A Model for Providing Quality Health Care While Reducing Costs
Dr. Lee Gross, Co-Founder and Sr. Vice President of Epiphany Health, presented a detailed plan to provide quality health care at reduced costs at last month’s AMAC National Health Care Symposium in Washington. In his Symposium remarks, Dr. Gross analyzed what a real primary practice could look like, the benefits of his suggested Epiphany Health plan, and some actual examples of how health care costs could be reduced.
According to Dr. Gross, “Since primary health care is the least expensive component in health care, (by) eliminating the middleman—in this case the insurance company—we can provide affordable care by contracting directly with the patient and reducing the administrative costs that drive up the overall cost of care.” He noted the Epiphany model offers several advantages: true price transparency, high quality care, affordable fees, no co-pays, no deductibles, no pre-existing condition exclusions, and a plan not tied to an employer.
He prefaced his remarks by explaining Epiphany Health’s program to save the practice of primary care physicians, and described how interference from insurance companies has driven a wedge between the physician and patient. Further, he said that the administrative burden has multiplied exponentially, with doctors being forced to spend less time with patients and more time on paperwork. “This trend is bad for both patients and doctors, and is worsening rapidly,“ he noted. He explained that the Epiphany plan is a membership-based primary care program where doctors contract directly with their patients and provide a distinct primary care platform.
Dr. Gross went on to point out that the medical practice environment has changed drastically over the past 12-15 years, with the main question now being how health care costs can be brought down. His slide presentation identified:
- Why basic health care is so expensive and the outside factors which drive up costs;
- Direct primary care membership and what it includes;
- A Free Market Model, along with an explanation of why health care is not a free market;
- Why health insurance is so expensive;
- What causes primary care cost to increase and decrease
Dr. Gross detailed the Epiphany Health approach, noting that their “monthly fee” concept covers all basic medical needs and illustrating how the approach produces savings and benefits to members. He also covered in-office and network savings, and provided an idea of what physicians price their services and the costs saved using Epiphany. To help illustrate his point, he displayed an actual hospital bill for a 6-8 hour emergency room visit at a local hospital costing $20,000, and contrasted this to what Epiphany’s cost for the same service would have been—roughly $300. As further illustration, Dr. Gross presented the cost of service for an individual, for an individual with a spouse, and for a family, concluding that a 10-year projected cost for a family of four under the Epiphany Health plan would generate savings of about $150,000.
Dr. Gross suggested that making a plan of this type available to the estimated 58-million uninsured in America would be a workable solution to a major portion of today’s health care problems.
The remarks delivered by Dr. Gross at the 2014 AMAC Foundation Health Care Symposium are available on-demand and in their entirety through the AMAC Network, a service of the Association of Mature American Citizens. Click here to access the Symposium segment.