When David Finally Gave In To Goliath–Temporarily

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I’m facing something I never wanted to admit, but I might have to.  I might have to give up on the first self-funded plan I ever set up.  I first partnered with this client in 2020.  Two years later, we implemented DPC where it existed, in about 60% of the zip codes on the census.

First, let me give you some background.  This plan covers a small group.  Only 21 employees are on this plan.  It has won Health Rosetta’s Rosie Award twice.  It has outperformed BUCA plans by 20% to 30% since I’ve worked with this group.  But the group lives in the land of Goliath hospitals.

These hospitals and their cozy relationship with the BUCAs could beat down the most innovative employer plan, regardless of size.  I’m proud of my little client who gave it their all, but couldn’t overpower Goliath.

Pair the superpowers of massive hospital systems with DPC deserts, and you have an unworkable situation for most.  And that, friends, is what my client and I are dealing with.  Indeed, we implemented DPC, and it worked for some, but this client has employees in about 20 different zip codes; some are more than 30 miles from the nearest DPC.

So, what now?  Do I sell them the next best polished turd of a BUCA plan?  Nope.  I don’t do that.  I’m not appointed with the BUCAs, so their plans are not within my reach.  I wouldn’t want them anyway.

Even though ICHRA plans are one step closer to each employee having to choose a BUCA, that’s where I’m having to go.  For those of you who follow, ICHRA got a name change.  It’s now “CHOICE” arrangements.  Whatever.  It’ll take me a while to adjust to the new name.

I’m not admitting defeat here.  I’m just giving my client a little time to gather their thoughts and figure out something different while we keep working on this together.  

Some employees will choose a Bronze Plan on the marketplace and use the accompanying HSA to keep the relationship with their DPC alive.  Some employees will choose a health share and will sharpen their healthcare consumerism skills, with their DPC at their side.

This is a short reflection.  I won’t keep you much longer.

Here’s the moral of the story.  We need more DPC.  We need one on every corner, in every zip code, for every family.  This ecosystem is hard to build.  But, we wake up every day and do it anyway, despite the challenges.

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About Cristy Gupton

A nationally recognized employee benefits advisor, Cristy Gupton has endeavored to solve healthcare challenges for employers since 1998.  Cristy has been named twice to Employee Benefits Advisor Magazine's Top 20 Women in Benefits Advising list.   In 2017, Cristy was credentialed by the Health Rosetta and Mitigate Partners, groups of the nation's leading healthcare consultants who provide transparent, employer-built health plans with independent, physician-owned direct primary care at the foundation.  Cristy has a BS in Public Health from UNC-Chapel Hill, a MS in Health Benefits Design and Health Informatics from University of Lynchburg and a designation of Global Financial Steward from Wake Forest University’s Center for Board Certified Fiduciaries. Other highlights: Spokesperson of the Free Market Medical Association, Carolinas Chapter Contributor to Industry Publications like BenefitsPro Magazine, Physician’s Outlook Magazine and DPC News Speaker at Wingate University’s Engaged Citizen’s Series, VAHU, SIIA, DPC Summit, Health Rosetta Summit (now called RosettaFest), Free Market Medical Association, BenefitsPro etc. Creator of Healthcare Smartypants, an employee education series meant to help employees become smarter consumers of healthcare. Creator of Sunlight Health Plans, a self-funded plan design for employers who embrace Direct Primary Care Cristy also serves her community and fellow citizens through organizations like Scouting America, and her local chapter of Rotary International.