An Employer's Journey to Affordable Healthcare
On November 18, 2022, at The Club at Sonterra, we had an exciting evening of exploration and learning at, "An Employer's Journey to Affordable Healthcare." The San Antonio Free Market Medical Association guests heard from keynote speaker David Balat, Executive Director of Free2Care, and a panel of leading industry experts including Bill Cox, President of Cox Manufacturing Co., Janice Martinez, Head of HR at Texas Disposal Systems, and Dr. Cliff Porter, a pioneer of Direct Primary Care.
Hosted by San Antonio Free Market Medical Association Chapter co-leaders, Dr. Roger Moczygemba and Shankar Poncelet, the event was generously sponsored by Direct Med Clinic, Shankx Healthcare Marketing, Eagle Care Health Solutions, Family Hospital Systems, Altiqe Consulting, and EZaccessMD.
This was an opportunity we hope you didn’t miss, as it was a night of valuable insights and information on the journey towards affordable healthcare. However, if you did, you can read our recap blog or watch the meeting in full below:
David Balat kicked off the night with a keynote speech, in which he recognized the "change makers," including:
David topped off his powerful speech with a quote from Isaac Newton that reads, “If I have seen further, it is by standing on the shoulders of giants.” He dedicated this quote to the appointed change makers, crediting them with being the giants upon which the Free Market movement will thrive off of.
Pictured: David Balat giving the keynote speech at the FMMA meeting
Following the brief introductions of the guest speakers, Dr. Roger kickstarted the main theme of the evening with questions aimed at the panelists; The first question being why employers should care about providing their employees with affordable care. Janice Martinez and Dr. Cliff Porter recounted the moment they stumbled upon each other and the way their collaboration came about.
Pictured: Dr. Roger Moczygemba moderating the evening
Pictured: Shankar Poncelet hosting the evening
The attendees listened with rapt attention as Dr. Porter, Martinez, and Cox shared their thoughts about the importance of Direct Primary Care. One of the most riveting points raised by Dr. Porter included that of Direct Primary Care’s spanning all over the country with about 2,000 clinics actively utilizing the concept. Dr. Porter shared that this large range can actually allow the clinics to form affiliations with each other which in turn facilitates access for patients who find themselves away from their normal clinic. This would also enable patients to seek care at the Direct Primary Care clinic nearest to them.
Pictured: The attendees at the meeting listening intently
After Janice shared why she decided to adopt the DPC model for the employees at Texas Disposal Systems, Dr. Roger queried what she found most attractive about Direct Primary Care and what were the hurdles she had to overcome in order to implement this concept in her company’s health plan. Janice responded, “The demographics in our organization are very diverse… we have individuals that are non English speakers, we have individuals who are illiterate (English or Spanish) … some of the challenges that we had were effective communication.” Despite the employees being wary of the program at first, they now describe it as “old fashioned medicine.” Similarly, Bill shared his own struggles with needing to communicate information effectively and motivate employees to make a change in their lives.
Pictured: (From left to right) Panelists Dr. Cliff Porter, Janice Brewster Martinez, and Bill Cox
Lastly, to conclude the speaking portion of the night, Janice shared a strong testimonial in which she praised the effectiveness of Direct Primary Care and boasted about the amount of faith she has in the concept to be able to entrust it with the most valuable things in her life: her family.
“An Employer’s Journey to Affordable Health” finished out by opening up the floor to the audience and inviting them to ask the employers questions.
Interested in learning more about the better ways for employers to offer healthcare? Join us to learn the ways of The Force: Medical Liberty and Patient Autonomy at the national annual conference for the Free Market Medical Association on May 3-5th, 2023.
What Does the Matrix Represent in Healthcare?
For those of us championing the cause of the Free Market in healthcare, the Matrix represents the overly complicated healthcare system that no one is supposed to know exists. This system wasn’t designed to serve you; the system was designed to frustrate and infuriate you. It’s a system where people make choices for a medical service that really do belong in a movie–like deciding which of their two accidentally severed fingertips to reattach in the Emergency Room without insurance that covers both, suturing their own kneecaps to avoid hospital care, or coming home after an unexpected $39,000 appendix removal only to wind up with even more surprise bills (albeit, with missing CPT codes) that eventually put them into bankruptcy.
