With the open enrollment period for healthcare for 2019 quickly approaching, individuals and employers have an abundance of options when choosing healthcare for themselves, or for employees.
“Right now we’re waiting to see what the impacts on rates are, they have kind of been ranging all over the place,” said Tyson Fuehrer, consultant and benefits department manager at Biggs Insurance Services in Vancouver. “Kaiser continues to be extremely competitive on rates and plan design. In the small-group market, employers have Regence, Health Net and UnitedHealthcare to choose from.”
Fuehrer said larger groups have a lot more options available to them when it comes to healthcare, including a lot more internal plan design, how the plans are structured and more.
One of the biggest changes Fuehrer said they are seeing this year is probably companies getting employees engaged in wellness programs, some offering wellness discounts if employees participate in different activities like biometric screenings, etc.
“This means a lot of different things to a lot of different companies and how they’re going to measure the success of those programs,” Fuehrer said. “The programs don’t need to be super intense. They’re looking for ways to engage employees, and it’s affecting retention and other things.”
“Self funding in the 25-50 employee space has doubled in the last year as forward thinking employers are choosing to look outside the box for more affordable solutions,” said Pete Scruggs, president of Golsan Scruggs Insurance & Risk Management in Battle Ground. “Employers in the 50-200 space are increasingly self funding with custom plans that accentuate healthcare supply chain management. These strategies allow employers for the first time to apply leverage to their health plan costs like they commonly require of material supply chain vendors.”
“Still, for many employers, fully insured association plans like the BIAW are an efficient way to get the pricing power of larger employers with as few as five employees,” Scruggs continued.
Direct Patient Care
Direct Patient Care (DPC), an alternative to healthcare that is offered through an insurance plan (usually an employer) that offers patient care without all the overhead cost to the patient and provider, is a relatively new idea in the healthcare world that has been gaining attention recently. Essentially, DPC is healthcare with a monthly membership fee where patients or employers sign-up with a participating doctor whose office offers this type of medical care. Open to individuals and families of all ages, this new type of medical practice allows members to see the doctor as often as necessary with most tests and things like flu shots covered under the membership.
Dr. Dino Ramzi cares about his patients and believes that his Patient Direct Care practice in Battleground is bringing family medicine back to the old-fashioned way of treating patients.
With no copay and 90 percent same-day or next-day appointments, first-time patients are scheduled for an hour and no patient ever waits more than 10 minutes. Building relationships with patients and allowing them the convenience of same-day or next-day, and after-hours calls and appointments, in-office lab testing, vaccinations, X-rays and even video skype (telemedicine), appointments for established patients make this type of practice a win-win for both patients and employers.
Prescriptions are usually available at lower prices because they can order through the clinic and not have to wade through insurance red tape. Patients have more one-stop medical coverage where they do not have an insurance copay and a yearly deductible.
“We have access to wholesale pricing for lab work and most tests, so we can offer a tremendous savings to our patients,” Ramzi said. “We are not priced for profit and we do not care about pre-existing conditions. We are about building relationships and are fed up with the rising cost of healthcare in the U.S.”
“We don’t have an answering service, so when someone calls at night to find out our hours, they usually wake me up,” Ramzi continued. “People aren’t used to this level of service, but once they experience it they get it. The service includes online specialty consultants, discounted labs and X-rays, as well as a generic dispensary at wholesale prices. All-in-one office labs are included without additional cost. Even suturing lacerations.”
Ramzi is looking to expand his growing practice, eventually adding more doctors and a larger staff. He also has plans to add another location in the Vancouver area within the next year or so.
Main Street Family Medicine office manager and MSN, RN Sue Hartley works for Dr. Steven Baker at his small Vancouver-based DPC family practice that just opened last July. Hartley job-shares with two other rotating RNs on staff and they currently have less than 100 patients enrolled in their growing membership-based healthcare program.
“The goal is to never have more than 700 patients so that we can take our time, establish relationships and keep the cost down for our patients,” Hartley said. “We have a significantly lower patient load than most practices as we schedule an hour for most appointments allowing them to take as much time as they need. We have no more than six or seven patients per day ever, which really allows us to give personal quality time and care.”
“We want our patients to feel safe, cared for and valued,” Hartley continued. “Our lobby was designed to look like a large welcoming family room where everyone is welcome to come and feel at home. Our membership fees are based upon age and we have a family plan that covers all vaccinations for children. Patients can get most treatments, labs done in our office and their prescriptions ordered here in our office. They can also call in or come back for as many follow-up visits as needed under our plan. The better we get to know our patients the better care we can give.”
With rising healthcare costs, these types of DPC practices are popping up all over the country as a cost-effective alternative to insurance-based medical care. This trend shows a decrease in visits to the ER as well as a major delay in the impulse to visit the ER when patients have access to their doctor and can get almost an immediate appointment and treatment versus waiting a month or two to get on a doctor’s busy schedule.
Costs are a huge factor as these types of practices can negotiate wholesale pricing, which lowers fees for lab tests, specialty advice and prescriptions. They can do tests and procedures in their offices and save money by not having to go through an insurance company for billing and authorization.
“We can do about 85 percent of patient care here in our office and refer out about 10 to 15 percent of our patients to specialists or for other testing,” Hartley said. “We help negotiate costs for them through our network of providers that we work with. Patients might pay half of what a radiology test would cost through insurance.”
Cash pay scales, financial assistance as well as having a high deductible or emergency type insurance policy to supplement a member-based policy is advised.
Most DPC practices do not treat Medicare/Medicaid patients due to insurance laws.
VBJ Editor Joanna Yorke contributed to this article
