As a veterinarian working in general practice and emergency medicine, I have seen first-hand the distress of families when their pet is sick or injured and in need of medical care that they cannot afford. Many more families feel the same distress but never walk through the door of the veterinary clinic. These families are often faced with difficult choices: to pay their rent and buy groceries or pay the veterinary bill to treat their pet; to surrender their beloved family member to a shelter or rescue that can provide treatment; or even to euthanize a pet for a treatable condition like parvovirus or pyometra.

Pets are members of the bonded family unit, so these decisions lead to mental and emotional distress for human family members—as well as the vet team who has no way to help. Enter AlignCare, a national program that utilizes a One Health approach to improving access to veterinary care.

Beyond the cash-based approach 

Traditionally, veterinary businesses function on a cash basis. Pets receive care and clients pay for services at the time of the visit. While pet insurance is growing in popularity, pet owners still pay the bill up front and receive reimbursement. Clients without funds readily available have limited options. Third-party financing can support some people, but still leaves many who can’t get financing with few options.

“Vulnerable individuals deserve access to healthcare whether they are human or nonhuman,” said Michael Blackwell, DVM, MPH, director for the Program for Pet Health Equity (PPHE), which developed AlignCare, on Episode 26 of AAHA’s Central Line podcast.

Blackwell noted that, “It is not [the veterinarian’s] problem alone to solve. It is not the problem of animal welfare alone to solve. It’s a societal problem.”

AlignCare seeks to offer a solution by connecting social services, veterinary social workers, and veterinary service providers. “By doing a better job of aligning the resources we have, we can achieve better outcomes,” said Blackwell.

What is AlignCare?

AlignCare is a community-based program that subsidizes the cost of veterinary care for families in need. Qualifying pet families with a sick or injured pet can apply to the program in communities where the program is available. Currently, need is demonstrated by the family being in a government assistance program, such as the Supplemental Nutrition Assistance Program.

Once approved, a family can receive care at a participating veterinary service provider, which includes a network of for-profit and not-for-profit veterinary hospitals. Once approved, they can continue to receive care for a year and reapply in subsequent years. The family pays a 20% copay, and the AlignCare Fund covers the remaining 80% of the bill.

AlignCare does not dictate how a veterinarian practices but encourages the use of an incremental care approach to ensure that funds can be used for as many patients as possible. “Just as we have always done when the client doesn’t have the means to pay for everything we want to do, we modify our patient management,” Blackwell said. “I believe most veterinarians want to help. They’re going to do what they can to make a system work that will help them to reach families that they previously couldn’t reach.”

AlignCare Community in Los Angeles

Jeremy Prupas, VMD, chief veterinarian for the City of Los Angeles, is one of the community leaders in the LA AlignCare community. The program, which has been providing care for pets and their families since March 2022, began with Prupas and his colleagues building connections among rescue groups, community groups, and vets who were already doing the work of serving these families and animals in need.

“The beauty is that each community can set the program up based on the needs of their community,” said Prupas. In Los Angeles, signups are run through intervention groups, such as animal rescues. People who arrive at the city shelter wanting to surrender their pets due to financial concerns around medical care are referred to these groups, who facilitate program applications. This helps keep families together and reduces shelter admissions.

“The main goal of the program is to help families and people by helping their pets,” Prupas said. By keeping pets with their families and providing care, the mental, emotional, physical, and financial health of pet owners are supported. The community is supported as well by reducing zoonotic disease risks such as leptospirosis, parasites, and vector-borne disease from fleas.

Bringing the One Health approach full circle

Veterinary social workers at the national and local level provide support for both pet owners and staff in the program who need to navigate challenging situations around pet care. These interactions also create an onramp for pet owners to be connected to other potentially beneficial social services, bringing the One Health approach full circle. The ultimate goal of the program is for veterinary services and human social services to partner in providing support for both human and nonhuman members of the bonded family.

AlignCare helps the vet team as well because it reduces the moral distress we feel when we have to turn someone away who can't afford care. The vet team can help the pet owner apply right there in the moment of need, and they can receive rapid approval.

“Just being able to say, ‘yes we can help,’” decreases the emotional stress for veterinary team members, Prupas said.

He has been surprised by the types of cases that come through the program. “We all thought these cases were going to be the huge, big-ticket items,” he said. In Los Angeles, the average client transaction in AlignCare is around $300. “It’s the normal stuff, the skin and ears,”—medical conditions that cause pets discomfort and that they’ve been suffering with because the pet owner couldn’t afford care. Now, these pets are happier and healthier, and so are their families.

LA AlignCare currently includes three intervention groups and six veterinary service providers, including one urgent care center. Funding is the most limiting factor. Initial funding sources included grants from national animal welfare organizations and support from community groups. Prupas noted that “to make it sustainable we need to go past this.” Government funding from local municipalities can help to support the programs long term.

The benefits of a successful AlignCare program go beyond healthier pets: Humans (including the pet's family and the patient care team) are better off. While limited data are available currently, some communities report that by providing funding to support pet health, spending on other social services is reduced because people are happier and healthier with pets as part of the family.

Get involved with AlignCare

Veterinarians in areas where AlignCare communities exist can enroll to be a veterinary service provider through the AlignCare website (aligncarehealth.org). Blackwell knows that veterinary clinics are small businesses, so the program tries to make it easy by minimizing paperwork and administrative burdens for practices. Clinics have the autonomy to determine how many AlignCare clients they will serve in a given time period.

Funding is always needed and can be made through donations to the PPHE or local community groups. Some communities are currently unable to enroll new pet families due to limited funding.

Individual community ownership is needed to make AlignCare a sustainable program, and that means developing local connections among social services, animal welfare groups, and veterinary service providers. Local governments can also invest in the program and provide funding for their area.

“If anyone is interested in starting AlignCare, they should do it,” says Prupas, “You only need three things to start—a vet provider, a human services coordinator, and money.”

Prupas invites anyone with questions about setting up an AlignCare program to reach out to him or the numerous contacts on the AlignCare website (aligncarehealth.org).

Kate Boatright, VMD, is a small animal veterinarian, speaker, and author in western Pennsylvania. She graduated from the University of Pennsylvania in 2013 and has worked in rural small animal general practice and emergency clinics ever since. She is passionate about inciting positive change in the profession through mentorship and servant leadership in organized veterinary medicine. She writes a monthly column for NEWStat on the role of the spectrum of care in improving outcomes in clinical practice.

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