Alternative Health Insurance Models

With insurance costs sky-high and reform questionable, other insurance options are popping up and become first choice for more people. Most families struggle to afford $700-$2,000 average monthly payments, sometimes paying more for health insurance than their house.

Diane, for example, is totally disgusted and very typical insurance shopper. At 27, she has a good job, lives in a decent apartment, and is finally getting her life settled. But, her job doesn’t offer health insurance, so she’s left alone to pay for it on her own.

Like many other young professionals, she’s faced with a huge decision:

Nearly $1,000 a month for health insurance she will barely use or go without.

But, if she ever ends up in the hospital, she could be faced with a lifetime of crippling hospital bills.

Facing this kind of dilemma is a daily struggle for millions of people and families throughout the US. Including mine. We went through a job transition and chose to go without health benefits for half a year. My wife and I had three kids in middles school at the time but with no stable income we just could not fathom paying almost $1,500 a month for COBRA benefits.

Different Ways Around Health Insurance

Like millions of other people in the United States, we’re looking at various ways of affording hospital bills without having to resort to high-cost healthcare. It’s not an easy choice, because some of the options do not cover extended hospital stays or treatment for diseases and some only provide discounts.

But, these are the options I want to make people know and use because they work. 

The uncertainty in the health care economy prompted a resurgence of alternative health insurance models people are flocking to by the millions. No longer fringe movements, many of these models are now standards in certain areas. 

You can also find more details on these alternative insurance models in my book Health-Wealth for You: 11 Steps to Save Big & Live Healthy throughout Part 3.

Health Savings Accounts

Many employers are opting for Health Savings Accounts (HSA) for their employees. These are specific employer-provided savings accounts that set aside a certain amount of the employee’s paycheck and/or employer contribution for the sole purpose of helping pay for medical bills. 

These became a much more popular option as insurance premiums skyrocketed. Employers began choosing higher deductible plans and setting up HSAs to offset the deductible. When employees paid for their medical care, the health savings account reimbursed them.

Will This Work for Me?

If your employer offers insurance and an HSA, most financial advisors will encourage you to contribute significantly to the HSA. It helps offset costs and used for many services such as nutritionists, massage therapists, and alternative medicines.

Some banks and credit unions will allow you to set up an HSA without your employer under certain conditions. This works very well for the self-employed or for those whose company does not offer health insurance.

Cost Sharing Community Models (CSCM)

One of the next steps away from traditional health insurance is having cost-sharing models that prioritize the use of virtual doctor’s visits, apps and technology, and remote monitoring. Many CSCMs help their members by offering discounted services, especially for patients who are paying cash.

Sedera Health is one program. Members of Sedera Health self-pay for the health care costs, and Sedera helps negotiate what the patients will pay. This bill negotiation process can significantly reduce the cost of many standard and emergency procedures. It’s also excellent for people who take a small number of regular prescription medications. Similar models exist for dental and vision programs. 

I regularly speak to organizations and businesses that want to offer their employees options to expensive and complicated insurance programs. Personally, I am a member of Sedera through a cost sharing model called Fit Health. If you’re going to explore this cost-saving measure in your workplace, please visit http://wearefithealth.com//drluke to learn more.

Will This Work for Me?

For people who are in general good health and do not often need to see the doctor, a CSCM works very well. It can significantly reduce your costs for health insurance. As new regulations are taking place and basic, emergency only insurance begins to re-emerge, the cost-sharing model will become more popular.

Faith-Based Cost-Sharing Models

Faith-based cost-sharing models are becoming more popular in the Mid-West to the West Coast of the US, although they are available through most religious organizations. Membership is usually limited, having to be part of the organization’s faith, and members are often required to live by specific standards. However, if this option is available to you through your church organization, it’s an option that can benefit you in the long run.

