What if health insurance companies like UnitedHealth Group, Anthem, Aetna, Cigna, Humana, and others were actually honest about how horrifically terrible they are?
This video investigates.
Wouldn't it be better to have a direct, personal relationship with your doctor without involving the "insurance goblin"? That's what Direct Primary Care is all about!
It's Open Enrollment season. Providing health benefits for employees is one of the highest expenditures for an employer. With such a significant amount of revenue devoted to keeping staff healthy, employers look to brokers for solutions that support their workforce while also helping their business remain profitable. As the costs of health care continue to escalate, employers and their workers are facing unprecedented challenges.
As businesses pass expenses onto employees, the skyrocketing costs of prescriptions, rising copays, and unattainable insurance deductibles have left many employees feeling neglected. It’s abundantly clear that traditional health plan offerings like high deductible health plans (HDHPs) aren’t enough on their own. A large segment of the population needs health care options that are more affordable and easily accessible.
Employers don’t know how to provide more cost-effective benefits for staff without taking a bigger hit to their bottom line. But by partnering with organizations that offer non-traditional benefits solutions, expert brokers and health care organizations can address clients’ needs for better care while also mitigating costs.
There are innovative ways to create customized plans that are utilized in the staffing service sector and within employer groups such as the three below, where fully-featured health plans aren’t offered.
Direct primary care (DPC) has taken the stage as an affordable and more accessible non-traditional health care alternative. Unlike traditional health insurance products, members pay a low monthly fee for unlimited primary care access and there are no premiums or deductibles to meet. There are also no claims for doctors to file or limits to the time they can spend with patients to meet insurance requirements.
DPC can help lower the cost of health plans by mitigating claims. Still, discerning brokers have learned the power of pairing direct primary care with other benefits to make an even more significant impact on health plans. Let’s examine some of these powerful benefit partnerships.
One powerful ally to a direct primary care plan is an indemnity health insurance plan. This limited benefit plan pays a fixed benefit amount per day to help people cover the cost of standard medical services. Some even provide access to a national PPO discount network to help minimize out-of-pocket expenses.
This benefit is attractive to employees because it can cover services such as hospitalization, surgery, anesthesia, accidents, and other big-ticket items. They can still utilize their DPC membership for unlimited visits to a primary care provider, virtual care, and prescription discounts. Plus, they get the bonus of knowing there’s additional coverage from the indemnity plan if there’s an accident.
Employers like this partnership because it can help them attract and retain talent for a lower cost. They can offer primary quality health care at a minimal cost, and the plan requires minimal administration on their part. These products are also relatively easy to find and implement, as there are already bundles on the market. Check with your direct primary care source to see if they have any DPC/indemnity products available.
Skinny medical plans are group plans that usually cover non-catastrophic health events. These plans can include routine preventive care and wellness benefits. Minimum essential coverage (MEC) plans also fall under this category.
Although far from comprehensive, these plans may appeal to young, healthy consumers because of their lower premiums. Unfortunately, these plans sometimes limit people with preexisting conditions. That’s where pairing them with a direct primary membership can be extremely helpful. Most DPC memberships include maintenance of chronic diseases within manageable ranges, including those with preexisting conditions.
These plans are attractive to companies that employ low-skill workers with high turnover rates. Restaurants, retail operators, hotels, and other hospitality companies can benefit from combining direct primary care with a MEC or another skinny plan.
Even a minor trip to the hospital can be a major financial setback for some. HDHPs offer coverage, but the average family often struggles to meet high deductibles in today’s economic climate. Paying a large portion out of pocket for hospital stays can add more hardship to an already stressful situation.
Hospital indemnity plans offer benefits for things like hospital admission, intensive care, and emergency room treatments. There are no deductibles to meet, and employees can also cover their spouses and children under these plans.
By pairing a hospital indemnity plan with a DPC membership, employees can get day-to-day health care for themselves and their dependents for little to no out-of-pocket costs. By utilizing unlimited primary care, people can also catch disease states and other acute conditions before they escalate to the point of requiring a hospital stay. In an emergency, having the added hospital indemnity can provide peace of mind for families already living paycheck to paycheck.
Companies of all sizes have adopted high deductible health plans (HDHP) as a strategy to reduce the costs of providing health care. A great way to lessen the blow of an HDHP is to insert direct primary care. Others are looking to self-funding/level-funding options coupled with DPC to deflect claims and limit their overall premium expense.
With DPC, employees get day-to-day benefits for routine care. When employees use their DPC membership for primary and preventive care before engaging their HDHP or self-funded plan, they can minimize their out-of-pocket costs and avoid meeting costly deductibles for primary care. It’s also a win for the employer, because the fewer employees that use the health plan for routine care, the fewer insurance claims the employer must pay. Minimizing the cost of primary care for staff and lowering employers’ claims expenses make DPC an ideal partner.
Medical cost-sharing plans are sometimes called healthcare ministries. They are not run by insurance companies; they are run by nonprofit organizations. Members pay a set amount into a group fund every month. When a member gets a large medical bill, the fund pays some or all of that bill. Plan guidelines spell out which expenses are shareable.
