As Big Tree Medical Home sought to find solutions to the health care problem in the US, we eventually landed on a structure that provided most of the care that most people would need while also protecting them against the low chance of a high cost medical bill. Once this structure was placed in the context of a highly relational, patient-centered, primary care practice, the Compassionate Care Organization (CCO) was born. We can typically provide the below care for around $200-300/month for an individual or $700-900/month for a family (depending on age).
- provides ordinary care at minimal or no cost,
- helps patient shop for intermediate care and
- protects against extraordinary care costs.
Ordinary Care: Minimal or no cost.
Relational Care from a medical home
- A personal relationship with your care team.
- 24-7 access to your care team via video and text message.
- Unlimited visits at no additional cost (virtual visits or in person visits, depending on plan).
- Same day visits (no need for urgent care and little need for ER)
- Management of most acute conditions (such as as UTIs and sinus infections), chronic conditions (such as diabetes and PCOS) and mental health conditions (depression and anxiety).
Affordable medications, labs and supplies.
- Most plans include over 100 free medications including most generic medications.
- Labs and supplies at over 90% off of retail.
Intermediate Care: pay cash at reduced prices.
Radiology, speciality medications and specialist care
- Directed to low cost, high quality care providers and pharmacies.
- Medications and labs ordered through care team, getting lower prices.
Outpatient surgeries and tests
- Care is directed to the site that best combines cost and quality.
- Many tests can be avoided with care follow up by care team.
Some systems include an intermediate payment structure. Innovative solutions like Paytient or gap insurance plans help cushion the blow of the intermediate care costs. Health-savings accounts (HSAs) can act as an intermediate payment structures. Unfortunately, current IRS regulations do not allow for “first dollar coverage” and contributions to an HSA. Our ordinary care payment system would likely qualify as first dollar coverage. The government is currently working on changing this for 2020.
Extraordinary Care: high deductible insurance.
Hospital Care and Emergency Care
- Though most ER and hospital utilization is avoided, a catastrophic insurance plan is in place to protect against large bills.
- For groups larger than 50 employees, we partner with a TPA to create a level funded or self funded health plan.
- For small groups and individuals, we partner with insurance companies providing short term health plans or with health share groups.
The following examples compare prices alone. They do not compare the value provided by the personalized care in a CCO. They also do not include the psychological costs of trying something new (such as a CCO) or the stress caused by being uninsured. This particular CCO plan was designed combining the Big Tree Unlimited plan with a short term plan. Similar setups could be achieved by combining a health share plan with Big Tree or a group self funded health plan with Big Tree.
34 year old female on birth control and an antidepressant. During the year she has an acute care visits for sinusitis and a UTI.
|Costs||Big Tree Compassionate Care Organization||Without Insurance||Marketplace Cigna Silver Plan|
|Annual Medication cost||$0.00||$204.00||$350.00|
|Annual Doctor visits/copays||$0.00||$975.00||$150.00|
|Total Annual Cost||$1,668.00||$1,179.00||$6,020.00|
55 year old female with heart attack in month 6. Requires 3 day hospital stay, a stent and then is discharged on 4 medications. Was only on a high blood pressure medication prior to the heart attack. The patient has a $5,000 deductible CCO plan or an $8,150 deductible silver plan from the ACA marketplace. The patient’s hospital provides a 60% discount for uninsured patients.
|Costs||Big Tree Compassionate Care Organization||Without Insurance||Marketplace Cigna Silver Plan|
|Annual Medication cost||$0.00||$1,764.00||$750.00|
|Annual Doctor visits/copays/hospital fees||$5,000.00||$10,036.00||$7,400.00|
Example Plan Costs:
This is a health share plan + Virtual direct primary care. Includes over 100 free medications (with free shipping) and a $500 IUA. Purchase this plan and see details here.
Do individuals that join a CCO get to avoid the penalty that individuals without insurance pay?
As of the end of 2018, this penalty is no longer in force, so yes, patients in a CCO pay no penalties.
Will the catastrophic insurance aspect cover an MRI or a minor surgery?
