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Three Strategies to Help Patients with High-Deductible Health Plans


Three practices are taking innovative approaches to assist with their patients’ out-of-pocket obligations.

Increasing patient deductibles and co-pays represent real, and growing, challenges for practices and patients alike. The public focus may be on the uninsured, but high-deductible policies leave a fast growing majority of newly underinsured facing thousands in out-of-pocket expenses each year, and many are struggling, increasingly to the point of foregoing all but the most urgent care.

I interviewed the heads of a large primary-care and multi-specialty provider, a regional ophthalmology provider, and a growing dental group, each with an innovative approach to assisting their patients’ out-of-pocket obligations. Simon Samaha, M.D., the president of New Jersey’s 250-doctor Summit Medical Group, is particularly sophisticated in his approach. He is working to cut patient out-of-pocket cost rather than price, and one year later, his first test program shows promising results.

With employers managing rising healthcare insurance costs by shifting them to employees in the form of higher deductibles in manufacturing-based, large employer-intensive New Jersey, this cost shift to patients is an issue for Summit, according to Samaha. It is exacerbated because big, diverse, service-intensive practices come with higher fee schedules than mom and pop offices.

Samaha and his team are working with brokers and CPAs to “explore opportunities to counter out of pocket contributions.” This means finding ways to manage usage of diagnostics and ancillary services with a changing definition of what is medically necessary. The largest casualties may be farming out ancillary services such as diagnostic ultrasound and blood work to third parties that have been in-house staples for years. More and more patients are beginning to price shop, and Summit, as big as it is, can’t compete with a specialized service, particularly when part of the plan is to reduce usage.

The real challenge, however, is not achieving reduced out-of-pocket expenses without reducing prices, but convincing patients their care will not be compromised and, while it will cost more out of pocket to start, the savings really kick in over time. Another even tougher challenge may be in convincing physicians who risk being second guessed in a malpractice suit.

The first test with a mid-sized/large employer was a perfect environment - the company announced higher deductibles with Samaha there to explain how Summit was working cooperatively to reduce out of pocket costs. It is a success and a second pilot is under way.

The Healthy Vision Institute is a multi-location, broadly diversified ophthalmology practice that focuses on treating diabetics in Tampa Bay, Fla. Their challenge is a serious one because increasing deductibles interrupt the continuity of care, which can lead to blindness. With such severe consequences, Healthy Vision has taken a three-prong approach for patients who can no longer afford care, insured or not:

1. Partnering with independent charitable foundations to fill both short- and long-term gaps for qualifying patients;

2. Providing interest-free, third-party medical loans for those not qualifying for foundation support; and,

3. Reducing billable charges to Medicare allowances and offering short term payment plans for others.

In cases where long term patients with chronic illnesses like wet AMD or diabetic retinopathy cannot afford care, an internally funded financial hardship program kicks in where the facility and physicians donate products and services.

Non-cosmetic dentistry is an area where even insured patients have historically paid for the bulk of their care out of pocket.

That historical view gives Jiten Master, D.D.S., a partner in a Clearwater, Fla.-based practice, an important perspective because dentistry is where medical is going, and the changes are stark.

A few years ago, his patients didn’t think twice about spending money on non-elective procedures. Now, patients are having a hard time finding the money to get necessary work done. According to Dr. Master, “the number of patients who make dental treatment a priority and have the means to pay for treatment has declined. We have had to be much more creative in helping them get the treatment they need.” Those that can’t afford treatment forego care, which leads to more serious and costly dental problems and can lead to medical conditions such as cardiac disease and systemic infection.

The practice uses a variety of third party medical finance services to help patients afford needed care. Third party financing increased 42 percent in 2011 over the previous year.

Find out more about James Doulgeris and our other Practice Notes bloggers.

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