Keeping Health Care Costs Down: The Latest Innovations

Virtual therapy, bundled payments, and more

As you know if you’ve ever received a bill for medical care in America, the mark-ups, which feel loopy, are only getting loopier. Obamacare, which has expanded access to millions of folks who were previously uninsured, hasn’t been as successful in keeping prices down, and it’s not at all clear what could work when the whole system seems invested, instead, in driving prices up.

Still, there are smart, good-hearted people out there trying to address the problem, as we’ve discussed in the past.

Lowering Health Care Costs: Some Benevolent Geniuses Are On It

Lately, I’ve heard about some more interesting ideas, too. Here are the ones that have stood out:

Virtual therapy

Trying to find a therapist means, as we’ve learned, risking rejection and/or spending a lot of both money and time to have them try to treat you but not understand you at all. Wouldn’t it be great if you could get mental health care without leaving your house?

Yes, argues TalkSpace, yes it would.

The service bills itself as “Therapy for how we live today.”

Introducing Unlimited Messaging Therapy™, affordable, confidential and anonymous therapy at the touch of a button. Your professional licensed therapist is waiting to chat with you right now, and help you make a real difference in your life. You can message your therapist anytime and anywhere, from your smartphone or the web, 100% safe and secure. Welcome to the wonderful world of therapy, re-invented for how we live today.

Caveats: Are these therapists any good? Can they actually be helpful? Without building an in-person relationship over time, can the patient ever trust the doctor and can the doctor ever understand the patient? I mean, the idea of “anonymous therapy” is almost a contradiction in terms and would almost certainly make Dr. Freud puff up so hard with indignation that he would burst buttons on his waistcoat.

But who cares? There’s literally a bright yellow “start therapy now” button on the screen. And at $32 a week, Unlimited Messaging Therapy may be better than nothing without being that much more expensive than nothing.

Bundled payments

Say you went to a restaurant and, instead of getting one bill for the cost of a meal, you got a whole stack of bills: one for the server, one for the busboy, one for the restaurant as a whole, and one for each of the various cooks. You’d go mad, right? You’d run screaming out into the street as though your hair had caught fire.

That, of course, is how we are billed for various health care treatments. There’s no one set of charges for “pregnancy,” or even just “1st Trimester: low-risk pregnancy,” as I so recently learned: instead, everything is itemized, from the superfluous ultrasounds to the redundant blood tests.

The “bundled payment” model would change all that:

Under a bundled payment model, providers and/or healthcare facilities are paid a single payment for all the services performed to treat a patient undergoing a specific episode of care. An “episode of care” is the care delivery process for a certain condition or care delivered within a defined period of time.

For example, if a patient undergoes surgery, payers would traditionally reimburse the hospital, surgeon, and anesthesiologist separately for their part in the treatment. Through a bundled payment model, the payer would collectively reimburse the providers involved, using a set price for the episode of care, which is usually based on historical costs.

Providers who exceed the pre-arranged reimbursement for the episode bear the financial responsibility for overages. This is intended to encourage standardized, cost-effective care decisions.

So obvious a kindergartener could have thought of it? Sure. But whether it works or not will depend on whether the patient and the institution can agree on a reasonable set price for each “episode of care.” There is some gambling involved, too, since if the care ends up being more expensive than the price paid, the hospital must suck up the loss, and if the care ends up being less expensive than the price paid, the patient may feel cheated.

Medical concierges

If you pay to be a patient of the new health care concierge service One Medical Group, you get a vastly different experience of health care practices than most patients. A TechCrunch reporter who tried it wrote that she became “obsessed” with belonging to what seems like the medical version of a country club:

The company charges a yearly membership fee between $149 and $199, which helps pay for services like email consultations and mobile prescription renewals.

In exchange for the fee, patient-members get access to care that is reputed to be high-tech, high-quality, and convenient. Oh and free hot apple cider.

Is it actually a cheaper way to see a doctor, or only a vastly more pleasant one for people who can join the club? Unclear. The Wall Street Journal reported back in 2013 that some of these concierges that are accessible to middle class folks do save their patients money.

clinics charge flat fees that generally include basic checkups, treatment of minor ailments and electrocardiograms, or EKGs. SignatureMD Inc., a somewhat higher-end concierge practice, includes in its $125 to $200 monthly retainer an “executive physical” that could cost $1,000 at a standard practice. Services like blood work, X-rays and vaccines can cost extra, but concierge doctors often negotiate with specialists and labs to secure discounts for patients who would otherwise pay out-of-pocket. Brian Forrest, who describes his $39-a-month Access Healthcare clinic in Apex, N.C., as “concierge-lite,” has obtained prostate-cancer tests for $5 from the same lab that would charge a Medicare patient at least $175, $350 mammograms for $80, and colonoscopies for $400 when the official rate is $2,000.

Plus, there’s a focus on keeping patients out of the hospital:

networks like MDVIP and others have reemphasized preventative care.

“If you keep the patients out of the hospital or the ER, it saves the patients a lot of money,” Jorgensen said.

Not going to the hospital is definitely good for your bottom line.

Any other innovations I should be skeptical and yet somewhat excited about? Send ’em my way!

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