How direct payment makes health benefits affordable

How direct payment makes health benefits affordable

Looking for an innovative and affordable alternative to traditional health insurance for your employer clients this open enrollment season – a season that will also help bring health plan equity?

Direct payments to service providers without the need to submit claims to a third party benefit everyone in Healthcare ecosystem. This mutually beneficial approach allows medical providers to extend discounted services, usually on equal or even less than what they collect from Medicare.

The direct payment network can be set up to cover 85% to 90% of all medical events, which includes daily acute primary care for both in-person and virtual visits, as well as diagnostics such as laboratories, imaging and pharmacies. Other layers could be added to the mix that would allow healthcare consumers to purchase coverage Psychological healthAnd the dentist And the vision care. While inpatient coverage and major Medicare will not be included in this arrangement, employers can continue to offer a more “traditional” insurance plan, explore alternative programs such as HealthShares, or even can arrange for direct contracting with local hospitals with the help of their advisor.

In this direct payment system, employees know and pay at the time of service a fair and reasonable amount for the entire visit without ambiguities of engagements, deductibles, co-insurances, etc. Employers may choose to support their employees by providing a set amount that can be used for these routine services.

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This approach not only brings transparency and cost control to members of health plans and employers, but also helps medical practices in many ways. For starters, we guarantee full payment. Direct payment also eliminates low-value and costly billing activities, which effectively increases medical practice revenue because a third of its revenue is “wasted” on such collection and claims activities, not to mention draining time away from treating patients.

Of course, it is also a big win for the registered broker, who will be considered the rain maker in the eyes of all parties involved at once treatment plan Members are moving away from the high out-of-the-ordinary costs associated with medicine-for-service. It is becoming increasingly clear to freelancers Brokers and Benefits Consultants Which is why so many working Americans are either cutting back or avoiding doctor visits.

But facilitating access to healthcare services with a concept like direct payments also has lasting benefits for producers. We’ve seen that great resignations exacerbate employee turnover, especially in the service sector, and the impact of economic uncertainty on benefit budgets. What happens if employees quit or the employer decides not to provide health care benefits anymore? What happens to all that effort you’re putting into a customer’s ecosystem?

Under direct salary, individuals who remain attached to the service, regardless of their employment status, will ensure that advisors continue to secure their share of the service fee charged. So there are long-term rewards to be reaped compared to the traditional health insurance model whose renewals can be unstable.

Read more: Replacing group health with individual market plans benefits everyone

These discoveries about direct pay date back early in my medical career as an emergency medicine physician and department manager. This is when I gradually realized that our healthcare system was broken and that alternative ways of making patient care more affordable were needed. What has become clear to me over the course of 15 years of working in a large healthcare system is that we weren’t really dealing with the problem of providing care. There was no vision or control of the average consumer.

And so about seven years ago, I left a comfortable job at the company to start a clinic, which was my first foray into community medicine and gave me insight into how blinding the patient and the employer can be when it comes to deciding who is responsible for payment. Medical bills. We had our staff in the clinic, which meant I was also an employer having to review our employee benefits options. A great gold plan was made available by Blue Cross, but the premium, which we were paying 80% of, kept going up. Only about three-quarters of our employees actually chose to take advantage.

I remember asking at a staff meeting if our employees would be open to the idea of ​​giving up employer-provided health benefits and giving everyone $400 per month to spend at your discretion – An amount that reflects our share of its premium. I was shocked because almost everyone raised their hands. Admittedly, we had a few younger residents, but it was still a great moment for me.

When viewed in a much larger context, direct payment can be used as a valuable talent management tool to help recruit and retain top talent during a period of unique business challenges. We all know how important the benefits of healthcare in general are compensationBut what’s the point of it if coverage is too expensive and no one can use it?

As I always say, a benefit not taken is a benefit not given – which means we all need to do a better job of making healthcare more accessible.

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