Allison de Paoli, CEO & Founder of Altiqe Consulting

We help employers get predictability. The happy side effects of what I do is that employees have access to higher quality care and lower out of pocket costs. I focus much more on connecting employees and employers to healthcare than I do selling health insurance."

Yes. We structure plans to help employers control their costs and help employees get access to care. One of the more ironic things about health insurance is the more access that people have to care, the less access you have to problems down the line. If I have diabetes and I go to see the doctor as I should, and I’m taking my medications as I should, and I get my teeth cleaned, and I get my eyes checked, I’m not a very expensive health plan. But if I do not go to the doctor and I do not take my medication then, one day, I can show up in the Emergency Room and will cost $40,000.​"

For a well-managed health plan, typically that means self-insured, it should not be an issue at all. If you are not on a well-managed health plan, I have no idea. I have seen -10%, -20%, +11%, +38%, +40% it’s been all across the board. It depends, but for a well-managed health plan, it should be a non-factor. If you have somebody that had a severe case of COVID-19, that’s going to be a shock claim for you but most employees have a typical amount of shock claims every year. If someone just had to stay home, that’s not a very big health claim. If you have someone that had to stay in the hospital for a couple of days, it can be a huge expense. It all comes back to how well-managed your health plan is.
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For months you’ve now had no elective surgeries. I know surgeons that are not just working Monday through Friday, but Saturday and Sunday to catch up on the backlogs. That’s all going to hit your plan now because most of the elective surgeries must be done.​"

Providers have all built a business plan that is profitable for them that is generally reasonably priced. You have an organization of people doing free market which shows that it’s possible, it’s a matter of connecting consumers to the members of the FMMA. Sometimes it is easier said than done, but there is high-quality, affordable care all over San Antonio, but you have to hunt to find it.​"

Employers offer employee benefits. More employers are starting to understand that the health plan they created is not helpful to the average employee. If your average workforce is making $12-15/hour and your deductible is $3,500 what you’ve given them is not useful to them. They will not seek care because they're afraid of what it will cost and they can’t afford it. They’re already living paycheck to paycheck, so it’s useless.

​My best clients, my favorite clients say, “We’re not wild about the cost, and we are a business and whatever we can do to reduce it we’ll do, however, we need to get something useful into the hands of the employees.” It takes all the stops off, because you can ask, “alright, have you considered Direct Primary Care or Direct Patient Care? Have you considered this kind of surgeon? Here’s cash pay only, but they cost a third of what it costs normally and their quality metrics are just as high and probably higher than this provider over here.” Helping an employer to understand this doesn’t happen in their office but they can set their parameters of the level of quality they want their employees to have access to and what kind of reimbursement level they want to pay for that care. It’s not an overnight conversation, it’s not a five-minute conversation, it’s a conversation that happens over time.​"

Family Service Association is one of the oldest organizations in San Antonio. They are 119 years old! Their mission is to strengthen families from cradle to grave. They own The Neighborhood Place. They keep kids in school and make sure parents are okay. They do community engagement, and more. South Texas Blood & Tissue Center is trying to get blood donations. Now that elective surgeries have started back up, San Antonio is in DIRE need. Donating blood is safe and easy. They are setting up at AT&T Center, and on social media, you can schedule your appointment so everyone is safe and protected.”

Allison is also the media chair of the San Antonio Health Underwriters. “We help insurance agents be better.”
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It just seems that the delta is getting wider and wider and I know banking employers that want to do the right thing for their employees but they don’t know how. Well, I know how. So I can help with that. 
Every employer is different, they don’t all need the same strategies and the same tools but they do need a bit of an individual kind of structure and those are easy to create, quite frankly.
Employers still need help in figuring things out and knowing what to do. I spend a lot of time talking to people.

I read all the time; non-fiction.  I actually read a fiction book called Untamed by Glennon Doyle and I highly recommend it.

Seth Denson

“There is only one way to reduce health insurance premiums, you reduce the number of claims you’re consuming, or the price at which you’re consuming those claims.”~

It’s also important to keep in mind, there are only two types of insurance, self-funded and fully insured; there is no “in between”.

“Healthcare trend will be up next year.  In turn, health insurance trend will be significantly up two years from now, and so those are the things that you want to start thinking about as you start thinking long-term.” ​​

“Roughly 90% of all APIs, (these are what are called active pharmaceutical ingredients), that go into the drugs that you and I take each and every day, are manufactured in the People’s Republic of China.  That should strike fear into anyone in the United States.  If China wanted to get really serious about having an overall impact economically or socially in the United States, they could do so without ever firing a shot.  They just shut us off from our drugs.” ​

 “As a result of Coronavirus, insurance companies who, by and large, along with Medicare have set RV units, have restructured the way by which doctors can be compensated for their work.

