Compassion Care Organization
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).
We have a variety of mechanisms to create a better and more affordable solution to health insurance. We work with families on a case by case basis to help them find an affordable solution.
- 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 out-of-pocket 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).
Intermediate Care: Innovative cost containment solutions.
Leverage the power of innovation.
- Big Tree has special pricing contracts with lab and radiology groups to provide deep discounts.
- As our team helps individuals navigate health prices daily, we know the lowest price options locally.
- We work with advocacy groups, international pharmacies and startups to provide low cost access to many new treatments.
- We treat many chronic diseases “in house” avoiding the high cost of many specialists.
True health insurance:
Insuring against a catastrophe is still essential.
- Health share programs and similar organizations provide a low cost health insurance alternative and are currently our most popular option.
- Short term health plans and “gap plans” have a role in creating a low cost health insurance solution.
- Some individuals can create a functional health insurance alternative using programs like AFLAC in combination with Big Tree.
Lower costs, better care
- By adding Big Tree to one of our several insurance-like options, costs go down by 50-70%.
- Contact [email protected] for more information or for us to help you set up a custom plan.
- Individual and family plans with Big Tree embedded can also be purchased here.
Care Example: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|
Care Example:A family with two parents in their 40s and 4 children ages 6-16. They take 4 chronic medications which are on Big Tree's free list. During the year, they have one specialist visit (a follow up for a chronic condition) and 6 primary care visits. This plan uses Sedera.
|Costs||Big Tree + Sedera||Without Insurance||Marketplace Cigna Silver Plan|
|Annual Medication cost||$0.00||$1,920.00||$480.00|
|Annual Doctor Visits/copays||$215.00||$2,140.00||$2,450.00|
|Total Annual Cost||$9,971.00||$4,060.00||$25,982.00|
Care Example:A 58 year old single patient with type 2 diabetes, high blood pressure, high cholesterol and depression. They are self-employed and make too much to get a subsidy through healthcare.gov. In the Cigna and uninsured scenarios, they pursue traditional care and are on two injectable drugs, 6 oral drugs, use a glucose monitor and shop at Walgreens. During the year, the patient has an episode of chest pain and is evaluated in the ER and has a cardiac cath. In the example with Big Tree + Sedera, the patient no longer sees their endocrinologist, and their diabetic regimen is altered to an equally effective, lower cost plan. They still have the ER trip and cardiac cath. The diabetes is a pre-exiting condition, so the patient must pay the entire cost of the care of the diabetes in the Sedera scenario. The chest pain is new, so that expense qualifies for sharing.
|Costs||Big Tree + Sedera||Without Insurance||Marketplace Cigna Silver Plan|
|Annual Medication cost||$420.00||$19,344.00||$4,500.00|
|Annual Doctor Visits/hospital||$500.00||$32,050.00||$3,650.00|
|Total Annual Cost||$5,072.00||$51,394.00||$19,742.00|
Do individuals that join a CCO get to avoid the penalty that individuals without insurance pay?
This penalty is no longer in force, allowing the marketplace to create innovative solutions.
Will the catastrophic insurance aspect cover an MRI or a minor surgery?
Yes. Our favorite way to structure a plan is with a health share plan, or similar, such as Sedera. With Sedera, an individual or person from a small business is only responsible for an “Initial Unsharable Amount,” of $500-$2,500 (depending on the plan). So if your Initial Unsharable Amount is $500 and the MRI price is $2,500, your out of pocket cost is merely the $500.
How will a CCO system cover my insulin-dependent diabetes (or other expensive, chronic treatment plans)?
Insulin and other expensive medications fall into a difficult category that the CCO system handles better than most systems. As an example, consider a patient that is on an insulin regimen that costs $500/month. They also require four $350 doctors visits per year and $400 worth of labs to care for their diabetes per year. They use supplies that cost $25/month. Their fixed medical cost for the year thus total to around $8,100 per year. In addition to this “fixed” cost, they have a chance (and it is higher than normal) of having an expensive event such as a heart attack or a hospitalization from their diabetes. Thus, in addition to their “fixed” cost, they also have an “insurance risk cost” of, say, $6,000 per year. Thus, if our diabetic patient is paying anything less than $14,000 per year for their “health insurance,” then someone else is paying the bill. For example, they could a part of a group of 10 that each pays an extra $1,000 per year to lower the cost for the diabetic.
So there are three strategies for dealing with the cost of care for these situation: 1) Adjust the price of the plan on a person by person or group by group basis based on the health of the group/individual, 2) Give a uniform price and exclude pre-existing conditions, or 3) help persons on higher priced treatments find lower cost alternatives.
Big Tree, as a group of providers that can prescribe, is in a unique situation as it is able to leverage option #3. If a patient is open to it, there are often lower cost treatment options that are as effective or nearly as effective. Consider insulin as an example. For a generation, we treated diabetics with a combination of “regular insulin and NPH” known as 70/30. It is very effective. It costs around $25/month. It is a little less convenient than the $500/month regimen. It takes a little more time to explain than the $500/month regimen. I know many patients that have decided that it is worth it to them to sacrifice the convenience, to learn a new system and save $475/month. We work with patients that have decided to utilize older medications to treat their rheumatoid arthritis. We work with patients that purchase medications from Canada. We work with patients that have traveled to foreign countries to get treatments. We work with organizations that help patients apply to get expensive medications for free or reduced prices through various non-profits. These are all options that we can coach a patient through. We are happy to discuss these with you on a case by case basis. In all these cases, however we use work arounds. The high prices of branded drugs is a fundamental problem that always exists.
What is the right insurance plan to pair with Big Tree?
We can help you work through this by putting you in contact with one of the innovative health insurance brokers we work with.
Can I still use the primary care doctor that I love (or OB/GYN, endocrinologist, etc)?
Certainly. In most of the health plans we work with, you still have the option of working with other providers, just with a copay or out-of-pocket amount.
What about OB and children?
Depending on the option we utilize, OB care can be covered and the care of children is a part of each plan.
Are these plans ACA compliant?
Typically no. While the ACA was a noble effort, the downstream effects have been catastrophic for many people. This is certain due in part because of the legal challenges that have occurred since its passage. Currently, the ACA is mostly important for two groups: groups over 50 employees and individuals with lower incomes. Groups over 50 employees must have an ACA compliant plan and we work with many of these. Many individuals with lower incomes will qualify for the government to pay some or all of the premiums of plans bought the the Healthcare.gov exchange.
Are a CCO and HMO or an insurance plan? Is it direct primary care?
We work with insurance brokers and similar businesses to combine our direct primary care platform with various types of insurance and insurance alternatives. This functions similarly to an HMO, though HMOs were a single legal entity that owned all pieces of the care process.