Crack Healthcare Costs with Cash

Mike Dendy wrote about the OPEC of Healthcare, a brilliant analogy that illustrates the intended and unintended consequences of 50+ years of unbridled growth in third party administration. It’s also a great reminder of how everything, even OPEC, can change…

Crack Healthcare Costs with Cash

By Lisa Beneke, M.D.

Mike Dendy wrote about the OPEC of Healthcare, a brilliant analogy that illustrates the intended and unintended consequences of 50+ years of unbridled growth in third party administration. It’s also a great reminder of how everything, even OPEC, can change…

In the words of Leonard Cohen, “There is a crack in everything. That’s how the light gets in.”

There is a crack in the OPEC of Healthcare, and the light gets in in the form of transparent bundled CASH prices. CASH bundles help consumers understand options and the implications of their choices BEFORE they receive care, when their decisions have the greatest impact on cost and quality. Self-funded employers can understand cost savings case by case, and reward employees for making good decisions that benefit both the employer and the plan. The consumer can be directly involved in paying the correct price and protecting against fraud and abuse. Self-funded employers can be good fiduciaries of plan funds, pay a fair price that enables employees to get the care they need, and give consumers the option to pay more for amenities that are personally important to them.

But how can a self-funded employer administer transparent bundled CASH prices? Decades of working in the OPEC of Healthcare taught us that You Can’t Fix Healthcare Without Fixing Healthcare Payment. We created the medEcash Payment Platform to make it possible for consumers to pay the full CASH price at the time of service, even when all or a portion of the funds comes directly from their employer or health plan. It’s a Better Way to Pay for Healthcare and it’s better for all parties to the transaction.

medEcash is the foundation for a custom-designed CASH health plan that enables self-funded employers to start with high cost elective surgery and diagnostics, and gradually escape the OPEC of Healthcare by paying transparent bundled CASH prices for most healthcare services including direct primary care, office visits, outpatient services, unplanned inpatient admissions and bundles of chronic disease care.

The key components of a CASH health plan are:

  • Payment Platform: A “real-time” HIPAA compliant ACH payment platform that can safely and securely draw funds from multiple sources (i.e. employer, consumer), distribute the components of a transparent bundled price to multiple providers (i.e. physicians, facilities, ancillary providers), and generate an administrative record of care so that no important data is lost for accounting, reinsurance, or population health analytics purposes.
  • Consumer Support: A personal concierge service that educates and helps consumers navigate care, use available transparency tools/quality data to find and consider appropriate high value options that meet their needs, understand how their benefits work, and know the implications of their choices BEFORE they receive care, when good decisions have the greatest potential to impact cost and quality.
  • Prices and Shared Savings Incentives: A CASH price, fixed transparent administrative fees and well-crafted incentives work in concert with benefit plan design to measure savings and reward consumers when they make decisions that benefit them and the plan, even after they’ve met any deductible and out of pocket maximums.

Here’s how CASH empowers consumers, “grows the crack” in the OPEC of Healthcare and “gets more light in” for self-funded employers:

My health plan is CASH.

  • I can use my medEcash mobile app to pay any provider willing to offer a transparent CASH price and accept payment in full at the time of service.
  • There is a one-time sign up process takes less than 5 minutes.
  • I need a price, a basic description of the service, and the diagnosis or some clinical information about why it’s appropriate.
  • I want to check with my personal concierge first to make sure I understand my benefits and find out if my health plan needs to review medical records before authorizing payment.

If I decide to use your services…

  • I will pay the full CASH price, including my plan’s part and my part, and you will not have to submit a claim or bill me later.
  • medEcash captures all the administrative information my health plan needs.

But my health plan does have payment limits…

  • My employer wants to make sure I can get the care I need, but value is important to us.
  • Every dollar spent on healthcare is a dollar that we can’t use for other purposes, like my salary, or the equipment I used to stay safe on the job, or more affordable pricing for our customers.
  • If your transparent CASH price exceeds my plan’s payment limit for this service, I am responsible for paying the difference personally.
  • I’m sure you’ll understand why I might want to compare prices and consider my options before I decide.

For More Information:  www.assertahealth.com

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