Health insurance and healthcare reform just got a reality check. In a presentation below, from January 30, 2014, AAPS (Association of American Physicians and Surgeons) Thrive, Not Just Survive XIX, in Louisville, KY, Josh Umbehr, MD of Atlas MD discusses working directly with his patients and cutting out the insurance and government bureaucrats to lower the costs for patients and increase the quality of care received.
Opening with this quote, “If you want a thing done don’t give it to the man familiar with the art, who knows that it can not be done, give to someone that does not know that it cannot be done and he will do it,” Dr. Umbehr explains that he began his initiative, straight out of residency, with a philosophy that insurance complicates more than it helps.
Built on a membership model, the program offers healthcare at a significantly lower costs, eliminating the insurance middle man and many of the tedious government regulations related to Medicare and Medicaid. With an ability to buy direct at wholesale, the medical professionals participating in the program are able to obtain medications and supplies at a reduced cost. Without the insurance company standing in the way, those savings can be passed directly on to the patient.
To try to put the program as simply as possible, the patient pays a monthly membership fee, instead of an insurance premium. This monthly fee is much lower than most insurance premiums, being just $10 for children and $50-$100 for adults, varying by age ranges. With their fee, they have membership to the healthcare program and the services it provides. Then, the physicians and administrators of the program buy directly from medical supply and pharmaceutical companies at reduced wholesale prices, always looking for the best deals and contracts to get the most out of the dollar, using the moneys obtained through the membership fee, rather than co-pays and insurance premiums. And the savings aren’t limited to just office visits. Prescriptions, lab tests, and other diagnostic testing are also available.
Dr. Umbehr refers to himself as the ‘token evil republican’ in med school, but his republican thinking proved successful for healthcare as he explains the savings his patients and members were able to receive on quality healthcare using his model.
It comes as no surprise to me that a doctor, fresh out of med school, can reform our healthcare better than the politicians in DC. Where the majority of politicians have no experience in the healthcare field, they also have no vested interest in the recent reform, being exempt from it themselves. Those in the trenches of today’s medical field not only have insight from their experience, but are also directly affected by the programs in place, not only as professionals, but as patients themselves.
Dr. Umbehr expresses the view that “business isn’t bad, money’s not bad, and the combination of medicine and business isn’t bad. It can be done wrong, but when done right, it creates a better product for our patients.” He goes on to say, “True doctor-patient advocacy is fighting for your patients, not being complacent in a broken insurance-based system when you know there’s a better way.” And a better way is exactly what Dr. Umbehr found as he quotes real savings of 90-95%, using his membership model for providing primary care and family medicine.
With increased convenience and decreased cost for patients, the program has proven successful, going from zero patients to over 1,500 in just over 3 years. Dr. Umbehr credits the value added for patients and the community for the success of his program model. Not only are patients experiencing savings themselves, many employers also saved money on the insurance premiums they provide their employees.
Another benefit of this model is more time for the doctors to spend with the patients because they are not forced to spend countless hours documenting, solely for insurance purposes, bringing the doctor’s attention back to the patient, rather than the chart. Although it is not directly mentioned in his presentation, the program as it is described would also provide for a streamlined billing process. Indeed, it sounds like this model simplifies many aspects of the healthcare process.
To drive home the point of how and why his membership program works, Dr. Umbehr uses the gas station analogy. Gas stations do not accept car insurance as payment for gasoline. If they did, the insurance would tell you where you can fill up, how often, and how much you can get. Not to mention, you would need pre-approval for a trip out of town. This begs the question, why are we using insurance for routine primary care?
Could this model be what it takes for doctors to turn out the lights on health insurance companies? As Dr. Umbehr asks, “Why stay in a broken system when you can make more money, seeing fewer patients, providing better care, that actually saves your patient money?” After 3 1/2 years, a better way has been proven through this model, and Dr. Umbehr encourages his colleagues to fight for it for their patients.
As a nurse with almost 20 years in healthcare, I’m shocked to hear the prices that this membership model has been able to obtain through buying direct at wholesale. What’s even more astonishing is comparing those prices to what is paid to healthcare professionals employed by insurance companies to review claims in an attempt to save the insurance company money. As someone that has worked on both sides of the fence, both as a provider in the field trying to get paid and as a reviewer for insurance, deciding if procedures will be paid, I’ve seen from the inside how broken the system has become.
Dr. Umbehr’s presentation filled me with hope and provided knowledge that has left me even more shocked and appalled with our current system. To know the number of healthcare professionals employed by insurance companies and what they are paid to review cases for approval, compared with the prices of services, medications, and supplies quoted in Dr. Umbehr’s presentation, I’m nauseated by the waste that is healthcare insurance.
Could a membership program be the way of the future? Could this be the healthcare reform we really need? Listen to Dr. Umbehr’s presentation and you decide.
What say you? Could this be the answer we desperately need? Even as a healthcare professional myself, I had never heard of healthcare offered quite like this. If you are as impressed as I am, don’t forget to share. We have other options. Obamacare, insurance, and copious government regulation are not the answer.