Most faith-based models have members pay a regular monthly due to a community account. Then, as members incur medical expenses, they apply to this community account for reimbursement. Members take a slight risk of not being reimbursed, depending on the status of the fund, but usually gain their money back.

Will This Work for Me?

If you belong to a faith-based community that offers these programs, it is worth your time to investigate how large fund typically is and what the repayment policy is. Currently, there are hundreds of faith-based cost-sharing models throughout the United States and well over a million people belonging to these groups. They are successful at helping people with bills and costs. Christian Care Ministry gives a great break down of their service and how it would work for you.

Value-Based Insurance Design (VBID)

VBIDs are specialized health care tactics that prioritize high-value, proven procedures.  This model emphasizes shopping around for the best value for specific procedures, not always the lowest cost.

Because the provider of this type of insurance requires prices and clinical outcomes to be specific and transparent, patients can choose between different providers and procedures. Because the rates, co-pays, and cost of the patient are available for review, healthcare costs are driven down with the right type of choices.

For example, the company Walmart has chosen the VBID for many of its procedures. When it comes to knee problems, Walmart fully supports its employees opting for knee replacement surgery. However, they’ve negotiated with various institutions to provide high-value services for the lowest cost. Employees can choose to use Walmart’s selected facilities, often with minimal co-pays, or other facilities with a higher co-pay. For some people, it’s a natural choice, but for others, they may have to travel a significant distance to use a preferred facility.

In Episode 21 of my podcast Dr Luke’s Waiting Room, Doctor Bill Hennessey, founder of Pratter, Inc. created a tool for companies to know how much they spend on various procedures at different facility. It helps people price shop and know the real value of their surgery. 

Will This Work for Me?

If you’re part of this type of system, it can save you money. You’ll have to do more work before procedures to choose the most cost-effective and highest value treatments. In the long run, for higher-priced services, it can save significant amounts of money.

Private Membership Programs

As insurances are driving up the clinic cost of many routine medical procedures and requiring extra personnel to submit insurance claims, many of these small clinics are opting out of accepting insurance altogether. For some, they face the choice of abandoning insurance or going out of business.

So, many created their own third choice: they’re offering a self-pay membership program. This is one insurance option that I support and belong to.

These membership programs offer a set number of services for the members to take advantage. Many of these programs charge a fixed monthly fee and provide routine health checks, urgent care visits, minor in-office surgeries and procedures, and other accessory medical needs. Membership to many of these doctor’s offices ranges from less than $50 per month to several hundred.

And it’s not just small doctor’s offices that are offering the service. Larger hospitals are also exploring this option and may be able to provide a broader range of services. Most of the time, the doctor’s websites will inform you if a membership option is available.

Will this work for me?

For most people in decent to good health, this is a very reasonable alternative to health insurance. People can get the routine medical care they need, the prescription medications, and minor procedures.

Catastrophic Health Insurance

With all the options available, and with changing regulations, catastrophic insurance may become an option in the near future. Coverage that supplies just emergency medical treatment, lengthy hospital stays, and extensive surgery, without providing any routine care, may become an option again.

If you choose an alternative health insurance model, be sure to have funds set aside for emergency care. Most alternative models do not cover emergency care, although they are perfect for routine care.

With the rapidly changing landscape of American health insurance, we can only guess where things will go. Remember, in the last decade, we’ve seen insurance costs rise nearly 1000%, force everyone to have insurance or be fined, take medical procedures they won’t ever use (maternity), and have over a thousand different regulations enacted and redacted. 

We can only wait and see what the future will hold. Taking control of your Health-Wealth maybe the only secure financial decision you can make.

Preventing Unnecessary Medical Care 5 Steps To Helping Your Employees Become Engaged Health Care Consumers

The days of trusting your doctor to take care of all of your health care is over.

Between doctors used to Medicare paying everything (which lets them over-prescribe and over-charge) and medications and health insurance cost going through the roof, the only option to save money on health insurance is to engage your employees into make smarter choices.

