The next time all three of Charles Olson's children come down with ear infections in the same month, Olson figures he'll save a bundle.
In January, he paid “$80 a pop” for each child to visit an Omaha Alegent Creighton Quick Care clinic. But when his company's new “clinic care” plan kicks in May 1, Olson will pay just $30 for unlimited visits to designated walk-in medical clinics. His firm, OCi Insurance and Financial Services, will pay the $55 monthly base fee, and Olson will pay $30 a month to cover his family.
Convenient Care Plus, a new Omaha company, is offering employers and individuals a monthly plan that allows unlimited visits to four Omaha-area and Lincoln medical clinics for basic health care issues such as sore throats, pink eye, allergies, ear or urinary tract infections or sprains.
The clinics are aimed at helping someone with a high-deductible health insurance plan and join other innovative plans being tried by employers seeking to curb rising insurance costs.
The clinics also raise some concerns about whether certain medical conditions would be missed because of gaps in the continuity of care.
“It's not meant to replace insurance or one's primary care doctor,” said Kevin Hensel, Convenient Care Plus' vice president, but he said the clinics provide a place to go, no appointment needed, and keep minor costs off the insurers' books.
“You're not tapping into your insurance to pay for a sinus infection,” Hensel said.
With the major provisions of the Affordable Care Act going into effect Jan. 1, 2014, and new health care exchanges — online marketplaces — about to open Oct. 1, employers, big and small, are seeking innovative ways to trim health care costs.
With the Convenient Care option, Rockbrook Urgent Care, Bellevue Urgent Care and Urgent Care of Papillion in greater Omaha and Heartland Urgent Care in Lincoln will provide the services.
Each clinic will have a supervising doctor, but patients may be seen by a doctor, physician's assistant or nurse practitioner, based on scheduling. The clinics are open evenings and weekends. Membership includes some basic lab tests and X-ray services.
Besides clinical care, members can access the 24-hour telephone consulting service staffed only by doctors, who can offer consultations and authorize prescription medication for minor ailments, Hensel said.
Membership is month to month, and membership can be discontinued with 30 days' notice.
Convenient Care's founding grew out of a need to address employers' increasing costs, Hensel said. The hoped-for outcome is that the clinics will result in fewer claims, lowering health insurance costs for employers and individuals.
And with more patients able to seek medical attention sooner rather than later, the cost and level of treatment — “sicker often translates into higher claims” — could be reduced, said Convenient Care President Scott Cooney.
A recent study by the Society of Actuaries predicted that the Affordable Care Act, with the goal of adding coverage for millions of uninsured Americans, could raise health care premiums for individuals and small groups more than 30 percent.
Walmart, the world's largest retailer, announced last fall that it was partnering with six medical centers around the U.S. to provide “exclusive ... bundled pricing arrangements” for “no-out-of-pocket cost” heart, spine and transplant surgeries for eligible employees and their dependents.
Such alliances provide employers with discounts and guarantee providers that the bills will get paid, an important feature given that last year hospitals throughout the U.S. provided $41 billion in uncompensated care, according to an American Hospital Association report.
Smaller companies in particular are seeking innovative health care benefits that will help them recruit and retain employees.
Convenient Care charges $55 per month for an individual membership. Adding a spouse or dependent bumps the price up to $70; a family, $85. There is no deductible, no copayment and no age limit, and patients don't use their health insurance.
As for those individuals who don't have any kind of coverage, it could help keep them out of the emergency room. “This gives them some security,” Hensel said.
In the future, he said, medical insurance is likely to, and should, look more like car insurance. “When was the last time you submitted your bill for an oil change to your auto insurer? Insurance for cars and people should be there for the big stuff,” Hensel said.
But insurers such as Blue Cross Blue Shield of Nebraska are concerned that clinic care plans could disrupt or fragment the continuity of patient care.
