Case Study Example: Direct Contracting
Updated: Apr 27
The Chronic Cost
I recently worked with an employee who was on a private insurance plan. They had previously undergone cancer treatments and is currently in remission. As part of the remission process, this employee was supposed to get an annual CT scan to look for recurrent cancer. There was not a co-pay on the employee’s plan, so they were required to cover 100% of the bill up to their deductible.
Most plans today only cover diagnostic imaging after the employee reaches their deductible. In this case, the employee’s deductible was $5,000. In some cases, CT scans can cost up to $10,000.
Due to the high out-of-pocket cost, the employee was behind on payments from the past two CT scans when we met. We built a direct contract with the imaging center that was a 5-minute drive down the road to ensure that the employee received their annual CT scans covered at 100%. This contract could potentially save that employee’s life. Without it, the employee could not afford another annual CT scan, which would mean she would not know if she had recurrent cancer until much later. By that time, it might be too late for her to get the care she needed to stop the cancer growth and return to remission.
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