direct primary care

How Running a High-Performing Health Plan is Like Driving a Toyota Prius--and that's a good thing!

I finally got myself a Prius which I’ve been wanting for a long time.  Watching the technology “do it’s thing” in the background while I drive really got my "wheels turning” (pardon the pun) about how health plans with great design and technology behind the scenes are similar.

I finally got myself a Prius which I’ve been wanting for a long time. Watching the technology “do it’s thing” in the background while I drive really got my "wheels turning” (pardon the pun) about how health plans with great design and technology behind the scenes are similar.

For about a decade my Mom had a Toyota Prius.  She absolutely loved it and I got to drive it from time to time.  Sometimes I’d meet up with her midway between my NC home and her SC home and I’d swap my GMC Yukon loaded down with my kids and our clothes for the weekend.  Then I’d get to drive the Prius around visiting a few clients on the way to reunite with them in SC.  I loved scooting around in that little thing and set my sights on owning one someday.

Well, it finally happened.  This week I became the proud owner of a cute pearl white Prius and I couldn’t be happier.  There were 9 miles on it when I drove it off the lot and today (2 days later) there are 400 miles on it.  Funny thing is, half of the “free” tank of gas the dealership put in still remains.  I’m in love.

I’m sure I know what you’re thinking…”but you’re supposed to be a successful benefits broker.  Can’t you afford anything better than a Prius?”  Trust me, with the abuse I put my work car through, I can’t be trusted with a car worth any more than this.  It’s just not a good idea.  After all, I’m not Contorno with his big, fancy car and his personal driver.

Yesterday, as I was driving, I began to pay close attention to the monitors and displays that light up with every touch of the gas pedal.  It shows me when the battery is providing all the power, when the power is coming from a mix of battery and gas and when the car is using 100% gas.  This really got my “wheels turning” (pardon the pun).

I was reminded of how a transparent, high performing health plan works and how a successfully run plan only spends about half as much as a traditionally funded plan that has no view into the actual unit cost of healthcare.  What I’ve told clients and prospects is that because of the technology operating behind a transparent, high-performing plan, it allows the plan to save money even when you’re using the high cost sources of funding like hospitals and facilities.  On the other end of the spectrum, you completely level out your exposure to claims costs (why don’t we call this renewable energy) by embedding Direct Primary Care into your plan design.  That’s just like when your Prius is only using the battery to get you from point A to point B.  Everything in between is a mix of great technology and a smarter use of your plan’s resources.  Just like the gas in your car.

Why is this so important?  Well, we all know that the Kaiser Family Foundation just reported that American families and employers are spending around 67% more on healthcare than they were 10 years ago.  Healthcare has exponentially outpaced inflation and it’s killing our economy, causing wage stagnation and keeping workers from being able to retire on time.

Why do we tolerate this?  Because big insurers are marketing geniuses.  And we bought it hook, line and sinker.  Even though the net promoter score of the major insurers is in the single digits, many American employers are too afraid to design a plan that isn’t run by one of them.  Until now.

At a very grassroots level, employers of all sizes and makeups are seeing the Direct Primary Care practices build a presence in their communities.  Many seek out that care and then decide they want to try it out for themselves.  They’re hooked instantly.  They want to provide it as an option to the rest of their workforce.  They ask their current broker to help them implement it and that’s where the difficulties start.  They hear things like, “this is just an added expense” or “your employees already have all of the doctors in the network” or “this won’t work with your health savings account”. 

As a Health Rosetta Advisor that’s music to my ears.  My most recent client acquisition told me just before I was hired that it was refreshing to hear someone say “yes you can” when cost containment solutions like DPC, transparent pharmacy benefits and bundled surgical agreements were inserted into the conversation.  They told me all they heard from their incumbent broker was how the status quo was the best they could do. 

But not all employers are so bold.  Many are too afraid that their employees are going to revolt at the mere mention of a different insurer.  Well, I’ll just describe the open enrollment meeting at this new client.  The changes were explained, the booklets were passed out, heads knodded, frowns turned to smiles and several employees were giving high fives to the CFO as they walked out of the conference room.  I’d say those employees were pretty happy with those changes.  Here’s the difference.  Instead of employees being given bad news, they were told the following:  “your primary care visits are free” and “your generic prescriptions can likely be dispensed right in your DPC provider’s office, no need for a separate trip to the pharmacy” and “if you follow the surgical advocate’s recommendation of the high-quality provider for your procedure, it’ll be no cost to you.”  I’m no genius, but that sounds a whole lot better than “copays, deductibles, co-insurance and premiums are going up again.”

What’s my point?  As an employer you have options.  More importantly, so do your employees.  Someday you may have to come to the sad reality that your outdated benefits package just cost you the great new hire you were recruiting.  When that day comes you know where to reach me.  I’ll show up in my cute, pearl white Toyota Prius that got me there at a rate of about 60 miles per gallon.