Advisers must break away from talking about health insurance

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NEW ORLEANS — An employee’s healthcare coverage has a huge impact on their medical decisions, with provider choice and cost of medications and treatment potential hurdles to their care. But an emerging model is providing the option of unlimited primary care for a flat fee.

With a direct primary care model employees pay a fee that provides them with unlimited access to a primary care doctor for anywhere between $60 to $150 a month — without insurance being billed. There are currently more than 1,000 DPC practices in the U.S., according to DPC Frontier, an organization that tracks this growing movement.

“As consultants it’s our responsibility to bring solutions to the table that can impact the cost of healthcare,” Julian Lago, president of healthcare and wellness benefits vendor Benezon, said at Employee Benefit Adviser’s Workplace Benefits Renaissance conference. “If you think about the fundamental way healthcare was assembled, the reality is that if you can take a variable expense and convert that to a fixed expense back to an employer, you’ve now taken a large variable out of that [system].”

Understanding how to negotiate DPC contracts can save money for employers and position advisers to take on new clients. But for advisers to devise solutions that will grow their business and provide employer clients with the right primary care options, they must leverage certain strategies that focus on healthcare literacy first and health status issues next.

“If you’re looking to grow your business in the self insured space then you really want to look at the healthcare supply chain management,” said Curtis Cannon, managing partner with insurance advisory firm Axis Recovery. “If you’re an employer and don’t have a model that takes away frequency and claims coming through, you’re going to be put at risk. DPC removes the middleman of insurance.”

Brokers and advisers looking to pitch a DPC model to their employer clients will want to emphasize it as a unique solution to healthcare cost issues, rather than their own relationships with the providing carrier, Cannon said.

“Lead with a solution that is unique to your market and you know your competition is not going to think about,” Cannon said.

Advisers and consultants must also shift the focus of the conversation from health insurance to healthcare. Employers are taking a more holistic approach when it comes to their employees’ overall well-being. Indeed, wellness programs are offered by 58% of employers, according to the Society for Human Resource Management.

“It is very common for someone to seek a specialist’s care [when it isn’t needed],” Lago said. “But a direct primary care physician has that knowledge to service 60% to 70% of common illnesses. As a consultant you need to break away from discussing insurance savings because you can bring other solutions. It’s a different conversation from talking about health insurance premiums to talking about healthcare.”

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Healthcare industry Employee benefits Adviser strategies Workplace Benefits Renaissance