You need to become partners in this fight!

In my book, we discuss multiple different apps, services, and cost-saving measures that will help you reduce your insurance costs and save your employees some money. See Health-Wealthfor Youfor more information.

The first step in saving money…

Getting your employees to become Engaged Healthcare Consumers.

Being an EHC means your employees know what’s going on with their health. They make informed decisions about medical tests, treatments, and prescriptions, and look outside of the traditional allopathic medicine community for alternative medicines.

It’s about personal responsibility – take care of yourself and your family first!

Imagine being able to talk with a doctor and get all of the options available to you, not just what your insurance will cover. Imagine being able to shop doctors, procedures, and medicine like you would for shoes or a new TV.

As new legislation comes through by executive order and Congress, people will be able to make informed choices and save money. But, like everything else with the government, it’s going to take time to implement, sometimes years.

We want to save money right now.

Start taking these steps to help your employees become Engage Healthcare Consumers. When they see the cost savings, it will be easier to implement bigger and better strategies with their full cooperation. And, some of these will help save you thousands of dollars on your health care costs.

1.    Discuss Health Insurance Premiums with your Employees

You and I both know that for every employee you insure, it cost you between $1,100 and $1,500 per month. How much are you having your employees contribute? 5%, 10%?

Chances are, your employees have no idea how much their insurance plans cost. All they’ve seen is the deductions out of their paycheck and the deductible at the office. And those keep going up – creating resentment.

It’s time to be upfront with your employees and let them know the actual cost of their health insurance. Discuss the different plans and the different costs, and you can get your employees on your side.

They may even have suggestions you haven’t thought of yet!

2.    Provide Apps & Services Directly

In my book, we discussed several services and apps designed to help people take charge of their medical care.

One of the apps you can provide your employees is called Calm. It helps people with frustrations, emotional upsets, and provides basic counseling. When you provide this app to your employees free of charge, they can engage with low-level counseling that will save hundreds of dollars in insurance costs.

Another option is paying for life coaching, massage therapy, and other holistic medicine out of pocket. Healthy, happy employees work harder and cost less. Providing free 10-minute chair massages from a licensed massage therapist costs significantly less than an insurance claim for a wrenched back.

In 2005, a study showed that back pain sufferersneed $2,580 more in medical care per year and nearly 80% of all people will suffer back pain. Plus, time off, lost labor, and reduced productivity cost you money.

Compare that to a 10-minute chair massage once per week costing $520 per year. It may save you over $2,000 per employee!

3.    Discuss Your Employees Health Issues (Legally)

Imagine if you knew your employees had a potential health problem before they caused problems? What if you could make a few minor changes and reduce them taking time off, visiting doctor after doctor, and driving up insurance costs?

It’s illegal to ask about employees medical conditions prior to hiring unless it interferes with their work and safety. It’s also a touchy area legally to discuss it after they’re hired.

But, if you ask them to share with you any medical problems to resolve right now, you may be able to work through some of them, make adjustments, and provide a better working environment. Just be sure to let them know that it is not a requirement they do so.

Pregnant and breast-feeding women have one of the most significant challenges in today’s workplace. The top discrimination lawsuits are from pregnant women over some really ridiculous reasons..

Let’s take for example a woman who is pregnant with her first child. She will see a doctor every couple of weeks, need more frequent bathroom breaks, and may require a different chair to accommodate her growing size and ability to move. For most businesses, that’s a really easy solution and makes you and the new mother happy.

If you start a dialogue with her early on in her pregnancy, you can communicate different services you can offer to help manage her needs during pregnancy long before they become a complication.

By being open and honest about your employee’s needs and what you can do, you avoid bad feelings and potential lawsuits.

4.    Provide Options for HSA, Alternative Medicine, and Self-Care

The fastest growing area in healthcare is Complementary and Alternative Medicine. Set to exceed $10 billion in out-of-pocket payments, people are taking full financial responsibility for different healthcare options, like massage, acupuncture, and supplements.

