Thursday, July 6, 2017

Excuse me, my copay is how much? - Direct Primary Care

As we ready ourselves to enter the 'dog days of summer' - you can't go online, read a paper or turn on a TV without someone utter the words, "HEALTHCARE" (cue horror movie music) 

We are inundated with updates about the repeal & replace debate going on in Washington DC.  The details and changes coming out of the halls of Congress move faster than a chicken on a june bug. 

Currently, under insurance - you get your outpatient, inpatient & pharmacy coverage through a policy that is managed by the insurance carrier.  You may get the new"ish" program embedded in that called Telemedicine where you have access to a physician 24 hours a day to deal with non-emergent issues, such as pink eye or a sore throat. The doctor can prescribe (routine medications)in most states, and you only have to go to the pharmacist to pick up the prescription.  No trying to get fit into an appointment or waiting in the waiting room for hours.  

But, did you know - there is a trend in the medical field - a trend that could possibly change how we receive our primary care?  It is called Direct Primary Care, and it is a new approach to medicine.  

We have seen this program in NYC, and some of our clients have actually purchased this for their employees, to sit on top of a high deductible insurance policy.  

You pay a subscription fee to a primary care group, and that fee gives you access to your primary care doctor.  Most visits are covered under the fee - you may pay a wholesale cost for blood work, and pharmacy is wholesale +10% (which, by the way, is the same charge that self-insured employers can get on their group plans).

Read more about this trend here.

By the way, the "dog days of summer" has nothing to do with dogs panting on a hot day, but comes from the Greeks and the rise of Sirius, the dog star and its position in the sky in July.  


Wednesday, July 5, 2017

Looking at the exchange numbers in NYS - while getting sun on a beach somewhere

Most of us enjoyed a 3, if not a 4 day holiday weekend celebrating our country's independence!  Hopefully, your vacation brought you to a state where you actually had access to your beaches and were able to take in some safe sun and fun.

If you still have some time for summer reading, I would suggest digging into the New York State of Health (NYSOH)'s report on enrollment for 2017.  For those that might not know, the NYSOH is the NY state exchange.  While many states opted out of their own exchange and use healthcare.gov, NY decided to manage their own.  The state was better off being able to manage and offer products that the federal exchange wasn't but the functionality of the NYSOH site is nowhere near the ease of the exchange site - I guess you can't have it all, after all.  

3.6M New Yorkers get their coverage through the exchange - that is about 18% of the total population of NY.  That does not include Medicare; those who get benefits through their employer or directly from a carrier with no subsidy.

Find out the details here NYSOH 2017 Enrollment Report

Enjoy the read, and it is quite timely, as it will give you numbers to put behind the debate that is occurring now in Congress.