This Is Not Working

If you are anything like the hundred and hundreds of people we've spoken to in the past few years, you share a story that sounds like this:

"Generally, I like my doctor. But I do not like the experience of getting care. Scheduling an appointment is a nightmare. When I do get in, I feel hurried and if I have deeper questions, I have to schedule another appointment and wait weeks to have my concern heard. I'm frustrated because I pay high premiums but do not have the quality of care, access, and attention for all that money I'm spending."

We heard this story so often, we knew an alternative needed to be built.

Because the fact is that Americans are spending more and more on healthcare and only getting sicker.

If we look at our spending on healthcare as a percentage of GDP, that number has more than doubled since 1980.

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Insurance premiums have also risen at a similar rate, putting significant financial pressure on employers and families. They are spending more and more on premiums, deductibles and co-pays.

In fact, in 2022, almost 200,000 families WITH INSURANCE went bankrupt due to medical bills.

Now, all of this spending could seem somewhat reasonable if patients within the system had better health outcomes. The sad truth is, however, that for all our healthcare spending (almost $4 trillion a year), we are only getting sicker.

In fact, almost half of all Americans have a chronic disease, up from an already staggering 44% in 1995. These chronic diseases are caused primarily by lifestyle and account for about three-quarters of our annual healthcare spending.

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What Can Be Done?

As we at HealthPass looked at these problems, four important questions arose.

1. How can we put the doctor-patient relationship back at the center of healthcare?
2. Is there a better way to protect people from overwhelming medical bills?
3. Can people be encouraged and incentivized to live healthier, more active lives?
4. How do we build a product employers can offer as an alternative to corporate insurance that satisfies all legal requirements?

We have not been the only ones asking these questions and looking for an escape hatch from the current broken healthcare system. In fact, a number of solutions were being built at the same time as HealthPass.

These solutions allowed us to answer our questions.

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Solution #1: Patient-Doctor First

A growing number of medical providers have found freedom and remarkable success outside of the insurance-first model of care. It was commonly thought that only through insurance could doctors make a living.

Then came the Direct Primary Care model, or DPC.

DPC providers take almost no insurance. Most do not accept insurance of any kind. Being completely outside insurance has brought down administrative costs and has allowed DPCs to consider first and solely the needs of their patients.

Corporate Care vs. Direct Primary Care

With corporate insurance, most primary doctors are in charge of too many patients and are given too little time to listen to or handle their patients concerns.

• The average primary care provider has 2000 patients or more in their panel.
• The average face-to-face time of a primary care visit is 7 minutes.
• A patient has to wait an average of 24 days to see a provider in-person.

With the DPC model, providers care for a much smaller group of patients, allowing them the time and freedom to build meaningful and effective doctor-patient relationships.

• The average DPC clinic has only 677 patients in their panel.
• The average visit time is between 30 and 45 minutes.
• Patients with an urgent need can be seen on the same day, with nearly all visits scheduled within one week.

Through HealthPass, we make it easy for employers to cover the cost of DPC membership for their employees. Ease access to primary care, and the benefit of an established relationship with your primary care provider greatly increases the quality of care and this model we controls costs.

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But what about the big "what-ifs"? How does HealthPass deal with rare, expensive medical events?

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Solution #2: Medical Cost Sharing

As we mentioned, health insurance is not a guarantee you'll be able to make it through an expensive medical event financially intact.

Thankfully, the market was full of medical-financial tools to help patients cover the high cost of cancer, pregnancy, or car accidents.

One tool is known as medical cost sharing.

Here are the basics:

• You choose an Initial Unshareable Amount, or IUA. (Similar to an insurance deductible amount.)  This is the maximum amount you will be responsible to pay in the event of a serious medical event.
• If the cost of the medical event surpasses your IUA, the medical cost sharing company covers the rest for the remainder of the event.

Compare this to the standard deductible - out-of-pocket max model. The out-of-pocket max costs for individuals can reach up to $9100 per year. And this amount resets (and can even rise) every year. That means if you have a medical event that requires care spanning three plan years, you could be responsible to pay $27,300 out-of-pocket.

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In the medical cost sharing model, patients will only pay their IUA once. Either $1000, $2500, or $5000.

Which is the better financial tool?

With HealthPass, we utilize Zion HealthShare to provide medical cost sharing for our members.

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Solution #3: Exercise As Medicine

A Lancet Public Health study found that for 2016, "modifiable health risks were linked to more than $730 billion in US health care spending."  Issues like obesity, diabetes, heart disease, hypertension, and others are directly linked to the way we live, what we eat, and how we move.

In the current system, even doctors who understand the importance of healthy, active living have no time to guide their patients toward that lifestyle. Seven minutes is only enough time to recognize a disease like diabetes and prescribe medication or pass you along to a specialist. Today, this approach to sick care costs the healthcare system trillions of dollars.

The truth is that the most expensive diseases are preventable, treatable, and even reversible through proper diet and adequate exercise.

HealthPass always includes access to a network of partner gyms. We do not create arbitrary distinctions between "health" and "fitness", "exercise" and "treatment", or “food” and “medicine”. Fitness is health. exercise is treatment, and food is medicine.

As an employer, you can offer more than a tool employees only can use when they get sick. With HealthPass and our gym partners you are offering a tool they can use before they get sick and a strategy to help them avoid becoming chronically ill in the first place.

Additionally, our partner DPCs believe deeply in the healing and preventative power of a healthy, active lifestyle. As opposed to most medical providers, they have the time and freedom to guide their patients' daily habits, plus find and treat any underlying metabolic conditions.

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Solution #4: Bringing It All Together

Most people receive some kind of health benefit from their employer. For employers, a robust health benefit is one of the best ways to retain employees.

Small employers have generally been stuck choosing plans from a short list of increasingly expensive options. As the cost of premiums has increased, many employers have been forced to shift more of the cost to employees.  Both employers and employees have been eager for an alternative.

We created HealthPass to bring together all these solutions and create a benefits package that was legally compliant and a program employees would love.

With HealthPass, employers can now offer better care at about half the cost of corporate insurance. While the average family premium has increased by 20% since 2017 and 43% since 2012, HealthPass has not raised prices one cent in over three years.

• Patients are developing meaningful relationships with their doctors and saving money on the most common medical care.
• Employers are retaining their best employees and creating a culture of health and wellness in their organizations.
• Doctors have the freedom and time to treat to the whole patient and address underlying conditions.

We believe these solutions delivered through HealthPass will save patients and employers millions of dollars in the coming years, and, most importantly, help hundreds of families live healthier, happier, and longer lives.

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Ready to bring HealthPass to your business or organization? Reach out directly to michael@joinhealthpass.com.

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