Massage therapy is the largest provider of alternative medicine. It’s also one of the easiest to get and cheapest to provide. As Ken Lee, owners of Kenneth Mark Mobile Massage, who specializes in taking massages to the people homes and offices, says: “Employees love massage day [from their company]. It give them a chance to de-stress, reset, and even just a few minutes in the massage chair can make their day better. A clear headed and refreshed employee returns to work feeling renewed.”

Your various options for self-care go way beyond just massage. You can provide a Health Savings Account for your employees to use for nutritional services, supplements, and other medical expenses not covered by your insurance. Not only is this a benefit for your employees, but it’s also the tax write-off for you.

5.    Negotiate with Local Doctors and Hospitals for Direct Pay Care

A growing alternative to traditional insurance is negotiating payments directly with doctors and hospitals. You pay for a certain amount of services or have a set fees for services to pay the doctor directly. By eliminating the headache of insurance paperwork and delayed payments, you can get significantly lower costs.

For one of my clients, we recently negotiated with a large health system to cover basic medical care, routine appointments, and some of the most common surgeries their employees obtained and ended up staying close to $3 million a year in insurance costs.

I don’t think you need to be a large company to save this money. Small businesses of all sizes are negotiating with different providers for services of care. If you would like more information, please call or email me directly.

Conclusion

The top principle of lowering your healthcare costs is getting your employees engaged. This means you need to talk with them and let them know what is going on with their health insurance and various costs. You need to get your employee to take responsibility for their health and work as partners to save money and time.

Engaged Healthcare Consumers are healthier, harder working, and save themselves and you money.

Becoming Engaged Healthcare Consumers

Originally Appeared on Forbes.com

Premiums are going up and your employees aren’t happy. If you’ve taken the steps in part one, you started the discussion on why your employee’s health care costs are going up. You’ll know who is now thinking about health care in a whole new way and who wants to stick to the old way of doing things.

It’s your duty to your employees and business to encourage Engaged Healthcare Consumer (EHC) behaviors. We have several tips and ideas to implement in the book, Health-Wealth. It’s designed to help you understand why prices keep jumping up and how to save costs on your health care spending. The Health-Wealth not for profit education division offers an interactive exercise for your corporate benefits teams, to assist them in starting the cultural shift of converting employees to EHCs.

Additionally, you can assist your employees to be more responsible by having them read Health Wealth for You, 11 Steps to Save Big & Live Healthy. This follow-up is for your employees to start saving money on their own health care costs.

Now, let’s take a look at a few of the suggestions.

Health Savings Account (HSA)

More insurance plans and companies are implementing HSAs. These are accounts that employees and employers contribute funds to, usually tax-free. These plans can be used for any health or medical expense. For example, many employees use it to pay deductibles and prescription costs. Other people may use it for massage therapy, nutritional services, or other wellness product.

One of the more significant benefits of HSAs is you as the employer can contribute to this account. Depending on your business model, your contributions can also be tax deductible.

Explain to your employees why you’re contributing to HSA rather than getting them a lower deductible. The reduced employee contribution and the HSA can offset the cost of the higher deductible for many employees.

For the younger generation, Generation Y and Millennials, HSAs can help pay for services not covered by the insurance companies. For healthier individuals, they may not fulfill the deductible no matter how high or low. An HSA makes more sense.

Higher Pay Vs. No Health Care

Depending on the size of your company, you may fall into a bracket that you may not need to offer health insurance at all. In some cases, these companies will opt to pay their employees significantly higher wages and/or contribute to large HSA.

For some companies, the cost of government fines for not providing insurance is lower than the cost of health insurance. Be sure to know your legal responsibility before choose not to offer coverage.