This current healthcare system, which is very much alive and well, keeps people from making wiser decisions and choices that, given the chance, would reward them for being responsible, healthy, conscious healthcare consumers, as illustrated in one of our local chapter's quarterly meetings last year. The consumer that shops by proxy instead of accepting whatever fake price the hospital system (enabled by the federal government) offers them, understands how the free healthcare market works. Health care providers that dodge government regulation by opening their own physician practices for more health-care freedom understand that the value of their services is determined by market forces. This “awakening” process is essentially what breaks the healthcare matrix. Using a free market approach to shop and pay for (there’s a distinction) healthcare changes how we purchase healthcare delivery and medical services, which lowers the cost of healthcare to its true cost and fair prices. With fair price controls, healthcare providers can do their jobs, the cost of healthcare lowers, and the entire industry changes with better health outcomes.
The Matrix, Theme of the Free Market Medical Association’s 2021 Annual Conference
Steve Forbes, Dr. Tony Dale, and other dedicated individuals gave presentations focusing not only on the demand side of healthcare, (i.e. lowering the medical costs of prescription drugs and healthcare costs), but the supply side. The keynote speech Steve Forbes delivered at the conference focused on how to safeguard free markets. In his presentation, Mr. Forbes offers a new understanding of how free markets work when there is no interference from Washington politicians and special interest groups.
The Highly Uncompetitive Healthcare Market Failure
"Healthcare is a uniquely uncompetitive market because of the numerous rules and regulations that protect incumbent businesses at the expense of new competition." -PolicyEd There is a market for healthcare, but we need insanely intense competition. That means we need to talk about getting more qualified primary care doctors and doctors-to-be in school. More nurses. More young people who are still deciding on if they want to be in an overworked, underappreciated, overregulated field of medical care, or if they want to go into a free market, explaining what that means to them, screaming at the top of our lungs that insurance and healthcare are not synonymous.
We should focus on new companies and, most certainly, not neglect the lack of doctors we have in this country. When we do these things, a competitive market emerges while we are waiting on changes in policy. However, it’s still important to examine the impact of regulations in the healthcare market and the direct impact of little-to-no, or even poor, entrepreneurship in the market. You can learn more about regulation vs. entrepreneurship in Per Bylund, PhD and Dr. Cristin Dickerson’s presentation on the Matrix of Healthcare Regulation vs Entrepreneurship. (PDF notes)
Small Businesses and Healthcare
Employment-based health insurance leaves a lot of room to focus on stories and case studies that show how employer plans can work in a free market-based system. Dr. Tony Dale, Founder & Chairman of Sedera, and Elaine Parker, President of Job Creators Network Foundation & Chief Communications Officer, explain how to overcome the “bumper sticker health plan” by providing plans that are patient-centric. The goals are to repair and restore the doctor-patient relationship and get bureaucrats out of the exam room to provide choice and affordability. Engaging Company CEO’s To Drive Transformational Change in Healthcare – Tony Dale & Elaine Parker (PDF notes)
Bundled Pricing in the Emergency Room and Maternity Care
Mankind’s greatest hope now lies in us, promoters of the free market in healthcare chasing people down and offering them the red pill they never knew existed. It has been a common misconception that emergency rooms and maternity wards cannot bundle their payments. Yet, in a discussion with Keith Smith, Christion Rice, MD, MBA, and Kylie M. Mayes, they smash the myth explaining how direct care can come to the rescue providing a range of predictable costs and transparency. Publishing prices helps to empower individuals and employers that purchase health insurance to create market pressure and discourage overcharging. Maternity or Emergency Care Can’t Be Bundled, Right? Another Red Pill for You! (PDF notes)
Laws to Improve Access to Care and Affordable Healthcare Coverage With Legislation
David Balat, Director of Right on Healthcare Initiative, Texas Public Policy Foundation, and Jonathan Small, C.P.A., President, Oklahoma Council of Public Affairs gave a legislative update explaining the impact of Medicaid expansion and other updates on the delivery of healthcare for Texans. Among the updates was that the Medicaid Expansion applies to 1-1.5 million people and costs $5 billion. It now extends coverage to able-bodied working adults, crowding out access for the disabled. It also increases the use of emergency rooms for non-emergency care cases. Fewer doctors accept Medicaid, which decreases the quality of patient care. 662K uninsured Texans already have access to Medicaid, but do not use it. See the full presentation here:
Legislative Update – David Balat (PDF notes) video
Our current structure that delivers healthcare services is also responsible for a denial of care, is not price sensitive, and has no interest in operating under a free-market system. When the purchase of health insurance is continuously conflated with the delivery of care and healthcare value, there are unintended consequences. Without care improvement project measures for surgery centers, hospitals, insurance carriers, and checking the outcomes for individual patients, we cannot easily control health-care spending. Doctors are stuck with uncompensated care by central planners with no regard for sound healthcare financing. Regardless of income level, patient outcomes should be favorable, but we've got to escape the Matrix of Healthcare.
