Studies show that going to the doctor regularly and preventatively is more effective for long-term health and well-being, yet only 54% of adults surveyed by Lively report that they do this.
Almost half only see a doctor if they are sick or something catastrophic happens (such as a broken bone). Lower-income adults tend to only go when something catastrophic happens.
Lively suggests many employees may not realize that their health insurance plan covers some level of preventive care, so helping employees understand all the components of their coverage will allow them to take full advantage of their insurance.
A former hospital administrator with Tenet Healthcare and Cancer Treatment Centers of America left to build a startup with a focus on giving employees better access to affordable primary care. Equal Health, a business-to-business (B2B) marketplace to help employers get employees connected to better primary care, was officially launched in April.
“In today’s health care environment, even people with insurance are not getting good primary care because they are afraid of getting a bill. Therefore, they end up over-utilizing urgent care or going into the hospital, which drives up employer costs,” says Ameeth Reddy, founder and CEO of Equal Health, based in Detroit.
Equal helps connect businesses and employees with direct primary care doctors for a monthly fee—employees pay no copays, and they can call or email doctors or get same- or next-day appointments. The company charges employers between $7 and $10 per month per member. If an employer has 500 employees, but only 30 signed up to be members, Equal Health would only charge for those employees.
According to Reddy, the direct primary care trend is becoming prevalent; many more doctors are in independent practice. There is no good way for large, self-funded employers to offer these insurers—they would have to contract with many of these doctors to give employees options. Equal provides access to doctors all over the country.
Reddy explains that each doctor charges a monthly fee instead of copays per visit for employees. Employers can choose to pay all or a share of that cost for employees; they could say they will pay up to a certain dollar amount and the employee has to pay any additional amount a doctor may charge out-of-pocket. Services other than primary care—for example, going to a specialist—will still be provided as per the terms of the employer’s plan.
However, Reddy notes that case studies have shown that by encouraging employees to use primary care doctors, which encourage them to get preventive care, employers reduce their claims for other services. One case study of an Equal Health employer member shows surgeries and hospitalizations dropped by more than 70% and patient satisfaction was in the 54% range for a control group versus 94% for those with primary care.
Equal manages all payments to all doctors selected and sends employers a monthly or quarterly bill—whichever they choose.
“There is no marketplace like this for direct primary care doctors,” Reddy says. “I spent a couple of months interviewing practices across the country. These independent doctors are able to do some marketing to get clients from their community, but they have no way to market to employers. So we said we can manage that and aggregate all doctors together on our platform.” He adds that the marketplace resides on Equal’s platform, but the firm can customize an employee’s experience to show his employer’s brand.
“Our marketplace works for any type of employer, but we are focusing on larger employers with self-funded benefits. They already have a plan in place, and our marketplace goes alongside the plan to help employees access direct primary care,” Reddy says.
“Trump’s executive order on health care called out direct primary care. The model is growing, and we can expand it to so many employers and employees,” he concludes.More information about Equal Health is at https://www.tryequal.com/.
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