Who should pay for primary care?

Today’s primary care is a series of one night stands from fractured silos of random providers. There’s a 22 day wait to see an experienced primary care doctor in NYC, but the future looks more like Boston’s 45 day wait. So folks turned to ERs because they were accessible. As insurance companies tried to get expensive ER overuse under control, this led to the rise of urgent care centers that were just as accessible but a bit less expensive. As every business executive knows, the more inefficient, the more expensive. Letting insurance companies pay for primary care created today’s sad state of primary care. But an accessible primary care system is the backbone of efficiency and, therefore, affordability.

So who could pay for primary care?

• Insurance companies. See above.
  
  
  

• Individuals/employees.
  
  
  

• Employers.
  
  
  

Employers should pay for primary care. Here’s why.

Health insurance is a benefit meant to protect employees from financial ruin when an expensive medical issue arises. However, health insurance paying for day-to-day care, often makes employees lives harder. They’re confused by what may or may not be covered. They’re frustrated with wait times for appointments. As employers offload more of the monthly premiums to employees, they’re increasingly paying for care out of their own pocket. They hope their conditions improve on their own so they delay care until things get worse and more expensive. Meanwhile, their ability to be a good worker suffers.

Up until now, employers had no way to easily pay for scalable primary care across their workforce.

Companies have offices and remote employees scattered all over America, but healthcare systems are local. Signing deals with the best healthcare systems in each city and state is untenable. Some companies have invested in brick and mortar primary care on corporate campuses. This is fine for those employees on those campuses but irrelevant to other offices and remote employees. Also, companies shouldn’t be in the healthcare delivery business.

How much should primary care cost?

$150 per problem. Easy and crystal clear. Problems can be simple, moderate, or complex. A simple problem is a UTI treatment that takes a few minutes. A moderate problem is tweaking asthma medications throughout a person’s springtime flareup. A complex problem is arranging and organizing a team of local doctors to perform surgery on a cancer case that’s ongoing for 6 months. There will be lots of simple problems, less moderate problems, and even less complex problems. No matter what, each problem should cost the same $150 and, over the course of a year, they average out.

Why $150? Let’s look at the competition. It’s $49 for a 10 minute Doctor on Demand video visit for the very simple things like pink eye, $200 for a typical PCP visit, $300 for a typical urgent care visit, and $1,233 for a typical ER visit. Averaging all of these out in a population of normal users and each case is ~$150.

Leaving it up to insurance companies to attempt to manage your employees’ care is markedly contributing to your 12% or 20% annual cost increases.

How can new models of primary care be delivered much cheaper than traditional primary care?

Seventy percent of primary care can be delivered virtually without the cost of in-person visits the overhead from managing brick and mortar clinics. Last year, more than half of Kaiser’s patient visits were done virtually. While this is wonderful for the 7 million folks in California who have Kaiser insurance, what about the other 323 million Americans?

Primary care should be accessible anytime from anywhere, consistently acquired from the same service, and affordable. That’s where Sherpaa comes in. Sherpaa is an online primary care practice available anytime and anywhere. It’s primary care in the cloud available to all of your employees, whether on campus or remote. We charge $150 a case, no matter how simple or complex and ongoing that case is. And we make your employees happier, healthier, and more productive.