“Insurance networks provide no intrinsic value to the healthcare system.  They create an opaque curtain by which the healthcare system and the health insurance system can be in collusion….What I loved seeing as a result of the situation that we were in is, for a brief moment, nobody was worried about insurance networks, the Javits Center in New York became a makeshift hospital. No one knows today whether or not that was in-network with Blue Cross, United, Cigna, Aetna, insert-name-of-insurance-company-here, and quite frankly, nobody cared.  And, that’s the way it needs to be.

In short, while they shouldn’t conflict with each other, healthcare needs to be healthcare, and insurance needs to be insurance, and neither one should interfere with an understanding of the care received or the price paid.

Future predictions for the short term; lower health insurance trend. Long term, however, higher health insurance trend..  Secondary long-term health insurance trend will be higher than the first.  As health insurance trends tend to follow healthcare trends, whatever healthcare does today, the health insurance industry will quickly follow.

 “70% of all drugs delivered in the United States are done so through a mechanism of one of three pharmacy benefit managers.  They were supposed to be the Sam’s Club and Costcos of the pharmacy industry.  Instead, they have become more like the loan shark on the back end where you never know what you’re getting and what you’re paying for. The pharmacy benefit manager is the cash cow for the health insurance industry."

70 percent of all prescription drugs are filled by one of three prescription benefit managers.

“You may ask, if they’re very thin and there’s no margin, why are hospital systems buying physician practices as quickly as they can and why would a recent financial report show that their average return on investment is eight to one? Because that’s the sales force. The doctor has become the sales force, which is why it has never become more important for you to engage with the doctor.”

​“The American citizen is not a good consumer when it comes to healthcare.  We must help them along and give them the tools to be that.  The second thing is everybody is self-funded.”  “You need to get engaged with your insurance company whether you’re fully insured or self-funded; start understanding the pool structure.  Ask questions! Get them answered!  You don’t like the answers?  Go find somebody else!  That’s the American way.  Start being a consumer and acting like it.  That’s the only thing that’s going to solve this problem.  Don’t be subservient to the industry.  Take control of it.”

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Dr. Ray Altamirano, San Antonio Business Journal 2020 Man of the Year, standing next to his lion portrait

We have a home 24/7 for those who have tested COVID positive and they can come here to get treated.

I reached out to people who were in this group of creative and eager social entrepreneurs like, 'hey, let’s find another way to get tests out there.' What we did is not a matter of competition, the goal is to test as many people as possible. When you look at the objective of testing it’s to help the current system in place, which is Metro Health locally. 

​Metro Health is hiring more contact tracers. If you get more contract tracers you can nip this thing and it’s usually the asymptomatic tracers that are spreading it. That’s what we’re trying to capture by testing more people.

I help those who test positive.

Part of what separates what we’re doing is that we include a telemedicine visit for those who test positive and for those who test negative but are symptomatic they can go to their doctor, or Casa Salud.

These last few weeks with this demographic, there are so many courtesy visits that I’m doing without them paying because they can’t. I think [about] doing the right thing for people.

It’s hard to predict who is going to get super sick.

At first, they thought it was only the elderly, but if you start looking at diabetes and obesity, San Antonio is the diabetes capital of the United States. Maybe you don’t have it but Gramma could get it.
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The more you can test, the more you contact trace.

​I’m from the south side. I’m very proud to be Mexican. I’m proud to cater this demographic that doesn’t exclude anybody but serves more blue collar workers that are just working contributing to this country.

They need access. And good access--not just any access. I decided I was not going to wait for a government agency to do it. It has to come from us.

I said, ‘the only way I’m ever coming back to primary care is on my own terms' because I don’t want to be working in the system contributing to these money games with diminished care.

I wanted to be back in the community through primary care and I knew the only way that would work is to be outside of the world of insurance, so that’s why in March of last year I formed my clinic, Casa Salud Family Medical Clinic.

There’s definitely more liberty to treat how I see fit. There’s luxury that I have working outside of the world of the networks of insurance. For me, I like staying fee-for-service mostly to fit my demographics. However, I have the luxury of having my ER job and I see my clinic as more of a service for people who don’t have insurance and I’m able to have some staff.

It’s a matter of creating a free market and what I’ve learned about insurance and about labs that take insurance, about imaging centers, etc., is the prices they fill out are completely arbitrary. There are numbers much less than that they’re willing to work with if you’re paying with cash, So that’s definitely what I love about my clinic and how I feel that freedom.

The most important thing that I’m doing outside of treating patients is training mid-levels. They learn conscious medicine, putting prices on what they need to do because that’s what people are most worried about.

