Affordable Direct Primary Care Affordable Direct Primary Care Lee S. - - PowerPoint PPT Presentation

▶
affordable direct primary care affordable direct primary
SMART_READER_LITE
LIVE PREVIEW

Affordable Direct Primary Care Affordable Direct Primary Care Lee S. - - PowerPoint PPT Presentation

Nov 11, 2023 261 likes •561 views

Affordable Direct Primary Care Affordable Direct Primary Care Lee S. Gross, M.D. Founder, Epiphany Health President, Docs4PatientCare Foundation What was the Epiphany? Primary care SHOULD be affordable! Why is basic health care so

slide-1
SLIDE 1

Affordable Direct Primary Care Affordable Direct Primary Care

Lee S. Gross, M.D.

Founder, Epiphany Health President, Docs4PatientCare Foundation

slide-2
SLIDE 2

What was the Epiphany?

  • Primary care SHOULD be affordable!
  • Why is basic health care so expensive?
  • Third party disconnect from cost makes it

expensive.

  • Outside factors drive cost

– Hospital – Administrative costs – Pharmacy – Imaging – Labs – Specialty care – Physical Therapy

slide-3
SLIDE 3

What is Epiphany Health?

  • Direct Primary Care

– Membership Based Patient‐Centered Medical Home

  • Includes:

– Comprehensive primary care and wellness services – Access to a local network of steeply discounted labs, imaging, specialty care, physical therapy, pharmacy and more.

slide-4
SLIDE 4

Free Market Model

Over time, new technology prices come down in a free market

slide-5
SLIDE 5

What about health care prices?

Health care is not a free market!

slide-6
SLIDE 6

Why is health “insurance” so expensive?

  • It’s not “insurance”, it’s health maintenance
  • Traditional “Insurance” is for catastrophic care,

not first dollar coverage – What would homeowners’ insurance cost?

  • Light bulb replacement
  • Landscape maintenance
  • Housekeeping
  • Routine repairs

– Third party coverage drives up costs

  • “I’m paying for it, I’m going to use it.”
  • Administrative costs
slide-7
SLIDE 7

All other care

Balancing the cost of care

slide-8
SLIDE 8

Remove the cost drivers

All other care

slide-9
SLIDE 9

Most patients can be cared for at the primary care level

slide-10
SLIDE 10

There is a solution!

slide-11
SLIDE 11

How does it work?

  • Separates routine from catastrophic care
  • Monthly membership fee for primary care
  • Clearly defined package of services
  • Fixes the cost of routine care
  • Catastrophic insurance becomes a true

safety net again

  • Not fee for service
  • Total price transparency
  • Network of discount providers
slide-12
SLIDE 12

What’s Included?

slide-13
SLIDE 13

What’s Excluded?

  • There are no pre‐existing condition

exclusions

  • There are no co pays
  • There are no deductibles
  • There are two exceptions…

– Our doctors do not treat chronic pain – Our doctors do not prescribe chronic controlled substances

slide-14
SLIDE 14

Examples of in‐office savings

Service Typical Charge Your Cost Additional labs $50‐350 each $10 each Joint injection (knee) $150 $0 Skin biopsy $160 $0 Drain abscess $275 $0 Laceration repair $260 $0

slide-15
SLIDE 15

Examples of network savings

Service Typical Charge Your Cost Savings Nuclear Stress Test $1,470 $520 65% CT of the chest w/contrast $940 $211 78% Carotid ultrasound $425 $120 72% Colonoscopy $4,028 $1,127 71% Chest x‐ray $220 $22 90%

slide-16
SLIDE 16
slide-17
SLIDE 17

Hospital Charges

Lab charges $38.14 Chemistry $3524.14 Hematology $1,782.95 Urology $231.79 Chest x‐ray $490.94 CT scan $10,955.13 ER Level 4 $2,700.18 TOTAL: $19,723.27

Epiphany Charges

$8.00 $70.79 $15.00 $4.50 $18.00 $185 $0 $278.79

slide-18
SLIDE 18

What Does It Cost?

Monthly Membership

Individual

$80

with Spouse / Domestic partner

$150

Family (Dependent child 5‐27)

$175

slide-19
SLIDE 19

Savings with Epiphany

Family of 4 = $ 175 per month 2013 Average PPO Insurance* Family of 4 = $1,836 per month Difference per year: $17,292

*http://http://www.forbes.com/sites/danmunro/2013/05/22/annual‐healthcare‐costs‐surpasses‐22000/

slide-20
SLIDE 20

10 year projection – Family of 4

$168,340 [VALUE] $51,960 $0 $50,000 $100,000 $150,000 $200,000 $250,000 1 2 3 4 5 6 7 8 9 10 Total Savings Traditional PPO Insurance Epiphany + HDHP* *Aetna Health Network Option Value 10000 www.ehealthinsurance.com ($10K deductible, $258/mos)

slide-21
SLIDE 21

Employer of 10: Ten year total projection

$1,683,400 $2,203,000 $519,600 $0 $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 1 2 3 4 5 6 7 8 9 10 Total savings Traditional PPO Insurance Epiphany + HDHP Assumes middle aged employees with families of 4.

slide-22
SLIDE 22

Saving a profession…

Service Revenue Annual patient dues $960 Labs Mammogram Influenza vaccine Pap smear 25 office visits Our Cost $30 $25 $6 $28 50% overhead

slide-23
SLIDE 23

Saving a profession…

  • Expenses of guaranteed services are covered

with first month’s dues

  • $80 per month x 11 months = $880 net revenue

per patient per year

  • 500 patients x $880 = $440,000 annual revenue
  • less 50% overhead = annual net $220,000
  • Epiphany can be added to an existing practice
slide-24
SLIDE 24

Saving a Nation

  • ACA estimates 32 million newly “insured”
  • Many of the “insured” will be on Medicaid
  • Estimated 26 million remain uninsured
  • Current 10‐year CBO projected cost $1.8 trillion
slide-25
SLIDE 25

Saving a Nation

  • If ALL 58 million uninsured were

enrolled in Epiphany Health…

  • Total 10 year cost = $556.8 billion

Net 10 year savings…

slide-26
SLIDE 26

Saving a Nation

$1,355,200,000,000!!! $1.3 Trillion

slide-27
SLIDE 27

Any questions?

www.docs4patients.org

slide-28
SLIDE 28

Epiphany Health Practice A Practice B Practice C Patient Business Other third party contracts Patient Business