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A conversation about Sustainable Health Care

The time to resume some responsibility for our health care has arrived. The way in which we engage our health care needs a complete reboot. How much longer can we continue to settle for getting less while paying so much more? Would you wait 4hrs for your latte, unsure of how much it is going to cost? Yeah, I didn’t think so. Understand the problems:

1. We need a return to understanding that health insurance is about risk management — not access to care. This is important for both individuals and for businesses. Just because you have great health insurance does not mean that you can get in to see a doctor when you need to — typical wait times in KC are 10-14d for those established with a doctor. This leads many people to end up in the most expensive, least wholistic care centers — Urgent Care and the Emergency Room.

The lack of access to care when you need it in has resulted in us only accessing care when it is most absolutely necessary. This reimbursement model of care for physicians — poor reimbursement resulting in a need to see a higher volume of patients (you have certainly felt the rushed doctor experience) and the improved reimbursement for sicker patients (you are worth more when sick than well) has created a self perpetuating sick-care system for both individuals and physicians. No wonder “health care” costs continue to spiral while we continue to get less for more.

2. For too long, insurance has dictated our access to care. How many of us feel like confused and bumbling fools when navigating insurance selection, insurance use and insurance claims? Understand the power of the design — once a year you make an expensive and painful decision that you then have taken out of your direct deposit paycheck and rarely think of again until next year. Additionally, the confusion of networks and co-pays and deductibles with percentages is maddening and misleading.

At the end of the day, if this is simply risk management, you need to consider the monthly cost (premium) and the total out of pocket (TOP) cost. Then determine a TOP that you can live with should worst case occur. Often the difference between a Gold and a Bronze level plan is the deductible and then the pathway to getting to the total out of pocket cost — via co-insurance and co-pays and the such. The TOP is often very comparable. The average savings in premium between each level of plan is 15%. A previous blog post offered an actual individual plan example from the health care exchange, but here is a hypothetical example of a favorable employer offered plan:

Gold plan: Monthly premium $220/mo Deductible $1500 with 90/10 co-insurance and a variety of copay options for Urgent Care and ER and a total out of pocket cost of $5000.

Bronze plan: Monthly premium $150/mo Deductible $3500 with 80/20 co-insurance and no copay options with a total out of pocket cost of $5000.

Most of us currently look at that and say, “Well, for $70/mo I get a much lower deductible and all the co-pay options — I can will go ahead, pony up and pay that amount.” What we don’t consider is that we still will not have very good access to care, so we will only go see someone when it a situation is most dire and leading us typically to the most expensive, and least personal, care options (urgent care/ER). Consider if you are healthy and your likelihood of a health emergency is low — how much are you paying to mitigate your risk. Many well intentioned companies in particular, by trying to provide good benefits, are missing the target with high dollar plans that their healthy employees thankfully are never going to use.

What if we chose to keep that difference of $70/mo ($840 annually) and then signed up for an annual DPC membership (Health Studio KC is $600) and had the same day access to care with a Doctor who knows us at a fixed cost. The numbers have shown the results — less expensive care with significantly better experience and better outcomes.

3. Too many people have felt the pain of losing their doctor when their insurance changes — having to start all over with someone new. Like any relationship, the Doctor-Patient relationship improves with time and conversation and trust builds with experience. Without trust and communication, there can be no care. As a physician, I moved into Direct Primary Care specifically because of the importance of that relationship. As patients, DPC offers you the opportunity to resume control of that relationship as well from the world of insurance. Having a relationship with your Primary Care Physician, where you can address the vast majority of your health care needs, questions and goals leads to a healthier you — while decreasing both the short term and the long term health care expenses placing such a heavy burden on individuals, businesses and the health care system currently. Primary Care use increases (at an already paid, known and fixed cost) while the use of our most expensive avenues the current health system decrease significantly.

4. There is the need to personally shift how we engage our health as well. To often, we only think of our health only when we are sick — that is how we have been trained. Thus, thinking about our health is scary and we avoid it at all costs — we are masterful in our avoidance, our rationalization, or simply in acceptance of our fate as a by product of the necessary stress in our lives. Additionally, the lack of access and the miserable experience — the general pain in the ass of it all — keep us on google MD and away from the actual doctor.

Your body has a design — there is a way in which you run most optimally, where the tensions are in balance and you feel well. How to achieve and maintain this? Well, the broad strokes are simple — eat well, move, get some sleep, hydrate. But life has a way of complicating things and as Charles Eames noted, “The details are not the details. They make the design.” Health Studio KC is here to help with the details — from conversation to plan to execution — enabling you to be a responsible participant in your health. We understand that health is not one size fits all and that each of us are a melodious medley of our past, our family, our work, our passions, our responsibilities and our choices, our present realities and our future hopes. What does health mean for you now and what do you want your health to look like in 5/10/20 years from now — because the choices you are making today are directly influencing those goals.

The Why of Health Studio KC is a desire to enable you to be a responsible participant in your health — to partner with you in achieving your most optimal design.

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