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CHANGING THE STATUS QUO WITH
HEALTHCARE 3.0
Who is in Control?
Healthcare Status Quo
Quality Healthcare
3 Components that Control Costs
Community Care
What You can do to help
AVOID healthcare cost
What You can do to
CONTAIN your Large
healthcare cost
What Your Doctor can do
to help MANAGE your
healthcare cost
Physician CareSelf-Care
What is Self-Care?
Things You Can Do
To AVOID Medical Costs
Be Health Focused
Personal Responsibility
Determine How Healthy You Are (Risk Assessment)
Develop the Habits of Highly Healthy People
What is Physician Care?
Things a Physician Can Do
To MANAGE Medical Costs
Provide Primary and Preventive
Arrange Care Continuity
Offer Care Logistics
Organize Case Management
(NOT AN INSURANCE COMPANY)
Things a Community Can Do
To Contain Medical Costs
Low Monthly & Out-of-Pocket Amounts
Provide Negotiations & Transparency
Needs Based vs. Annual Deductible
Support Cash Pay Patients
What is Community Care?
SELF DIRECTED
“DIY”
VIRTUAL PHYSICIAN
DIRECTED
Virtual “VPC”
DPC PHYSICIAN
DIRECTED
In Office “DPC”
• Self Care
• -----------?
• Community Care
• Self Care
• Physician Care
• Community Care
• Self Care
• Physician Care
• Community Care
3 Plan Options
YOUR PLAN CHOICE SHOULD BE DETERMINED BY:
• YOUR CURRENT STATE OF HEALTH AND WELLNESS
• ARE YOU MANAGING ANY CHRONIC CONDITIONS
• DO YOU SEE YOUR DOCTOR FREQUENTLY
Option 1: Self Directed HealthCare
“DIY” HEALTHCARE NO
Physician Care Included
GOOD
Self-Care
AVOID Medical Costs
• Personal Medical Records
• Concierge & Pharmacy
• Tools and Apps
• Education and Resources
Community Care
CONTAIN Medical Costs
• Large Curative Needs
• NO Network
• Low Monthly Amounts
• Bill Mitigation programs
Option 1: Self Directed HealthCare
“DIY” HEALTHCARE NO
Physician Care Included
GOOD
Self-Care
AVOID Medical Costs
• Personal Medical Records
• Concierge & Pharmacy
• Tools and Apps
• Education and Resources
Community Care
CONTAIN Medical Costs
• Large Curative Needs
• NO Network
• Low Monthly Amounts
• Bill Mitigation programs
Option 1: Self Directed HealthCare
“DIY” HEALTHCARE NO
Physician Care Included
GOOD
Self-Care
AVOID Medical Costs
• Personal Medical Records
• Concierge & Pharmacy
• Tools and Apps
• Education and Resources
Community Care
CONTAIN Medical Costs
• Large Curative Needs
• NO Network
• Low Monthly Amounts
• Bill Mitigation programs
Option 2: VPC – Virtual Primary Care
BETTER
YOUR “VIRTUAL” PRIMARY
CARE PHYSICIAN
PREVENT & MANAGE
Medical Costs
• $0 Co-Pay Virtual Visits
• 24/7 Access
• Preventative Care
• Care Logistics
AVOID Medical Costs
• Personal Medical Records
• Concierge & Pharmacy
• Tools and Apps
• Education and Resources
CONTAIN Medical Costs
• Large Curative Needs
• NO Network
• Low Unshareable Amounts
• Bill Mitigation programs
Option 2: VPC – Virtual Primary Care
BETTER
YOUR “VIRTUAL” PRIMARY
CARE PHYSICIAN
PREVENT & MANAGE
Medical Costs
• $0 Co-Pay Virtual Visits
• 24/7 Access
• Preventative Care
• Care Logistics
AVOID Medical Costs
• Personal Medical Records
• Concierge & Pharmacy
• Tools and Apps
• Education and Resources
CONTAIN Medical Costs
• Large Curative Needs
• NO Network
• Low Unshareable Amounts
• Bill Mitigation programs
Option 3: DPC – Direct Primary Care
BEST
DIRECT PRIMARY CARE
PHYSICIAN
CONTAIN Medical Costs
• Large Curative Needs
• NO Network
• Low Initial Unshareable
Amounts
• Bill Mitigation programs
AVOID Medical Costs
• Personal Medical Records
• Concierge & Pharmacy
• Tools and Apps
• Education and Resources
PREVENT & MANAGE
Medical Costs
• $0 Co-Pay Office Visits
• Unlimited Office Visits
• Preventative Care
• Care Logistics
Option 3: DPC – Direct Primary Care
BEST
DIRECT PRIMARY CARE
PHYSICIAN
CONTAIN Medical Costs
• Large Curative Needs
• NO Network
• Low Initial Unshareable
Amounts
• Bill Mitigation programs
AVOID Medical Costs
• Personal Medical Records
• Concierge & Pharmacy
• Tools and Apps
• Education and Resources
PREVENT & MANAGE
Medical Costs
• $0 Co-Pay Office Visits
• Unlimited Office Visits
• Preventative Care
• Care Logistics
Join the Association and become part of our Community.