​Patients are more concerned about what it costs than why they’re sick.

When they see there won't be any back billing that will put them in bankruptcy for a procedure or for anything because I was able to negotiate upfront a price and approach the problem with a price tag to it, it is more effective.

I really like the service in my community. I think what I’m doing serves as a blueprint for anyone who wants to do that for their own community. If they want to train under me that’d be great. I tell everyone that there is a way to make money and you don’t have to be a specialist. 
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You can be a primary care doctor and still earn a good living through this model and be completely free and have the liberty to practice as you choose and you’re working for your patients not the payer,

​so that’s exactly why I do what I do with my clinic.

Pictured above: Member of the San Antonio Free Market Medical Association Dr. Ray Altamirano of Casa Salud Family Medicine Clinic holding his artwork from his collection that can be found on Facebook page ‘Amar es Vivir.’

Dr. Mark Haverkorn, DDS, MD receives a Nice List Certificate from Santa Claus during Open House and one year celebration.

​I joined FMMA to get the word out. I really believe in being transparent about prices. We have all of our prices posted on our website and Facebook. Currently, River City OMS is the only Oral & Maxillofacial Surgery center with prices as low as ours. I’m hoping that other surgeons will follow and do the same and that coming together through FMMA will help.

​There’s three groups of patients we deal with:
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• We’ve got patients who don’t have insurance or who do not have a lot of money, we obviously help them.

We’re the cheapest oral surgeons in the state of Texas, probably in the whole country. The going rate in San Antonio for four wisdom teeth removal is about 3 grand, I do it for $1,000.

• The patients who want higher-end treatments

You see the commercials that say, “Come in take out all your teeth put in implants in a day!” What they don’t tell you is that it averages $25,000 per jaw, about $50,000 for the mouth. But we can do it for $40,000, that’s 20% off.
We can help the high-end consumers, we can help the folks who are just looking for an affordable way to get care.
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• Then, in the middle, patients who have insurance and a job are a little more hesitant, but they come out ahead too.​

We had a patient who had two impacted wisdom teeth removed. Our prices are $675. That patient submitted a claim to their dental insurance and got $475 back. That means their out of pocket was a little over $200 to have two impacted wisdom teeth removed.
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$100 a tooth? You will never find that kind of a deal like that. The dental school charges a lot more than that and they have students in residence who are doing it. The clients who come to us and try this do well!
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Problem wise, I think we help out people who just cannot afford to get treated. All the time, we have patients who walk in. They've been to a couple of other places and they couldn’t afford it and they were just going to have to deal with their problem until they could take care of it.

​Some will fly down to Honduras or Central America to get surgery at a discount, but then you have patients that don’t want to do that, but don’t want to fork out 50 grand so when we come a bit lower, that helps them too.

No one’s angry, but I think a lot of people think it won’t work. In dental school, everyone wanted to be fee-for-service, which we are, but they wanted to be FFS with ridiculously high prices. Like $3,000 for a crown. No one ever talked about being fee-for-service at a price people could afford. They’re intrigued by it.

Members of the SATX FMMA pictured left is Mark Haverkorn, DDS/MD of River City OMS, center is Chrissy Navejar, DO of Dominion Primary Care and right is Co-Founder of FMMA and CEO of Shankx Web Development, Mr. Shankar Poncelet.

Giving back. I’m very fortunate that my wife is right on board. We’ve always liked to do charity. We like giving things away and trying to help people. This Wrappin’ Jack will be at Fiesta Texas and we’re collecting donations and sponsoring that. It goes to Family Services Association that started in 1903 serving underprivileged families. The average family makes less than $10,000 per year.

I learned about where the name Camp Bullis came from! There’s a colonel in the army that was fighting on the border in the 1800’s in the Indian War. I was always interested and then I found an article about it.

​I’m a Cattle Rancher! My father-in-law was a rancher so he taught me. My pickup truck is actually used for that.

We sponsor a football team! South Texas Rangers. Cops, firefighters, paramedics, everyone on the team is an active officer or relative. They’re growing. We also have a small ranch and we sponsor a local 4-H chapter. We also sponsor a couple of events the Christian Dental Association does every year.

My passion for oral surgery started from seeing my dad, who was also a surgeon and then discovering there was a lot of variety in this field. We do trauma, pathology, cancer. Some do cleft!

What's the last book you read? I really enjoy non-fiction. The last book I read, was Killers of the Flower Moon by David Grann. An Indian tribe in Oklahoma is given a reservation that everyone thought was worthless, but they found oil. They were the wealthiest people in Oklahoma. People came in and tried to take advantage and there were murders. It’s an interesting story!