Currently, one-third of American workers are in high deductible health plans and this will only increase as employees and employers attempt to save on premiums. But our healthcare system is not set up to know how to spend your money wisely. It’s impossible to know how much visits, tests, and procedures cost ahead of time. Even when doctors and reporters, who should know how to figure this stuff out, try to shop for prices, they are stymied by gag orders and complicated billing practices spread out across surgeon’s fees, anesthesia fees, and facility fees. Just getting a price for a PCP, urgent care center, or ER is impossible. And the average out of pocket costs (co-pay + bills received later) for each are:
- PCP: $250
- Urgent Care: $350
- ER: $2,000
High deductible health plans alone are unfair to employees. They’re stuck on their own with nobody to help them spend their hard-earned money intelligently. If you’re going to offer them, you’ve got to partner with virtual primary care (VPC) services that can diagnose and treat the vast majority of their problems for a fixed, transparent cost and help them spend their money wisely when they need in-person care.
VPC Benefits Employers
Virtual Primary Care prevents the majority of employees from reaching their deductible and generating claims (a $36,000 ER bill for a simple pneumonia? Really?) that subsequently impact a self-insured employer’s costs.
VPC Benefits Employees
VPC helps employees spend toward their deductible only when they absolutely need to be seen in-person, instead of going to an ER, an urgent care center, or directly to a specialist when they feel they have nowhere else to go.
How much do employees with high deductible health plans spend on care?
Luckily most of your employees are likely pretty healthy and not huge spenders.
So, this means ~80% will spend money on healthcare but not reach their deductible. As the concept of the high deductible plan has caught on, doctors and hospitals are still billing as if insurance companies are on the hook for the first dollar. That’s why they’re billing $4,500 for an MRI when the cash price for an MRI is ~$700. High deductible plans are unfair to employees.
So, how can you help your employees who are on their own facing a system designed to extract as much money from them as possible?
There are three ways:
- Keep them out of this opaque system as much as possible
- Introduce them to a healthcare service that transparently solves the majority of their problems instead of in-person care
- Use cost-conscious online doctors who will work with your employees to coordinate local in-person care and procedures intelligently and cost-effectively
What are the majority of their problems?
It’s just bread and butter primary care. They get sick, hurt, or have some relatively not-so-serious thing that still requires a visit to a specialist. They’re finding random PCP doctors who have availability that day on ZocDoc, or visiting urgent care centers, or if they Googled something and got themselves super worked up, they may even visit the ER for $2,000. It’s things like:
What are options for companies?
They are limited because primary care is hard to scale geographically to reach all employees with a service that can diagnose and treat the vast majority of primary care issues online without sending employees into the System.
- Video Visit Services: limited to diagnosing 30 simple problems and get 2-3% engagement.
- One Medical: They’re mainly in SF and NYC with a small number of practices in a few other cities. Employees must travel to a brick and mortar practice to get care and they must switch their care to One Medical. Benefits should scale to all your employees in America. Their telehealth services are limited to a few conditions staffed by nurses only after you’ve established an in-person relationship with one of their PCPs.
- Direct Primary Care: directly contracting with many different primary care doctors located where your employees live and work is untenable. It’s impossible to scale to all of your employees.
- Sherpaa. We’re an exclusively online medical practice delivering care anywhere in all 48 states. We diagnose and treat 70% of your employees’ health issues without an in-person visit. And for the times when we do refer, because we’re primary care doctors and know exactly what the employee needs for their unique situation, we refer appropriately to specialists, urgent care centers, and occasionally ERs. Only about 3% of the time we refer to local PCPs and because of that, we scale primary care to all employees in America.
Pairing high deductible health plans with accessible primary care available anytime from anywhere is simply the right thing to do. For the 80% of employees who do not spend their entire deductible, this will save them hundreds to thousands of dollars and keep them out of the high spender category that impacts your company’s healthcare costs. And Sherpaa can help.