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Co-founders Shankar Poncelet and Dr. Roger Moczygemba of the San Antonio Free Market Medical Association, host Seth Denson, author of “The Cure; A Blueprint for Solving America’s Healthcare Crisis” in this virtual meeting on the current state of healthcare in America.
A Broken Healthcare System and the Need For Transparency
Seth Denson, aka the “Modern-day Lorax,” believes that unless all Americans become “healthcare entrepreneurs,” not much will change with our broken healthcare system in the United States. His ideal is that our healthcare system would operate like every other aspect of our consumer life, which would include price transparency, understanding, and accountability.
On Tuesday, June 23, 2020, The American Hospital Association lost its legal bid to stop the Trump administration from requiring hospitals to disclose secret rates they negotiate with insurance companies. Even though the fine of $300 per month is minimal, it’s a great first step in the right direction!
Healthcare and Health Insurance are NOT the Same Thing
To start off, it’s very important to differentiate between healthcare and health insurance. Healthcare is the care we get; health insurance is how we pay for the care we get. In two words, our problem in the United States can be summed up when it comes to healthcare; COST and PROFIT. In order to understand how our healthcare system operates, we need to identify where the costs and profits are.
“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.”~
How COVID Is Impacting Insurance
During COVID, the CDC basically declared that any procedure that wasn’t an emergency or life-saving procedure was considered elective, making it difficult for doctors to provide care. This has resulted in a short-term windfall for insurance companies as most Americans, sitting at home, are still paying their health insurance premiums.
So, while the health insurance trend for 2020 might not be too bad, healthcare trend could go up exponentially in 2021. The healthcare industry will be looking for a way to make up for low profits in 2020. Why is that important? If you’re a self-funded employer, you will need to start thinking differently about how your self-funded plan is structured.
“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.”
How COVID Has Impacted Healthcare Delivery
Most likely, and unfortunately, COVID is here to stay. While we can look forward to herd immunity and a vaccine,--this isn’t projected to happen until sometime next year. (2021) What does this mean from the perspective of healthcare? Not a whole lot necessarily,--however, it will impact the way in which we approach the healthcare system.
“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.”
We must start restructuring how our drug manufacturers operate here in the United States and start looking for other ways to generate APIs! If there has been anything good to come out of the pandemic, perhaps it will serve as a wake-up call not only for our federal government to step in and take action by generating solutions to the API problem, but for every single American to seek to become part of the solution.
Expansion of Telemedicine
Thanks to COVID, telemedicine has finally made it to the frontline, and we’re realizing that doctors can actually use it to successfully help patients without having to see them in an office. Unfortunately, the way our system has been set up, telemedicine has not been encouraged. Someone, somewhere along the way, came up with a “relative value unit” measurement that stated a doctor should be able to see 4 patients an hour,--or in other words, spend 15 minutes per patient.
“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.
