Currently, payors (health plans and self-insured employers) are paying ~$25 per employee per month for traditional office-based primary care from doctors out in the wild. We all know today’s standard primary care is in disarray and it’s diametrically opposed to payors.
Doctors out in the wild:
- Are the antithesis of team players as they bill patients and payors as much as they can
- When making clinical decisions around treatment strategies or referrals, they are unaware of costs and they don’t think they should have to be cost-conscious.
- They are unaware of bespoke strategies each employer or health plan has put in place for their group to lower costs and improve the member’s experience
- Have ~70% overhead consumed by the 3 to 4 staff working for each doctor, the brick and mortar spaces they occupy, the inefficient processes needed to get reimbursed
- Are highly unproductive making them unnecessarily expensive (EMR documentation to maximize reimbursement consumes 40% of their day)
- Are happy to bring members into their offices unnecessarily because they make far better margins on the quick and simple things at the expense of the convenience of the member and the productivity of the employee
- Prescribe any medication they feel like, price be damned
Here’s a crazy thought.
Give primary care away to plan members.
Not today’s version of primary care, that would be really stupid. But primary care that can:
- Diagnose and treat 95% of what a traditional office-based PCP can for a fixed cost, without the variable costs and inconveniences of office visits.
- Scale to all plan members anywhere in America
- Be available 24/7/365
- Be powered by cost-aware doctors who, at each point in the clinical decision making process, are privy to each member’s bespoke strategies put in place by their employer or health plan
- Coordinate in-person care anywhere in America with preferred local specialists, labs, and facilities
- Serve as coordinators for predictable procedures performed at surgical centers that offer bundled pricing per procedure
- Do all of this for a fraction of the cost of today’s $25 PEPM messy primary care costs
Primary care doesn’t really move the needle. But a reimagined process of getting care and coordinating expensive downstream care does. When primary care rethinks itself, becomes a team player for plans and employers, and is a fraction of the cost, it should be given away. It becomes the Trojan horse that gets ahead of the downstream costs that truly drive most of the messy spend:
- Unnecessary in-person cost abyss care at specialists, ERs, and urgent care
- Procedures hawked by doctors who make more by doing more and charge professional and facility fees at nonsensical prices
- Medications prescribed by doctors who have no idea how much they cost
Sherpaa is Virtual Primary Care that does exactly what’s described. And it costs, at most, $250 per year per user. Give it to your employees and plan members. It’s a fraction of the cost of what you’re currently paying and you get so much more.
Health plan? Read more here.
Broker? Here you go.