Membership Fees As New Model for Providers

[Crabcake Johnny]

In addition to your gym membership, go ahead and set up the billing for your primary care membership.

Healthcare: Doctors charge membership fees - latimes.com

So can this work? Possibly in rural areas. I can't see this model working in any urban setting. Providers would have to limit membership to "X" number of patients which means the only workable solution for this model would be a lot of locations.

This, by the way, if you read the article - cuts insurance companies right out of the mix. The patient pays the membership fee, the providers render the services and the carriers get zilch.

 

[AndreaSti]

In addition to your gym membership, go ahead and set up the billing for your primary care membership.

Healthcare: Doctors charge membership fees - latimes.com

So can this work? Possibly in rural areas. I can't see this model working in any urban setting. Providers would have to limit membership to "X" number of patients which means the only workable solution for this model would be a lot of locations.

This, by the way, if you read the article - cuts insurance companies right out of the mix. The patient pays the membership fee, the providers render the services and the carriers get zilch.

This could work I guess, unless I am missing something here. Do this and have insurance for catastrophic coverage. Not sure what it would do to premiums. I had a doc who went concierge. She wanted $2000 year per patient. Wow - they would still file the insurance. So in other words, the regular office visit copays, coins, etc would still exist, on top of the $2k. She did promise, however that she would spend as much time as you needed per visit. Her thinking was she could see less patients with the $2K helping to pay the overhead.

 

[Crabcake Johnny]

The issue with the model in the article is for now, no product exists for it to work well.

High deductible plans such as HSAs, while they don't offer copays, cover office visits and are priced accordingly. The cost of those visits goes towards satisfying the deductible.

Currently there is no plan I can think of that doesn't offer any coverage for primary care yet picks up the tab for medical events over, say $5,000. Don't even get me started on hospital indemnity plans.

In order for this to work we'd net a true catastrophic product that started to pick up the tab no lower than the 10K mark that was very affordable.

 

[AndreaSti]

The issue with the model in the article is for now, no product exists for it to work well.

High deductible plans such as HSAs, while they don't offer copays, cover office visits and are priced accordingly. The cost of those visits goes towards satisfying the deductible.

Currently there is no plan I can think of that doesn't offer any coverage for primary care yet picks up the tab for medical events over, say $5,000. Don't even get me started on hospital indemnity plans.

In order for this to work we'd net a true catastrophic product that started to pick up the tab no lower than the 10K mark that was very affordable.

Sounds good to me. Combine that with a membership at your favorite doc and you're good to go! How about the HSA model for hospital only. Supplemental accident for ER. Pay as you go for when you are on vacation.

The only problem with the HSA is the money is tax deferred, and I swear our government doesn't like that.

 

[Crabcake Johnny]

Actually HSA money is tax free when spent on eligible expenses.

 

[Ann H]

In the article, it used an example of a person paying $69 per month for this service. Hmmmm.... $69 a month for the service? If you talked to an insurance company, and asked them to design a product with no Primary Care Physician coverage, would the premium be $69 less? I doubt it.

Let's do a little math. If the average PCP Dr. visit is $65 (using a typical insurer's discounted amount for a PCP visit in Arizona where I reside), and the copay is $25, that means the insurance company typically pays $40 for the office visit. There is usually less than one office visit per month. Heck, most of us have one or two office visits per year, plus one preventive care visit. Even if you factor in a little extra for the risk of high utilizers, I can't see where PCP visit coverage should cost $69 out of the health plan's total premium.

I know a "wrap around" product doesn't exist right now, but let's pretend that it did. What coverage would be carved out? Just PCP visits? How about Specialists? How about surgeons? How about lab & xray? In the article mentioned above, it quickly slid over the fact that the member must pay for outpatient lab & xray, and medications. Sometimes this is expensive, sometimes it's not. But what if you got cancer, for instance? What if you saw a cancer specialists twice a week, got many blood tests, diagnostic tests, etc. You could get socked with a huge bill, and then find that you "wrap-around" coverage didn't include those items but just included hospitalization.

This brings us back to the old days, when sales people used to tell the client, "Aw, just buy hospitalization coverage. You can pay for the small stuff yourself." I often tell people to list the number of hospitalizations their family has had in the last 10 years, then list the number of Dr. visits, lab, xray, Rx that they had in just the previous year alone. The hospital may be the large bill in terms of DOLLARS for one incident, but the volume of small bills really adds up. More families incur the volume of small bills than the occasional large hospital expense. Then I show the client the miniscule amount of premium they would save for buying a "hospital" plan, or something like NASE, and they can clearly see that a full-coverage plan is better. A lot of people are trying to carve out prescription coverage right now, only to find that their prescriptions are more expensive than they once thought.

It's a much better idea to buy an HSA that COVERS the PCP visit, Specialist, Rx, etc., but just after the deductible is met.

Furthermore, this isn't the first time that the medical profession thought they should be insurers. Remember when doctors tried to set up their own health plans, only to find out that insurance was more complicated and risky than they thought. In Arizona, we had the Mayo Clinic plan, and some other Dr. group plans that failed miserably. Doctors don't realize the RISK they will bring on. They will become a magnet for over utilizers. Who eats at a Smorgasborg? Fat people. Who pays $69 a month for unlimited PCP visits? Over utilizers and poor people who don't buy wrap-around health insurance. Over utilizers will buy this like fat people buying unlimited fried chicken. Poor people will visit the PCP only, but they will not get the Rx or expensive diagnostic tests, and then they will become over-utilizers when their sickness escalates.

Good luck.

 

[somarco]

Concierge services are not that new. They have gained a little traction in the last few years but work only for primary care.

Yes, you still need to carry health insurance.

This service
Atlanta Doctors Offices and Care with My Georgia Doctor - Flat Fee Medical Membership Plan

has been around a few years with moderate success.

Only works with docs that do not need admitting privileges.

 

[AndreaSti]

Actually HSA money is tax free when spent on eligible expenses.

I stand corrected. Was referring to the $$ left over after age 59 1/2 (?).

 

[jbage007]

another name for medical membership plan = HMO