As 90% of all healthcare costs in the United States are generated by 6% of our population, expanding the use of telemedicine can help us achieve two very important goals. First, it can help the 6% access healthcare easier. Second, it can help prevent people from becoming part of the 6% by providing more doctor engagement.
COVID has left us keenly aware of how healthcare is delivered. We’ve been able to think about health care differently and restructure how healthcare is delivered.
If Seth were Czar of Healthcare, He would...
“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.
The first step in any solution is recognizing the problem, and the problem here is the actual healthcare. Healthcare is a series of supply chains broken down into four components:
It’s really important to understand that discounts don’t matter; prices do. This is also why price transparency is of utmost importance. Of the four aforementioned supply chains, the two easiest ones to address are the pharmacy benefit manager on the prescription drug side and the doctor.
“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."
Numerous pharmacy benefit managers in the United States are not linked to any insurance company, so it’s important to do your research and understand the data, the drugs, and how they, (PBMs), operate so you make sure you’re getting the best deal. Also, many pharmaceutical companies offer patient assistance programs where, in certain instances, the drug can be obtained for free. This is especially important to look into if you’re an employer as if your employee gets the drug for free, so do you. You don’t have to use your claims money to pay for it. Also, beware of the new “stupid drugs” which are nothing more than a combination of over-the-counter drugs with a prescription label such as Vimovo, a combination of Nexium and Aleve. Why pay $2,500 when you can buy Nexium and Aleve for a grand total of $15? We have to be more informed, especially as employers. Employees are looking to their employers to help them navigate.
Seth makes the analogy between doctors and “milk in grocery store.” Why? Well, milk in the grocery store is often found in the far back corner and there’s no margin in milk. There’s no margin in being a doctor.
“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.”
Direct Med Clinic on Price Transparency - https://directmedclinic.com/direct-med-clinic-in-san-antonio-express-news-for-price-transparency/
FMMA San Antonio - https://www.sanantoniofmma.org/
FMMA San Antonio Facebook - https://www.facebook.com/SATXfmma
Shop Health - https://shophealth.fmma.org
Seth Denson - https://sethdenson.com/
“The Cure; A Blueprint For Solving America’s Healthcare Crisis”
Seth Denson’s Company, GDP Advisors - https://gdpadvisors.com/
Shankx Web Development - https://www.shankxwebdev.com/
DRUG DISCOUNTS AND INFO
Drugs.com - https://www.drugs.com/discount-card/
GoodRx - https://www.goodrx.com/
Medical Assistance - https://medicineassistancetool.org/
Needy Meds - https://www.needymeds.org/
Rock Pharmacy -https://www.rockpharmacytoday.com
Rx Assist - https://www.rxassist.org/
Script Save - https://www.scriptsave.com
Scriptco - https://scriptco.com
WellRx - https://wellrx.com
Armour, S. (2020, June 23). Trump administration price-transparency rule covering hospitals upheld. WSJ. https://www.wsj.com/articles/trump-administration-price-transparency-rule-covering-hospitals-upheld-11592945973
Class action targets CIBA insurance as 'Ponzi scheme'. (2018, April 19). PropertyCasualty360. https://www.propertycasualty360.com/2018/04/19/class-action-targets-ciba-insurance-as-ponzi-scheme-414-125761/
Employer-sponsored healthcare revisited. (2019, October 30). Direct Med Clinic San Antonio. https://directmedclinic.com/employer-sponsored-healthcare-revisited/
Luhby, T. (2017, July 27). What was in the failed Senate 'skinny repeal' health care bill? CNNMoney. https://money.cnn.com/2017/07/27/news/economy/senate-skinny-repeal-health-care/index.html
Rep. Chip Roy on H.R. 6690, the BEAT CHINA act. (2020, May 22). Representative Chip Roy. https://roy.house.gov/media/press-releases/rep-chip-roy-hr-6690-beat-china-act
Interview brought to you by Shankx Web Development and Consulting. For more information, please visit https://shankxwebdev.com
The FMMA was founded in 2014 by Jay Kempton and Dr. Keith Smith based on their mutual desire to fix our broken system. They founded the FMMA based on three pillars.
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