Over-Utilization Prevention

Managing supply chain costs is key to reducing the costs of doing business.  The cost of providing health benefits to employees has spiraled out of control and companies have been powerless to manage the supply chain costs in this area of their budget—until now.  Remember, COSTS = PRICES x UTILIZATION.  Status quo brokers want to keep you fully insured because you can’t manage costs that are contractually set, often at 5-10x the cost of those same services at cash prices.  And they focus on the 20% of your costs that are fixed because they can't offer you a strategy to reduce the 80% of your costs that come from your claims.  Our benefits advisor partners show you how to pay your own claims at cash rates, with stop-loss protection against costly claims.  We add the most valuable layer to the control of health benefits supply chain cost—controlling your claims, particular among your "high-utilizers", by providing direct primary care for your employees.  This accessible care at a low PEPM cost reduces unnecessary services from ER visits, preventable specialist visits, high cost imaging services, and pharmacy costs.  Cash pricing for services, combined with reduction of unnecessary services, with a layer of stop-loss protection on top, leads to as much as 30% lower health benefits costs rather than 6-10% increases annually.  Simply put using real numbers: per 100 covered employees, at an average spend of $10,000 per employee per year, these strategies can help you lower your healthcare cost by $250,000 or more annually, rather than just accepting a $60,000 premium increase.  Don't you think it's about time that you rejected the status quo?


Tracking employer cost savings from claims prevented

We will provide you with quarterly reports that help you see your return on investment for providing a direct primary benefit.  You will be able to track prevented claims in several important areas:

  1. Primary Care Claims—quite simply, there are none.  80% of primary care visits are Level 3 or 4, with average fees of $80 and $120.  Most visits include the additional costs of urinalysis, strep tests, EKG, spirometry, to make a few.  All these services are included in the direct membership fees.  Our quarterly reports will show you the amount of primary care claims you saved by offering the DPC benefit.  You can compare this directly to the primary care claims paid on the employees who did not opt for the DPC benefit
  2. Urgent care claims prevented—Our reports will show you when a virtual visit or same day office visit prevented an urgent care claim
  3. Specialist claims prevented—when a dermatology procedure is done by the DPC physician, it results in dramatically lower cost.  We will report this quarterly.

When you compare actual claims in your employees who selected the DPC benefit to those who did not, you can expect to see an average of $100-200 less per month per employee, above and beyond the cost of the DPC benefit.


Transition assistance for primary care physicians into DPC

We assist primary care physicians in the process of converting to a direct primary care practice.  We will share our forms, give you advice on practice set up, help you make decisions about a hybrid vs. straight DPC model, advise you on which platforms to use for the unique aspects of DPC practices such as billing and communication.  We are just “paying it forward”from those who helped us get started.  We all benefit from your success, including the companies and employees we serve.