“We have a Frankenstein Health Plan! PLEASE tell us about your Sleeping Beauty Health Plan!” – Struggling in Pretoria
A recent post on Linkedin rings true:
“It’s a bit crazy that many brokers are so terrified of Medical Cost Sharing + DPC that they will put together the ugliest Frankenstein of a health plan with 12 different vendors and like 20 contracts for an employer who has no clue how it all works. The employees are utterly confused and need to be handheld by some random RN who serves as care coordination. Still almost no consumerism injected into the plan. Just a ton of steerage, coordination, and handholding. Is that really “innovative”? Yeah, I guess you saved the employer money for a few more years, but it still seems pretty unsustainable.” – Ben Butler
Self-funded non-traditional health plans are typically loaded up with all kinds of fees for this and that and everything else. Legal representation, repricing fees, concierge fees, etc., all adding up to over $100 pepm in many cases leaving less to pay claims.
Most of these add-on fees are designed to make healthcare more affordable with easier access to care and a better consumer experience. The unspoken premise driving all of this is that ignorant plan members are incapable of navigating the complex health care system on their own.
Plan sponsors need to give plan members some credit and stop practicing Helicopter Motherhood. It’s an unnecessary expense and creates dependency.
Instead of all the bells and whistles and the added expense involved, why not duplicate the plan that most American medical providers accept?
The Sleeping Beauty Heath plan.
Here’s what the plan looks like:
HOSPITAL: $1,632 in-patient deductible, then 100% DOCTOR & RELATED SERVICES: $240 annual deductible, then 80% PRESCRIPTION DRUGS: broad formulary PROVIDER REIMBURSEMENT: 100% of Medicare
Summary: $240 annual deductible (2 office visits or 1 lab test) and you’re off and running. In the rare event you are hospitalized (how many times in your lifetime have you been hospitalized? Once when you were born and then how many more, 1 or 2 more times?) you have an in-hospital deductible of $1,632 which is well below what most plans require in this day and age. This coverage is so good you don’t need a supplement.
Providers accepting Medicare patients should have no problem accepting this plan because it’s the same plan. And the best part is lower plan costs. Whereas traditional managed care plans tout a 50-60% phony discount, a plan paying 100% of Medicare averages an 80-90% discount off phony billed charges.
Will employers adopt this model? Employees should hope so because employers that do will reduce health care costs which have always been paid by workers through lower wages (try explaining that to Joe Sixpack). The savings can be passed on in the form of higher wages (No need to explain that to Joe Sixpack, he will immediately grasp the concept).
We know of one employer who has adopted an improved version of The Sleeping Beauty Health Plan…………..they removed both deductibles. And the employees love it!