Before the plan pays out, though, the member must cover some of the cost first. This amount, called the member’s “personal responsibility” or “annual household portion,” works just like a deductible does for health insurance.
People choose these plans instead of health insurance because the monthly charges are usually lower. To control costs, some plans urge members to to join a direct primary care practice.
Providing equitable and easily accessible health care for employees is no longer optional. Businesses are facing unprecedented challenges to recruit and retain quality talent. In addition to better pay, better benefits will be a determining factor to differentiate one employer from another. As a result, organizations focus on strategies that will help them stand out to candidates without exhausting their resources.
Now more than ever, it’s imperative for brokers to customize solutions for clients. Brokers who lack the savvy to build more cost-effective and robust health plans will lose to their more innovative competitors. Direct primary care is one of many non-traditional benefits that can add value to any health plan. It’s essential to educate yourself on the new options available in the health care marketplace so you don’t get left behind.
Creating custom solutions for clients is easier than you think. There are many options and product bundles available if brokers take the time to look. By expanding the resources available to employers, brokers can foster a partnership in which employers and their employees feel a greater sense of satisfaction with their benefit offerings. Working productively and strategically to offer more, while remaining cost-efficient, strengthens the entire health plan and, hopefully, the organization.
portion of this article from "Partnering on customizable benefit solutions yields powerful results" from Andy Bonner of Healthcare2u
With health care costs on the rise, a growing number of Americans are throwing out the old way of seeing a doctor and turning to a membership model. A monthly or annual fee gets you direct access to a doctor, no insurance needed.
This concept called Direct Primary Care (DPC) simplifies health care delivery, taking the focus away from visit volume and reimbursement, and allowing doctors to focus on patients and their needs. When reimbursement is not tied to individual visits, patients and physicians are free to have as much contact as required, whether in-person or virtual. Problems can be followed and resolved in real time instead of fragmented, spaced-out visits.
Physicians become invested in people, and patients learn to trust their physician again. This translates into significantly decreased ER and urgent care visits, decreased hospitalizations, increased patient satisfaction, and increased physician well-being, as found in a recent study done through Milliman by the Society of Actuaries and attested to by the hundreds of physicians already in DPC practices.
Using the DPC monthly membership model, physicians can decide how much time and attention their patients need without the onus of check boxes and insurance-based decision making. Each patient and the context of his or her ailments can be evaluated and treated on an individual basis:
■ The single mother whose child is sick with pneumonia can come to the clinic, receive a diagnosis, and get access to antibiotics without even having to stop at the pharmacy.
■ The 80-year-old patient who needs more time to move from the waiting room to patient room can now be seen and heard without the rush.
■ The 40-year-old with a broken ankle can get an x-ray, pay only $35 for that image, get a boot ordered from Amazon, and see a physical therapist on a cash basis, all for a fraction of what insurance would charge.
Patients can meet with the DPC doctor at the clinic or consult with him or her through email. Healthcare happens outside the office as well as inside, and patients with quick questions can simply avoid the drive to the office and speak to their DPC doctor on the phone or even email them.
Patient satisfaction, therefore, is fostered through convenience, instant-access to care, and safe discussion. Furthermore, with Direct Primary Care, physicians can realize efficacy and find purpose in their day-to-day interactions with patients, trusting that patient satisfaction will be the natural outcome.
Dr. Sharyl Truty is the physician-owner of a Direct Primary Care practice called Balanced Physician Care located in Ponte Vedra Beach, FL. She has been in practice as both a board-certified Family Medicine and a board-certified Sports Medicine physician for over 15 years. She has completed a fellowship in Integrative Medicine from the University of Arizona with Dr. Andrew Weil. Dr. Truty is committed to finding the best solutions to help you live the best-balanced life possible.
The short and sweet of it is that HMOs are very restrictive and want you to remain in their “network” - which means you need a Primary Care Physician who participates in the network with them. Such a physician has signed paperwork saying they will follow the insurance companies rules, only refer you where the insurance company says, and receive payment when they bill your insurance of a set rate.
On the other hand, PPOs are flexible. They allow you to go “out-of-network” - including not only any specialist you’d like to see but also any primary care doc! That’s why we encourage patients to check their insurance plan before joining our practice. If your plan is an HMO, it lets us (as out-of-network doctors) to care for you as you and we see fit. The gist is that we can see you, you can see who you want, and we are only paid by your monthly membership fee to be part of the practice.
If you’re a patient who has lots of specialists and needs help with coordination, likes the idea of a doctor who is not “on the hook” with the insurance companies, or just plain likes the idea that you can choose who you’d like to see - a PPO plan alongside a DPC doctor - like us at Balanced Physician Care! - might be the perfect match for you. And no it's not paying twice for healthcare, we think it’s making a smart choice for your health! For more on how we practice primary care differently in Jacksonville, FL, check us out at BalancedPhysicianCare.com
