“There’s not much we can do”, say employers who believe their brokers’ excuses.
Today’s article in the Kaiser Family Foundation’s newsletter called “A New Car vs. Health Insurance? Average Family Job-Based Coverage Hits $27K – KFF Health News” quoted a small business in South Whitley, Indiana. The company’s CFO is exhibiting typical behavior that can be harshly defined as a breach in fiduciary duty, or more kindly described as a lack of courage to try something new. One of my taglines has been, “all you need is a good advisor and a little courage”.
The truth is that the company’s leaders could explore at least a handful of easily deployed cost-containment tools to achieve sustainable health insurance costs and a better plan for all employees. DPC is one of those tools. The article states that half of the company’s 20 employees decline their coverage. Most employees who do that are no dummies. They know a bad deal when they see it, so they decline to participate. That’s a serious problem for everyone involved.
This is specifically why I bring up a plan sponsor’s fiduciary duty. Even a plan sponsor who chose a fully insured product for their small group has a discretionary role in selecting that product. Maybe they chose it because their broker told them it was the best choice. Maybe their broker told them it was the best choice because it brings the highest commissions and bonuses. See where I’m going with this? If you have discretion over plan choices, then the argument can be made that you have a fiduciary duty to the members or even the eligible members of your health plan, whether they currently participate or not.
Looking at www.dpcfrontier.com, yes, at first glance, it appears that South Whitley, Indiana, is in a DPC desert. But if you zoom out on the map, you’ll find a handful of DPC options. I measured one option at a mere 32 miles from that company. That’s less than the distance between me and my DPC doctor, and I have more than quintupled the number of encounters with Dr. Kramer than I had with my prior primary care doctor, who operated in the insurance model.
As the article states, you could buy a new Toyota Corolla for your employees every single year and still spend less than health insurance annual premiums through the big carriers. I bet some employees would rather have a new car every year than the crappy insurance offered.
Some of the most common cost-containment measures you’ll find used in smart health plans like advisors involved in Health Rosetta or Mitigate Partners include:
- DPC
- Cash-Pay solutions for Rx, procedures, inpatient/outpatient needs, imaging, etc.
- Transparent PBMs
- 501R Advocacy
- Medical Bill Review and claims audits
- Open, Transparent Networks (code name for reference-based pricing)
- Care Coordination with independent clinical utilization management
- And many more!
Next time you hear an employer belly-aching about the cost of healthcare, you should ask them which one of these levers they’ve pulled and how long they have been using those strategies. If they give you the deer in the headlights look, that’s your cue to open their eyes.
Both Health Rosetta and Mitigate Partners have many case studies that should encourage employers of any size to seek better health insurance options that include DPC.
