Health care cost outlays by insured Americans represents almost one-fifth of the country’s Gross Domestic Product (GDP), amounting to almost $ 11,000 for every person in the U.S. Beyond the cost, there is an often-confusing array of paperwork relating to co-pays, deductibles and other elements of the system.
With such a sizable investment in our health and well-being, health care providers, insurers and others are constantly looking at how to ensure that dollars are spent wisely while still getting a good bang for the buck in terms of a high level of care and services.
In coming weeks, Medical Matters will take a hard look at proposed solutions and ideas for the care/cost conundrum and how some organizations see fixes not as improving the status quo but turning the current model on its ear.
One such company, Planstin, feels bullish on a better future for medicine and some patients by helping simplify the link between doctor and patient. The result is the health care consumer receiving cost-effective care.
Timothy D. Hirsch, Affiliate Sales & Support Specialist at Planstin, calls the company’s model, “a different way to pay for health care.” He says that “far too often, our system creates barriers and paperwork between doctor and patient. This can increase costs and hurt efficiency. What we offer to our clients is a more direct connection to their doctor.”
Planstin is a third-party administrator (TPA) and works to connect employers of all sizes, including sole proprietors, to medical services. The company offers employee families and employers a variety of options, each tailored to the specific needs of a company. Programs include: The Base Health Plan (two levels of preventative benefits), the HealthShare membership offered in partnership with Zion Health, and options for Dental and Vision plans.
Hirsch says that Planstin’s collaboration with a proven leader like Zion Health creates a uniquely low-cost and effective health care solution for members. A HealthShare plan is literally an organized community that shares medical expenses. Zion Health operates in 50 states. This entity supports the Direct Primary Care movement and has plans specifically designed to work with the memberships of direct primary care providers.
“This is not an insurance company,” said Hirsch. “Rather, it is designed to help members help one another through participation in the plan.” He went on to say that the plans were most beneficial to those without serious pre-existing conditions or chronic diseases.
For instance, the Planstin Preventative HSA (Health Savings Account) provides coverage for a range of preventative services (100 percent as outlined in the Affordable Care Act, aka Obamacare), discounts on prescription medication, access to a national network of providers and zero co-pay, 24-7 phone access (Teladoc) to a licensed physician to get your questions answered. There are no-copays or out-of-pocket for this service. For an individual, this plan costs about $ 75 a month; for a family of four, the price tag is about $ 150 a month for the plan year, before any employer contribution.
The Direct Primary Care (DPC) model is growing in popularity. While it is similar to “concierge medicine where providers require commercial insurance and bill the carrier as appropriate, DPC doesn’t require insurance. Patients pay a monthly subscription fee for guaranteed access to their provider.
Under this model, providers have a smaller panel of patients and can spend more time with each. He added that for these patients, working with Zion Health can truly be a solution to lowering health care expenses.
Hirsch stresses that Planstin’s programs are not for everyone. “We’re not a one size fits all model,” he said. “But for those whose health and lifestyle align with our model, our plans represent an opportunity for lower-cost care of the highest quality.”
In future columns, we’ll provide the perspective of providers in New Hampshire who utilize the Direct Primary Care model as well as views from local patients and how they benefit from the program.
As always, I welcome your press releases, news tips, and story ideas. Please email me at ChrisDugan@manchesterinklink.com.