A CCO:

  • 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.

Care examples:

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
Monthly cost/premiums $139.00 $0.00 $460.00
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
Monthly cost/premiums $313.00 $0.00 $854.00
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
$8,756.00 $11,800.00 $18,398.00

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