A Shift In Healthcare

There is a shifting taking place in healthcare. Our current healthcare model and insurance options are expensive and disappointing. But, there might be one good thing that comes out of the 2020 pandemic: it might change the future of how we view healthcare.

I don’t know about you, but I have been fed up with conventional medicine for a LONG time.

Among other things, conventional medicine and insurance do the following:
1. Name a disease and manage symptoms.

2. Charge enormous amounts of money for insurance that is terrible and barely covers anything. Many people even purchase supplemental policies because their plan doesn’t cover enough.

3. An insurance model that forces conventional medical providers to outrageously inflate pricing just to have the insurance company “discount” it, then charge me the rest. When in actuality, if I had paid cash in the first place the bill probably would have been less.

4. Premiums are through the roof on top of it. You’re lucky if your employer covers 2/3-1/2 the premium. Well, let me tell you: those people like me who are self employed pay out the whazoo!!! A family of four can pay up to $2,000 PER MONTH just for premiums. And, that was with a high deductible and max-out-of-pocket of $7,000 and $8,500 respectively.

So essentially, a visit to the doctor (unless it was a wellness visit) was completely on us, doctor/medical provider jacked up fees, insurance “discounted” it, then we paid it until we reached our $7,000 deductible. So, really all it was good for was a major medical plan if one of us ended up in the hospital or needed surgery.

We have to think about health insurance differently.

We have to do healthcare differently.

Health Insurance

As far as insurance, we switched to a medical sharing program. We qualified for their healthy lifestyle discount for having good blood pressure numbers and waist measurements (indicative of diseases like diabetes, cardiac risks, metabolic problems).

Our monthly premiums are less than $400! We set our max-out-of-pocket (also our deductible) to $10,000 – not much more than then standard insurance max out of pocket anyway). Note: you can choose a lower deductible/max amounts and that will change premiums – but still affordable.

So, we could pay $24,000 per year with standard health insurance. Or, $4,800 per year with a medical sharing plan with about the same coverage.

The medical sharing plan still discounts the doctor visit but it seems like I pay less for a conventional doctor visit. Plus, I can see one of their contracted doctors via telehealth for free anytime!

We need to look at health insurance differently.

You’d never expect your car insurance company to pay for your oil changes or for new tires or brakes. You expect your car insurance to cover for an accident that requires major repair work.

The same applies to our health insurance. We need to maintain our vehicle (healthy eating, exercise, sleep hygiene, stress management) and pay for regular visits to achieve our optimum health (such as with Functional Medicine practitioners). And, then look at our health insurance as major medical plans for major health issues/accidents.

Now, I realize with only 6% of Americans engaging in regular healthy activities. So, we have a lot of sick people here.

But, I have hope things can change.
We can change.
YOU can change.
The broken system can be changed.

Healthcare

First, we have to change from the mindset that we only want to pay $10-30 co-pay for a doctor visit. For one, doctors do need to be paid what they’re worth. But, also, YOU are worth more time than conventional medicine has allowed you!

Traditionally, you see a doctor and he or she prescribes a medication at the end of the 12-minute appointment. The medication only addresses the symptoms. The root cause of the symptoms is never addressed or discussed. The problem just gets worse until you are back in the doctor’s office and the medication is being increased or changed. But, the root-cause is never addressed.

I have seen a Functional Medicine provider for the last 4-5 years. I pay cash. My practitioner doesn’t take insurance because he spends MUCH more time with me as a patient, listening and getting to the root cause of my symptoms so he can address the problem at the source and turn it around. Yes, it costs more upfront. But it is SO worth it because I’m not just managing symptoms, I’m eliminating them completely and preventing the need for further medical care for that problem in the future. Besides, even if he were covered under insurance, I’d be paying anyway!

An article last month in The Hill talked about how doctors have been incentivized to see more patients. It seems to me that they didn’t have an interest in helping people get well. It was all a numbers game to earn more money. I am sure the doctor cares, that is why he or she became a doctor, but the system is rigged against them.

Maybe now that the structure is changing, and healthcare can be better.

A portion of The Hill article says, “Why isn’t patient-centered care just standard of care? One of the major barriers is how we have traditionally paid for health care: Under the fee-for-service model, the provider only received payment for a procedure or visit. But patient-centered care requires many time-consuming duties that are not patient visits, such as reviewing the medical record, reading and responding to email and phone calls, and monitoring tests. Under the fee for service model, those activities were not compensated.

The transition from fee-for-service to a more integrated form of patient compensation has been much too slow. As a result, physicians have been incentivized to fill their schedule with office visits. Many of these visits are not needed; they benefit physicians and the health care facility more than patients. Now that telehealth visits are being reimbursed at close to or equal to what office visits were, we can come closer to putting the patient at the center.”

Thanks to the Coronavirus, telehealth is booming. Now that the system is getting used to telehealth and virtual doctor visits, it means that they may start looking at a membership-based model or clinics may receive monthly payments from health plans to care for a defined group of patients. This will better incentivize clinicians to improve patient outcomes versus see as many as possible. I am all for this because it means better care for you and me!

An article in the Los Angles Times presents a membership model of healthcare by saying, “In addition to their monthly payments, which vary substantially based on how sick patients are, (Iora and other) clinics that don’t use the fee-for-service system often get bonuses if their patients stay healthier. They can lose money if their patients get sicker or end up in the hospital.

“This creates financial incentives for the clinics to find ways to improve patients’ health instead of simply bringing patients into the office to see a doctor. That’s particularly important for people with chronic medical conditions such as diabetes and heart disease, which can lead to serious and expensive complications if not well managed.”

So, if there is one good thing that has come out of the Coronavirus, it is a possible change in how healthcare is structured.

However, health isn’t something that should take place in a doctor’s office a few times a year. Chronic disease is driven by diet, whether we choose to exercise, how much sleep we get, and how we handle daily stressors!

Health insurance should be viewed as a major medical plan for major incidents. Healthcare should happen every day through the choices we make to maintain our vehicle – our bodies! Our health will change when we begin to view it as part of our daily lifestyle choices and not just a doctor visit, and when WE start taking charge of our health.

As a health coach, I help people manage chronic conditions and make healthy lifestyle changes they can sustain so they can properly maintain their vehicle. If you would like to explore the possibilities, reach out and schedule a free 30-minute call. Let’s talk about how you can change your healthcare.