, and that of all non-profits, is sustaining the financial model and making it work in a time and environment where there’s less philanthropic money going around. I happen to think that some hybrid type of model where you’re running the mission of a nonprofit is still a needed mission, but you adopt more business-like attributes to run it well.”

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