Maybe, but probably not. The system is designed to cover major issues (think heart attacks, cancer diagnoses and similar) that would bankrupt most families. Insurance plans that cover costs in the thousands (rather than just the tens of thousands, like a CCO plan does) are available. Such low deductible plans are generally cost prohibitive for most individuals.
How will a CCO system cover my insulin-dependent diabetes (or other expensive, chronic treatment plans)?
We like to divide this into “care,” “financing” and “insurance.” The CCO will provide care, in that, the health team will provide all aspects of the diabetes care (foot exams, prescribing medications, etc) that can be done by a primary care level team (some diabetics need to see an endocrinologist, which is not covered). The care team will also help the patient buy appropriate supplies and insulin at wholesale cost. They will discuss the pros and cons of various systems, including prices, allowing the diabetic patient to choose. Do they want the convenience of a system that costs $99-$300/month or the low price of a $25/month system? The insurance aspect will also help reduce the exposure to risk if the patient has a heart attack or developed cancer. But the system will not finance the care. Just as you can’t buy insurance while your house is burning down, so too you cannot buy insurance for expenses that you know you will incur. The only way to get someone else to pay for your care (i.e. get it financed) is for the government to take the money from them by threat of force. Our organization has no position on this idea (taxing one group to pay for the care of another, or single payer health care). There are pros and cons to this approach. We are merely facing the reality as it is today for our patients. And in the present system, each of us has to pay our own bills. And while a CCO can reduce the costs dramatically, we cannot make it free. We will help patients consider less than ideal treatment plans that are affordable. We also help many people apply for aid of various types.
What is the right insurance plan to pair with Big Tree?
We help you connect with an insurance agent that can help you answer that question for you as individual or for your group.
Can I still use the primary care doctor that I love (or OB/GYN, endocrinologist, etc)?
Of course! Many primary care doctors are so overwhelmed with patient care and busy work that they cannot get patients in the day they need care or provide oversight over each patient’s care. You will just pay cash for PCP visits and most primary care doctors have affordable cash prices. Some of our insurance partner plans also allow for copays (think $25-$50/visit). You will still get care coordination from your personal care team. They will still help you navigate the system, act as your urgent care, help you get low priced medications, etc.
Example: Let’s say you have to pay an extra $100 for two office visits, a visit to see the gynecologist you love and a visit to see the primary care doctor you have had for 20 years. But in our system your monthly premiums are $300 rather than $800. Your net savings is $5,800 per year.
What about OB and children?
Plans that include maternity/newborn care are more expensive, but an insurance professional can help you with this. We have plans that include spouses and/or children as well. As is typical for such programs, the family plans are about 3-4x the cost of the individual plans.
Are these plans ACA compliant?
No. We would love it if everyone could afford an ACA compliant plan. But many people cannot, or don’t want to. This program simply allows for freedom of choice. As long as people understand exactly what they are getting, we believe it is somewhat paternalistic to force everyone to buy particular plans. Or it is a way to force one group to pay for the care of another group (a tax). Again, paternalism and taxing are certainly potentially appropriate approaches to financing health care, they just are not the current situation today.
Are a CCO and HMO or an insurance plan? Is it direct primary care?
A CCO combines direct primary care with an insurance plan to create something that somewhat resembles an HMO. Direct primary care is not insurance. Insurance does not practice medicine. HMOs require a different set of regulations due to the combined nature of the care and payments. In our case the CCO just is a friendship between an insurance or insurance-like organization and a direct primary care organization to care for the same person. They are legally separate organizations.
Can a business take advantage of this idea?
Of course! Smaller businesses 5-50 employees typically combine a health share plan and direct primary care. Larger organizations usually use a level-funded or other type of self-funded health plan with integrated direct primary care. Patients then get unlimited zero cost maintenance medications and primary care with catastrophic coverage for serious issues. Businesses usually save 20-40% of off their health plan. Even companies that have a self funded health plan often are able to cut spending by 40%+.
For more information email firstname.lastname@example.org
To sign up visit: myenrollmentadvisor.com, where you can choose from a CCO that pairs Big Tree with a traditional insurance short term policy, Big Tree with a health share plan and other options.