How Heimes saved on an employee surgery.
This case study covers best practices in setting up and executing a self funded health plan with a direct primary care plan integration. Partnering with Strada Healthcare helps Heimes Corporation save money on primary care. In many cases, Strada Healthcare’s negotiating power can save employers money on speciality care and catastrophic events, too. In particular, Heimes was able to save drastically on an employee surgery.
Heimes Corporation employees perform tasks like excavating, recycling, plumbing, boring, wrecking, and more. Without tools for easy access to healthcare prevention and management, compounded with the expensive cost of healthcare, some employees tend to let problems go unresolved. This potentially increases the cost of care for both Heimes and their employees. One “con” of self-funded insurance is that for unpredictable, expensive healthcare costs like surgeries, Heimes pays the full cost.Heimes Corporation Need: Reduce costs on health claims – especially expensive, unexpected, catastrophic claims – for both Heimes and employees. In particular, reduce the cash-pay cost of an upcoming shoulder surgery for an employee.
Heimes Corporation takes care of their people. As such, they came to Strada Healthcare wanting to add an employee health benefit to give employees tools to help prevent conditions and manage their care while also reducing costs – both in the present and in the future. To accomplish this, Strada Healthcare recommended implementing Direct Primary Care as employee benefit.Heimes Corporation Solution: Offer an additional employee benefit of Direct Primary Care through Strada Healthcare and integrate it into their self-funded healthcare plan.
A little on Direct Primary Care (DPC)
Strada Healthcare offers direct primary care that integrates into both fully insured and self-funded insured healthcare plans. In direct primary care, patients contract directly with their provider for a low, monthly fee. That fee does not contribute to a deductible. In fact, proponents of direct primary care believe that primary care should be free from insurance entirely. The patient pays no copays. Rather, the contracted fee covers most of their care. Patients also get unlimited access to their provider, both digitally and in-person, and longer visit times, allowing for a more focused direct patient care experience.
It is recommended and encouraged that those who contract through DPC also have insurance – most commonly a high deductible plan that can cover catastrophic events, like surgeries.
Integrating DPC into self-funded insurance plans can even help greatly reduce the cost of specialty care, like imaging and surgery.
Paying cash versus going through insurance for employee surgeries, labs and imaging.
Many people and companies don’t know that they can opt out of insurance for healthcare and pay directly. This is often what Strada Healthcare clients like Heimes choose to do. By paying cash directly, they bypass the politics of expensive insurance rates, and get down to the negotiated, and sometimes at-cost, prices.
“One reason our employees love Strada is the financial savings. There have been several situations where an employee has had an issue, contacted their Strada provider and utilized the cash price to diagnose their issue quicker and at a better price. Getting diagnosed with a quick X-Ray or MRI and not having to go through insurance, and rather paying cash, has saved our employees up to hundreds of dollars.” – Adam Heimes
And because of their partnership with Strada, Heimes gets access to set negotiated cash prices for things like imaging, labs, physical therapy and more – and they get access to a team who has negotiating power for expensive, one-off costs like surgery.
How Strada negotiated on behalf of Heimes for an employee surgery
When an employee recently needed to have shoulder surgery performed, Adam Heimes reached out to Strada’s team. He wanted to know if it made more sense to go through insurance administrators and pay their rates for the surgery, or to pay the hospital and surgeons directly with cash.
The Strada team used their negotiating power to get quotes directly from the orthopedic hospital. A new agreement was drawn, bundling the hospital, physician and anesthesia fees.
Result: Instead of paying insurance’s rate of $26,000 for the procedure, Heimes paid Strada’s negotiated cash price of $13,700 for the same exact procedure.
(Strada gets nothing out of this other than bragging rights!)
As stated above, Heimes takes care of their people. Because their employee was willing to have their procedure bundled and price lowered, Heimes met their deductible for them, paying for the procedure in full.
As a partner of Strada, you can get this preferred treatment, too. Inquire today.
Categories: DPC News