What is Medical Cost Sharing?
Medical Cost Sharing to
Eliminates the potential of financial catastrophe from bad health.
Healthcare Expenses
For the benefit of the shareholders that own the Insurance Company
The Healthcare Status Quo
For the benefit of the members that share in the Community Funds
Changing the Status Quo with Healthcare 3.0
Medical Cost Sharing
a Fast Growing Health Care Solution
A Better Way
Health Care through
Community vs Health
Care through Insurance
Industry Wide Estimate:
1 Billion in Sharing
1 Million Members
Freedom from
Networks
Big Savings Over
Health Insurance
Sharing begins at $500, $1000,
$1500, $2500 or $5000 per
need you decide
Promotes a Healthy
Lifestyle
Medical cost sharing by Sedera Health is not insurance and is specific to the Sedera Health membership community.
“Industry-wide statistic source: www.healthcaresharing.org
Medical Cost Sharing is “Need” Based
Defining a “Need” and how it works
A “Need” is one or more medical
expenses caused by a SINGLE accident
or illness
Initial Unshared Amount (IUA)
What members pay before Sharing begins for the Need
Needs over the IUA ($500, $1000, $1500, $2500
or $5000)
Limiting your out-of-pocket costs
Fully Shared with the Community
Three (3) for Individual and five (5) when there are
family members participating. Everything is fully
shareable after that point.
Medical Cost Sharing in Real Life
Comparing $5,000/Family Member Insurance Deductible vs a $500 Initial Unshareable Amount
For Example, a family’s two year old
daughter had a persistent ear
infection. Their deductible was
$5,000/per family member threshold
Care for the child required:
1. A series of antibiotics and booster
injections
2. Visit with an ENT specialist who inserted
tubes in the child’s ear at a local hospital
Cost of an average family insurance policy with a primary of 45 and a
$5000 deductible is $1450.00 per month, a $500 IUA healthy care strategy
is $783.00/mn
Medical Cost Sharing in Real Life (continued)
Members pay for visits and treatments up to the IUA, costs are fully shared thereafter.
Pre-Existing Conditions
Pre-existing Conditions:
When well controlled, these conditions DO
NOT have sharing restrictions
• High Blood Pressure
• High Cholesterol
• Sleep Apnea
• Non-Insulin Dependent
Diabetes
Pre-existing Conditions:
Sharing Restrictions*
A condition is considered pre-existing if a
member had symptoms or treatment in the
last 36 months at the time of joining the
community.
• Year 1: No Sharing for the
Condition
• Year 2: $15,000 sharing limit
• Year 3: $30,000 sharing limit
• Year 4: Fully Shareable
* Standard sharing restrictions apply when joining the community for genetic defects and/or hereditary disease. There are also restrictions on
existing pregnancies when joining the community. Please see the Sedera Member Access Membership Guidelines for more information..
Prescription Drug Coverage
Medications
Cure
Examples: Antibiotics, pain medications
related to a car accident or post pregnancy,
chemotherapy drugs
+ Same sharing rules apply
Maintenance
Examples: Blood pressure medication,
cholesterol medications
+ Sharing eligible for first 120 days following a new
diagnosis
+ After 120 days on a new diagnosis (or for an
existing diagnosis): Our Pharmacy Consultant has
good resources for securing discounted prices for
maintenance medications (paid from pre-tax HSA or
Health Matching Account HMA)
In addition to sharing medical expenses, Sedera
provides access to:
• Counseling – Marital, Emotional and Spiritual
• Medical Bill Negotiation
• Telemedicine
• Expert Second Opinion
• Personal Member Advisor
MPoweringBenefits.org
info@mympb.com
(855) 816-4650 ext.403
Take CONTROL of Your Health Care…
THANK YOU FOR
YOUR INTEREST
Presented by John Kach

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MPB Presentation to MAR Members

  • 1. Sponsored by: CHANGING THE STATUS QUO WITH HEALTHCARE 3.0
  • 2. Who is in Control? Healthcare Status Quo
  • 3. Quality Healthcare 3 Components that Control Costs Community Care What You can do to help AVOID healthcare cost What You can do to CONTAIN your Large healthcare cost What Your Doctor can do to help MANAGE your healthcare cost Physician CareSelf-Care
  • 4. What is Self-Care? Things You Can Do To AVOID Medical Costs Be Health Focused Personal Responsibility Determine How Healthy You Are (Risk Assessment) Develop the Habits of Highly Healthy People
  • 5. What is Physician Care? Things a Physician Can Do To MANAGE Medical Costs Provide Primary and Preventive Arrange Care Continuity Offer Care Logistics Organize Case Management
  • 6. (NOT AN INSURANCE COMPANY) Things a Community Can Do To Contain Medical Costs Low Monthly & Out-of-Pocket Amounts Provide Negotiations & Transparency Needs Based vs. Annual Deductible Support Cash Pay Patients What is Community Care?