If the primary doctor isn't aware of the medications or therapies a patient has received at a clinic, it could compromise his or her health, resulting in additional claims, said Dr. David Filipi, chief medical officer at Blue Cross Blue Shield of Nebraska.
And clinics that treat patients for a one-time episode may miss an underlying problem, Filipi said. “A sore throat that keeps recurring, for instance. If a pattern is developing and no one is watching, that's a problem.”
Communicating with a patient's regular doctor is not yet a seamless process, despite electronic medical records, said Dr. Kevin Nohner, president-elect of the Nebraska Medical Association. “Do they have a robust IT system where they can track the patient? I wish that transferring medical records were that simple.
“Some are encrypted. Some doctors aren't on computers or they run different software programs that don't mesh.”
In response, Cooney said he understands the skepticism of insurance companies and primary care providers.
“Anything innovative shouldn't be done in a bubble, but collaboratively.” The key, he said, is sharing information with a patient's regular doctor.
“We want to work hand in hand with their regular doctor,” Cooney said “If symptoms persist, patients will be directed to follow up with their regular doctor. Individuals with chronic diseases such as diabetes and hypertension are best served with a primary care provider.”
He added, “If they don't have a primary care provider, we'll help them find one.”
Traci Jenkins, a nurse practitioner who works at Rockbrook Urgent Care in Omaha, said it is increasingly common to see patients with high-deductible health insurance delay seeking treatment because they don't have the money.
“People with plans where the deductible is $6,000 or $7,000 don't always go to the doctor when they should,” she said. “I've seen patients hold off on fractures or infections and wound infections. By the time they come in, it's so bad they can't walk.”
The Convenient Care plan doesn't cover preventive care, but many so-called wellness services such as annual physical exams, mammography, Pap smears and required vaccinations typically will be covered under health insurance plans to meet the Affordable Care Act standard.
“This works well for those that have high-deductible health plans and want to be able to supplement their employee with this very innovative base-line service,” said Ann Frohman, who headed the state's insurance department from 2007 to 2010. Frohman now is a lobbyist for the Nebraska Medical Association.
“It does provide convenient, basic medical care for routine ailments,” Frohman said. It's not clear what the health care landscape will look like when health care reforms go into effect, and innovation designed to cut costs and boost patient health is a necessity, she said.
Convenient Care, which launched about a month ago, so far has enrolled about 150 people from a half-dozen companies, including OCi, Cooney said.
Facing a 30 percent to 35 percent increase in the potential cost of health care premiums, OCi won't be offering employees health insurance next year, said Olson, the firm's vice president.
With 27 employees, OCi, an employee benefits brokerage, is below the 50-employee threshold and won't face federal penalties for not offering medical coverage. Company officials expect employees will get a better deal in the online marketplace than with any plan the firm can offer. “Many of the employees will qualify for subsidies,” Olson said.
However, in an effort to recruit and retain employees, the firm plans to offer its staff an enhanced menu of benefits, including Convenient Care Plus. Olson said that, as with any new product, his company would closely monitor the impact.
While Convenient Care Plus' model is unique to Nebraska, similar plans, including concierge services, or those in which patients pay an annual retainer directly to a doctor for enhanced care, are cropping up all over the country.
Nationwide, there are more than 70 doctors and clinics that deliver basic medical care or primary care services directly to patients through monthly fees or annual memberships rather than insurance reimbursements, according to the Direct Primary Care Coalition, which track those services at www.dpcare.org/practices.
As for Convenient Care, Cooney said he hopes within six months to have a network of clinics in five states: Nebraska, Iowa, South Dakota, Colorado and Illinois. “Around the time that people will be searching for options,” said Cooney, referring to the January health law's effective date.
At OCi, Olson said he is looking forward to the plan's implementation both for his employees and himself.
“I can tell you, even in my own family,” said Olson, “we'll sit there and try to tough it out instead of going to the doctor. With this plan, we're not going to be waiting until we're super sick to go in.”
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