Part 3 Overview: Solutions for Lowering Your Chronic Costs Without Sacrificing Care Quality
Updated: Jan 31
The Chronic Cost
How Direct Contracting Works
Did you know that your company has the option to negotiate with healthcare providers through direct contracting? When you create direct contracts with doctors at facilities, you can see significant cost savings without giving up the quality of care your employees receive.
"With direct contracting, employers can collaborate with healthcare providers to agree on healthcare service costs that are significantly lower than what insurance carriers get charged. In some cases, they can be even lower than Medicare costs." - Part 3 of The Chronic Cost by Clayton Wood.
This also benefits the provider by allowing them to get paid upfront as well as increasing their amount of new patients. But how do your employees benefit?
"The central benefit employees get is $0 out-of-pocket expenses. That is often enough incentive to encourage employees to use the direct contract instead of the expensive hospital or physician in a PPO network." - Part 3 of The Chronic Cost by Clayton Wood.
A way to lower costs for professional services is through a Direct Primary Care model.
"In the DPC healthcare model, patients pay their primary care physician or practice directly. These payments are made periodically for a defined set of services." - Part 3 of The Chronic Cost by Clayton Wood.
The DPC model has several benefits. It gives transparency to patients on cost expectations, appointments are more likely to hold since it's already paid for, and it gives healthcare providers more flexibility in managing their care for their patients. The DPC model also benefits employers.
"Employers only have to pay for the annual cost without paying for any claims that might occur due to an employee seeking treatment from a DPC physician." - Part 3 of The Chronic Cost by Clayton Wood.
Pharmacy Benefit Managers (PBMs) negotiate with drug manufacturers and pharmacies to control the cost of drugs as well as negotiate discounts and rebates. Although, they are not required to pass along the savings to you.
"This creates issues for health insurers, who argue that they could lower costs if they received these rebates. Of course, it also creates problems for patients who would be happy to have lower copays and are largely unaware of the rebate system that PBMs are using." - Part 3 of The Chronic Cost by Clayton Wood.
You can avoid using traditional PBMs with the solutions below:
Utilize a pass-through PBM
International mail orders
"Big box agencies teach their brokers only to sell bundled insurance. Around 75% of insurance brokers are not trained to do anything else. Their income goes up when your premiums go up, so they do not have an incentive to look into alternatives. They can raise your premium rates from one year to the next without telling you why and they still make more money." - Part 3 of The Chronic Cost by Clayton Wood.
We've only scratched the surface on savings solutions for your company's Chronic Cost. If you're interested in learning more, get your FREE Download of The Chronic Cost: Saving Hundreds of Thousands of Dollars for Companies with 50-500 Employees, by Clicking Here!
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