Gym Memberships, Weight Loss Programs, & Other Incentives

Before purchasing any new health insurance, talk to the wellness advisors to see if there are any discounts for healthy employees, wellness plans, and other incentives. Many insurance plans are helping to lower deductibles and premiums when employees take advantage of weight loss programs, gym memberships, and insurance sponsored wellness plans.

For example, most insurance companies have nutritionists on staff to help with weight loss, dieticians to help with diabetes and blood pressure control, pain management specialist to help people avoid painkillers and other opioids, and health coaches the help people feel better and be more active.

You should also help your employees to quit smoking, avoid recreational drugs, and reduce their alcohol intake. Because premiums are built upon risk factors, lowering the risk factors in your employees can help lower your overall insurance cost. Many people who smoke and abuse mind-altering substances, like alcohol, genuinely desire to get rid of their addiction but don’t have the support in place. By offering that support, you help your employees be healthier, more productive, and lower your insurance premiums.

Some insurances offer discounts when you hold a health fair for your employees. Usually, local businesses and health offices will volunteer to set up a table and give out free information during these fairs (many come for the free lunch). It’s a chance to talk to potential new patients for these health businesses.

Telehealth & Remote Monitoring Services

Nearly all insurance companies now offer some form of telehealth or the ability for the insured party to contact a doctor via phone or video. Many doctors can diagnose, prescribe, and treat a patient without ever having to see them in person. These services usually are significantly reduced in price, often being less than a standard deductible.

These services are an especially important step in the treatment of chronic and lifestyle diseases. For example, heart disease requires frequent check-ups. Patients who can monitor their blood pressure and diet at home can use electronic links to automatically submit the information to the doctor. Medications can be adjusted as needed, and a wellness coach can be consulted virtually to help with lifestyle techniques. Patients who visit a doctor every three months can reduce this frequency to once a year.

Overall, patients have better and faster access to doctors and medicine via telehealth.

There are several other examples of how an employer will save in the book Health-Wealth, such as how to save money on prescriptions, choosing center-of-value hospitals, and much more.

Navigating Negative Feedback

We all know you’re not going to make everybody happy. No matter which plan you choose, how low the deductible, or how small the premiums, someone will find faults with your choice.

This resistance is especially true when it comes to having to talk to your employees about raising their insurance costs.

There are three basic steps you can take to reduce the impact of negative comments and help all of your employees understand your position and the inevitable rate increase.

Listen to constructive negative feedback

There’s a significant difference between listening to constructive feedback and allowing people to rant and rave. Tell your employees you welcome calm input and are willing to have a conversation about what’s happening with the insurance. However, do not allow your employees to fall into the trap of venting their frustrations with no purpose.

Listen to constructive negative feedback

Yes, we know we listed this twice. It’s that important. Once you know you are getting valuable feedback, listen to it thoroughly without interruption. Ask questions if you don’t understand something. Once your employee has finished their feedback, summarize and repeat back to them what they said. Then, ask them if that is their concern and if you missed any significant detail.

Once you have your employee’s feedback, it is up to you to decide what to do with it. If it is something that will help you lower your costs and benefit your employees, you should work with your employees to implement the process. If it is something you cannot do or will end up costing too much of your profits, explain to your employee why it is not a good idea.

Share the feedback you receive and your response

If one of your employees has a complaint, chances are many more do and are unwilling to come forward. By not sharing, resentment can fester.

When you share the negative feedback and your response to it, you help address many problems that could potentially arise in the future and resolve them before they ever become a problem. It also shows your employees that you are willing to listen and consider their concerns.

Will this solve all the problems? Probably not. Insurance premiums will likely continue to rise over the next few years.

Many changes came to the healthcare system in a very short amount of time. The rising cost of healthcare and insurance left many people choosing to opt out of the system entirely, placing a more substantial financial burden on to doctors and hospitals, which eventually get passed through to the insurance companies and back to the people.

While we can’t change how the insurance companies work, nor beat the health care system, communication with your employees can help them understand why the costs are going up so much.