In 2018, the Access to Veterinary Care Coalition issued a report stating millions of low-income families could not afford veterinary care for their pets, constituting what the coalition described as “arguably the most significant animal welfare crisis affecting owned pets in the United States.”
The report ultimately led to AlignCare, a model for improving access to veterinary care and addressing the needs of people and their pets through a network of veterinarians, animal welfare organizations, veterinary social workers, and local resources.
AlignCare is the work of the Program for Pet Health Equity, established at the University of Tennessee in Knoxville to address the problems identified in the AVCC report. During a virtual summit held Oct. 11-12, PPHE staff presented preliminary findings from the yearlong pilot phase of AlignCare in several communities across the country.
“We got to AlignCare through three years of research and development into a health care system intended to reach underserved families, knowing that finances would be the primary barrier,” Dr. Michael Blackwell told JAVMA News following the summit. Dr. Blackwell is director of the PPHE and a former assistant U.S. surgeon general.
Access to veterinary care can’t be improved without first considering the reality of the pet owners who face barriers, he said.
“They are largely defined by low socioeconomics. They are the working poor,” Dr. Blackwell said. “We understand the barriers they face are a result of their low socioeconomic status—and that’s more than lack of money. It can also be a lack of transportation or a language barrier.”
Nuts and bolts
According to the AVMA’s 2021 survey of pet and pet owner demographics (data not yet published), about 24% of dog owners and 35% of cat owners don’t bring their dogs or cats to see a veterinarian at least once a year. The primary reasons given relate to the perceived value of that care and affordability. Less than 10% of respondents said it was because of inconvenience or a veterinarian not being available to them. This means that, of the roughly 150 million cats and dogs in the U.S., over 37 million are not getting regular veterinary care because of cost. Either their owners cannot afford veterinary care, or they don’t value that care sufficiently to pay what it costs.
AlignCare partners with existing veterinary practices in communities where the need for veterinary services is great.
“We wanted to make it as easy as possible on veterinarians,” said T’ Fisher, PPHE’s director of operations, after the summit. “We know they already have a lot on their plate, so we wanted to make AlignCare just another tool in their toolbox to help members of their community who cannot afford veterinary care for their pet.”
During AlignCare’s pilot phase, which ran March 2020 to June 2021, the participants were 25 practices in nine communities: Spokane, Washington; Reno and Las Vegas in Nevada; Phoenix; Buffalo and Long Island in New York; Asheville and Raleigh in North Carolina; and Knoxville, Tennessee.
“We’re still in the process of analyzing all that data to see where we go from here,” Fisher said.
Shortly after the virtual summit, Maddie’s Fund announced it was awarding $3.4 million to the PPHE to expand AlignCare’s national reach.
To be eligible to receive AlignCare assistance, pet owners must be receiving some means-tested public assistance, such as Medicaid or food stamps.
Just over 1,230 families are currently enrolled in AlignCare, according to Fisher. When they are approved, families receive an email with a list of veterinarians in the community partnered with AlignCare whom they can contact for an appointment.
Clients are responsible for a 20% copay at the time of the visit. The practice invoices AlignCare for the remaining 80%, which is “a little bit different for our veterinary practitioners because they are not used to dealing with third-party payers,” Fisher said.
Most families can cover the copay, but for families that can’t, AlignCare has partnered with local animal welfare organizations able to help cover those costs. Families and pets can continue to benefit from that relationship with the organization, which may also offer free or low-cost vaccinations and neutering, according to Fisher.
Local social service agencies are an essential component of the AlignCare model. They identify eligible families needing veterinary care. They are responsible for introducing the family to AlignCare, screening the family for eligibility, and referring the family to the veterinary social work coordinator for AlignCare enrollment.
Veterinary social workers are key to helping with communication between the family and veterinary practice staff, Fisher explained.
“We can help them (the veterinary practice staff) with that, explaining to a family why a certain procedure costs as much as it does,” she said, “but also we’re there to help veterinary service providers and their staff deal with the stresses of the job.”
Dr. Blackwell hopes AlignCare is the catalyst for what he believes is a much-needed paradigm shift within the delivery of veterinary services. The current system, he said, is largely a cash-based system in which insurance companies—which could greatly help low-income pet owners—play too small a role.
Another component about AlignCare is the language it uses. Its enrollees are identified as “bonded families” in acknowledgment of the reality that most Americans think of their pets as a member of the family.
“These are not animals. These are nonhuman family members,” Dr. Blackwell said. “We’ve got to get away from this animal-centric posture. If we just started to think about ourselves as in the business of providing health care to families, that starts to change a lot about how we see our role and how we talk about what we do.”