Amid news that health insurance premiums will rise for nearly two-thirds of small businesses under the Affordable Care Act, Physician Care Direct today announced that Eastside Family Medicine Clinic has joined several other Puget Sound medical groups in adopting a health plan designed to better manage employer costs while benefiting patients and providers alike.
The addition of Eastside, a nine-provider group in Bellevue, brings to over 60 the number of Puget Sound primary care providers who have agreed to participate in the Employer Health Ownership Plan™ (EHOP™).
The EHOP is a healthcare purchasing strategy from Physician Care Direct that encourages greater use of primary care – low-cost medical services that address 90 percent of patients’ needs. Employers buy personalized primary care directly from providers and then add coverage for specialists and hospitalization. The approach ensures that primary care providers are fairly compensated for comprehensive care, while employers share in the savings from keeping employees healthy.
“Many studies have shown that timely and excellent primary care reduces emergency department visits, specialist visits, hospitalizations and surgeries,” said Antony Engal, MD, president of Eastside Family Medicine Clinic. “It’s about time that someone developed a health plan that recognizes that fact. Physician Care Direct’s approach is unique and one that we hope many more Puget Sound physicians and employers will embrace as they seek to improve the quality of patient care while lowering its cost.”
How the EHOP Works
The majority of U.S. companies contract with insurers for healthcare benefits that remain a fixed cost throughout the term of the contract. If they reduce healthcare expenses by encouraging employee wellness, those savings benefit their insurance company. Employers’ premiums rise as health system costs increase, leaving them at the mercy of cost shifting in an inefficient market.
The problem is especially acute for smaller businesses, which pay between 10 and 18 percent more for health insurance than larger companies, according to the Commonwealth Fund. Compounding the problem, the Centers for Medicare and Medicaid Services announced in late February that nearly two-thirds of small businesses that currently offer health insurance to their workers will pay more for coverage as a result of new rules in the healthcare law, as will millions of small-business employees and their family members.
Self-insurance under the EHOP can help by converting approximately 60 to 70 percent of a company’s healthcare expense to a variable cost. As a result, when the company and the EHOP succeed in reducing healthcare spending, underwriting profits flow back to the employer not their insurance company. The EHOP can also include reinsurance to limit the employer’s financial risk.
EHOP participants pay few if any out-of-pocket costs for primary care. Having comprehensive primary care available at no or little cost enables employees to better manage their health and reduce healthcare expenses.
Hospitals and health systems can offer their own private-label EHOP to employers in their area. The approach lets hospitals become the center of a community-based solution to improve care coordination and health outcomes.
“We know that timely primary care can improve the health status of Americans and lower costs, yet our healthcare purchasing methods are pricing employers out of business, causing physicians to abandon primary care, and bankrupting patients,” said William Lawson, M.D., CEO of Physician Care Direct. “With the Employer Health Ownership Plan, employers can save up to 30 percent of their costs, providers can practice medicine the way they’ve always wanted to, and employees can minimize their costs by engaging in healthy behaviors. It’s a common sense approach to a problem that’s been needlessly complicated by insurance companies.”
Along with Eastside, two other primary care medical groups are participating in the EHOP – Family Care Network, based in Bellingham with clinics throughout Whatcom and Skagit counties, and Qliance, an innovative venture capital-backed company that operates five “direct primary care” clinics in the Seattle area.
Upcoming Presentations on the EHOP
Physician Care Direct will participate in three upcoming meetings on health insurance reform in Washington State:
- March 12 at the Matrix Insurance Broker seminar in Seattle.
- March 25 at the Washington Association of Health Underwriters (WAHU) Spring Symposium, held at the Hilton Seattle Airport & Conference Center in Seattle.
- March 26 at the Washington Association of Health Underwriters (WAHU) Spring Symposium, held at the Lincoln Center in Spokane.
At all three events, Christopher Shoffner, Chief Risk Officer for Physician Care Direct, will present “Changing the Way We Pay for Healthcare: Aligning Incentives and Outcomes.” Shoffner will review the current state of employer health insurance and the benefits of the Employer Health Ownership Plan.
About Physician Care Direct
Physician Care Direct partners with employers and health systems to make healthcare more affordable. We deliver the Employer Health Ownership Plan™ (EHOP™)—an innovative health plan solution that starts with personalized primary care, then adds physician and hospital networks for a comprehensive solution. Now businesses of all sizes can offer their employees meaningful healthcare benefits while controlling and reducing costs. For more information, visit www.physiciancaredirect.com.
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SOURCE Physician Care Direct