Friday, March 25, 2011

Seeking new ways of paying for healthcare in the United States

Few if any people would argue that the healthcare insurance system in the United States works, at least unless they are making political arguments against President Obama’s health care bill. Even those folks, however, I’m sure would privately admit that the system is failing. Americans are paying more for their healthcare every year, yet health outcomes here are average at best. Additionally, with health insurance benefits being steadily cut, many Americans are finding themselves in the situation of having to pay for their healthcare, in addition to paying for their healthcare. Now is the time to begin experimenting with alternative ways to pay for healthcare, and I’ve recently noticed a couple of options that have really caught my imagination. And despite being a ‘crazy naturopath,’ I’m not going to suggest you go out bartering free-range organic quail eggs for your healthcare!

The first interesting trend I’ve noticed is the rise of fee-for-service practices. While NDs and acupuncturists have traditionally operated such practices, an increasing number of MDs and NPs are operating their businesses this way as well. This new wave of providers are offering not only primary care, but urgent care as well. In such an arrangement, you pay for services only when you need them, rather than paying a monthly premium whether or not you use the services. As a result, one of the groups that has gravitated towards these practices are the uninsured looking for lower-cost urgent care visits. Many fee-for-service clinics argue that by not contracting with insurance companies, they are able to offer lower prices to consumers, as much as 40% lower, in fact. For the uninsured, these clinics are often the best option in non-emergencies.

The other group that gravitates towards these types of clinics is the underinsured. This group is increasingly large, and includes everyone from people with high-deductible ‘catastrophic’ plans they have purchased themselves, to those with employer-based plans that also carry high deductibles and offer few services. Fee-for-service clinics often have shorter wait times, and patients find that they are able to get appointments sooner than they would with the doc designated by their insurance plan. Additionally, most of these clinics offer paperwork that can be submitted to insurance companies so that their fees can be applied to deductibles or be reimbursed. The combination of a high-deductible ‘catastrophic’ plan to guard against emergencies, combined with visits to fee-for-service clinics for urgent care and primary care is becoming an increasingly viable option, as it decreases the amount of money spent on unused services, and allows for better patient care and better access to doctors.

The second movement, still in it’s infancy, that’s caught my eye is being pioneered by Qliance in Seattle. This clinic operates as a modified ‘concierge’ practice, in that members pay a monthly fee that guarantees them access to a primary care doctor, covers visit fees and covers the most common lab work. Patients are still responsible for some incidental fees, such as medications and more advanced lab testing, but even so, Qliance offers very affordable services. The practice recommends that patients purchase high-deductible ‘catastrophic’ health insurance plans in addition to their subscription to the clinic, and most patients thus end up in a situation where they pay separately for emergency care (through insurance companies) and primary care (through Qliance). While in most circumstances, purchasing items a la carte increases costs markedly, this arrangement keeps costs low for consumers, and most importantly, provides excellent customer service. Qliance deserves plaudits for taking the ‘concierge’ model and using it to create affordable healthcare at a larger clinic.

Finally, I read recently about a start-up company named Castlight, who are taking it as their mission to ‘cast light’ on healthcare costs, with the goal of allowing patients to do comparison shopping when they purchase health insurance. If you are like me, you’ve tried to do comparison shopping for health insurance and have found it maddeningly impossible. It’s difficult to compare services, it’s difficult to compare what will and won’t be covered, and above all, it’s difficult to compare how much it will all cost you. Castlight seeks to enable consumers to comparison-shop, and understand how their actual health expenses will vary depending on what plan they choose.

While still in a pilot phase that’s being offered only at select employers, Castlight is planning on offering its services more broadly as they expand. This company has been lauded by the Wall Street Journal for applying free-market mechanisms to health care, and I believe that it will likely be a company you’ll hear more about in the future, and one that may inspire competitors offering similar services. I applaud Castlight for working to arm consumers with information; as I wrote in a previous column, I believe that it is important for health care consumers to be knowledgeable about health when they see their doctor, so why shouldn’t they also be informed about the economics of health as well?

The days when physicians were able to maintain something of an ivory tower about health are gone, and it’s time for us doctors to work in co-operative partnerships with our patients, not in benevolent dictatorships, as was done in the past. Patients want high quality care, and they want to be able to afford it. For decades, the American push for low prices has meant a similar trend to low quality, but these fledgling programs are showing that affordability and quality don’t have to be mutually exclusive. Ever skeptical, I can’t fully anticipate whether or not this will be able to expand into a viable option for millions of people, but even as we speak, a growing group of Americans are feeling great and not breaking the bank to do it.