And why that’s not changing anytime soon
If you’re thinking about Decent, the thought may have crossed your mind that “this seems too good to be true.” You’re not alone. Many of our potential (and eventual) clients wonder the same thing.
For those who purchase health insurance for their company and employees - you’ve likely had such a bad time that it’s tough for you to legitimately trust that things can get better at all.
Decent’s plans - administered on behalf of the Texas Freelance Association Benefits Trust - are something different. Something new and fundamentally redesigned to keep costs low without hiding them later with sky high deductibles, or inaccessible care. Here’s how we’ve been able to offer such low pricing year over year.
Counter intuitively - really nice, free primary care
It’s no secret in the medical community that primary care is the most cost effective way for patients to receive care. On average - treatment in the ER costs about 12x as much as treatment in a primary care setting for applicable illnesses (obviously, if you have something like chest pain - PLEASE GO TO THE ER). But there have been three trends in health plans that have emerged over the past several decades that have really reduced the accessibility of primary care physicians.
The emergence of hospital-centric HMOs
- What is this. Kaiser hospital back in the 1940s was the first healthcare system to begin experimenting with embedding primary care physicians into hospitals so as to better “facilitate the coordination of care.” This model exploded in popularity, partly because it was very profitable to the hospital chains which found it to be a good way to ensure referrals went to their own specialists.
- Why that sucked for patients. No one wants to go to the hospital to see their doctor for minor things. It’s inconvenient to get to, confusing to navigate once there, and generally pretty scary. The more doctors centralized in their ivory towers, the less likely their patients were to engage with them for minor and preventative issues.
The rise of high deductible health plans
- What is this. Back in 2004, some healthcare policy officials had an idea - if health plans placed more of an up front cost burden on consumers, they could encourage the consumers to shop around for coverage. Fast forward 20 years and High Deductible Health Plans are becoming the most popular health plan structure in America.
- Why that sucked for patients. Well, mainly for the obvious reason that no one knows what a procedure is going to cost before they receive the bill, which makes “shopping behavior” impossible. High Deductible Health Plans still worked though. They did a great job of driving down health plan costs because they placed a multiple thousand dollar barrier between consumers and seeking care.
The explosion of freestanding ERs
- What is this. If you’ve driven around Austin or Houston or anywhere in Texas you’ve probably seen dozens of these new ER clinics emerging.
- Why that sucked for patients. These clinics, that sort of look like an urgent care, but price their services as a hospital, are actually rarely in people’s network meaning that they’re going to go home with a pretty massive bill. That means that a patient's least cost effective way to get care has never been easier to accidentally wind up at.
Now that might have been a little depressing but it was important for us to level set on the state of Primary Care in America. Decent is working to change it.
Decent’s plans are built around Direct Primary Care (DPC) - that means that for every member assigned to a doctor, that doctor is paid a set monthly amount vs. the more traditional fee for service model. That does a handful of really awesome things:
- It VASTLY reduces the amount of time that our doctors spend doing paperwork. The fee for service model typically requires about 10 minutes of paperwork per patient seen. To put that amount of paperwork into context - most fee for service doctors see at least 20 patients per day which amounts to over 3 hours a day of paperwork. Which leads us to the next benefit…
- DPC doctors have much more availability. Imagine what you would do if you suddenly had 5 hours of busy work back in your work day. You could probably do more work, which for these people means they can spend more time with patients, giving them better care.
- Decent members never have to pay anything out of pocket to see their primary care physician. That’s right – $0.
We’ve found that if you remove the barriers between people and seeing their doctors, they’ll go see them. Decent has been driving industry leading utilization because the members we serve actually enjoy using primary care as it was (initially) intended.
The PEO structure
All PEOs (Professional Employment Organizations) underwrite their business before accepting them which means we verify that things like Workers Compensation, financial solvency, and other fundamental business processes are in a good state before members join our plans.
Bundling these small businesses together allows us to create a shared risk pool which makes it possible to offer our plans. The important thing to remember here is that the PEO construct allows us to bundle a lot of different small employers together to create one large employer.
That’s where our next big savings piece comes into play.
Extending access to what big companies are already doing, to everyone
Large companies have been saving massive amounts of money on their health insurance for decades using a system called “self funding.” In this process, they group a ton of employees and a ton of money together, and essentially custom construct their own health insurance structure. In the process, they’re holding more risk (and doing more work) so it winds up costing substantially less.
Here’s a good visualization from the Portland Chamber of Commerce:
The only problem here is that small businesses have never had the scale to put this together themselves. Until Decent that is. Using the PEO structure (coemployment model) to bundle together small businesses, we can extend to them access to our captive insurance structure, and save them a lot in the process.
Intentionally constructed network
Ever since PPO plans came into vogue, provider pricing has spiraled up. Health plans effectively had to get every provider in network, regardless of pricing, to compete with these broader and broader network plans. That left health plans with little to do when clinics started charging $15,000+ for an MRI. Pricing became completely decoupled from the quality of procedures. It’s time we reset that.
Decent works with Healthcare Highways to give members access to an intentionally crafted network of high value providers. Yes, that does mean there are fewer of them than your BCBS PPO+ mega plan, but it also means you aren’t paying hundreds of additional dollars per month in premium to cover some of the most expensive (and not necessarily the best) providers in Texas.
A system and network that encourages health providers to provide great care and service for a reasonable price is good for everybody.
There’s no catch with Decent
We often get comments like, “so…what’s the fine print.” And now you know, there is none. Decent’s health plans are what health care should be: affordable with features you need. Too often what’s available for small businesses is anything but that. That's not decent.
Wondering how much your business could save by switching to Decent? Get a quote here or contact us at support@decent.com
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