  • 7. SELF DIRECTED “DIY” VIRTUAL PHYSICIAN DIRECTED Virtual “VPC” DPC PHYSICIAN DIRECTED In Office “DPC” • Self Care • -----------? • Community Care • Self Care • Physician Care • Community Care • Self Care • Physician Care • Community Care 3 Plan Options YOUR PLAN CHOICE SHOULD BE DETERMINED BY: • YOUR CURRENT STATE OF HEALTH AND WELLNESS • ARE YOU MANAGING ANY CHRONIC CONDITIONS • DO YOU SEE YOUR DOCTOR FREQUENTLY
  • 8. Option 1: Self Directed HealthCare “DIY” HEALTHCARE NO Physician Care Included GOOD Self-Care AVOID Medical Costs • Personal Medical Records • Concierge & Pharmacy • Tools and Apps • Education and Resources Community Care CONTAIN Medical Costs • Large Curative Needs • NO Network • Low Monthly Amounts • Bill Mitigation programs
  • 9. Option 1: Self Directed HealthCare “DIY” HEALTHCARE NO Physician Care Included GOOD Self-Care AVOID Medical Costs • Personal Medical Records • Concierge & Pharmacy • Tools and Apps • Education and Resources Community Care CONTAIN Medical Costs • Large Curative Needs • NO Network • Low Monthly Amounts • Bill Mitigation programs
  • 10. Option 1: Self Directed HealthCare “DIY” HEALTHCARE NO Physician Care Included GOOD Self-Care AVOID Medical Costs • Personal Medical Records • Concierge & Pharmacy • Tools and Apps • Education and Resources Community Care CONTAIN Medical Costs • Large Curative Needs • NO Network • Low Monthly Amounts • Bill Mitigation programs
  • 11. Option 2: VPC – Virtual Primary Care BETTER YOUR “VIRTUAL” PRIMARY CARE PHYSICIAN PREVENT & MANAGE Medical Costs • $0 Co-Pay Virtual Visits • 24/7 Access • Preventative Care • Care Logistics AVOID Medical Costs • Personal Medical Records • Concierge & Pharmacy • Tools and Apps • Education and Resources CONTAIN Medical Costs • Large Curative Needs • NO Network • Low Unshareable Amounts • Bill Mitigation programs
  • 12. Option 2: VPC – Virtual Primary Care BETTER YOUR “VIRTUAL” PRIMARY CARE PHYSICIAN PREVENT & MANAGE Medical Costs • $0 Co-Pay Virtual Visits • 24/7 Access • Preventative Care • Care Logistics AVOID Medical Costs • Personal Medical Records • Concierge & Pharmacy • Tools and Apps • Education and Resources CONTAIN Medical Costs • Large Curative Needs • NO Network • Low Unshareable Amounts • Bill Mitigation programs
  • 13. Option 3: DPC – Direct Primary Care BEST DIRECT PRIMARY CARE PHYSICIAN CONTAIN Medical Costs • Large Curative Needs • NO Network • Low Initial Unshareable Amounts • Bill Mitigation programs AVOID Medical Costs • Personal Medical Records • Concierge & Pharmacy • Tools and Apps • Education and Resources PREVENT & MANAGE Medical Costs • $0 Co-Pay Office Visits • Unlimited Office Visits • Preventative Care • Care Logistics
  • 14. Option 3: DPC – Direct Primary Care BEST DIRECT PRIMARY CARE PHYSICIAN CONTAIN Medical Costs • Large Curative Needs • NO Network • Low Initial Unshareable Amounts • Bill Mitigation programs AVOID Medical Costs • Personal Medical Records • Concierge & Pharmacy • Tools and Apps • Education and Resources PREVENT & MANAGE Medical Costs • $0 Co-Pay Office Visits • Unlimited Office Visits • Preventative Care • Care Logistics
  • 15. Join the Association and become part of our Community. What is Medical Cost Sharing?
  • 16. Medical Cost Sharing to Eliminates the potential of financial catastrophe from bad health. Healthcare Expenses
  • 17. For the benefit of the shareholders that own the Insurance Company The Healthcare Status Quo
  • 18. For the benefit of the members that share in the Community Funds Changing the Status Quo with Healthcare 3.0
  • 19. Medical Cost Sharing a Fast Growing Health Care Solution
  • 20. A Better Way Health Care through Community vs Health Care through Insurance Industry Wide Estimate: 1 Billion in Sharing 1 Million Members Freedom from Networks Big Savings Over Health Insurance Sharing begins at $500, $1000, $1500, $2500 or $5000 per need you decide Promotes a Healthy Lifestyle Medical cost sharing by Sedera Health is not insurance and is specific to the Sedera Health membership community. “Industry-wide statistic source: www.healthcaresharing.org
  • 21. Medical Cost Sharing is “Need” Based Defining a “Need” and how it works A “Need” is one or more medical expenses caused by a SINGLE accident or illness Initial Unshared Amount (IUA) What members pay before Sharing begins for the Need Needs over the IUA ($500, $1000, $1500, $2500 or $5000) Limiting your out-of-pocket costs Fully Shared with the Community Three (3) for Individual and five (5) when there are family members participating. Everything is fully shareable after that point.
  • 22. Medical Cost Sharing in Real Life Comparing $5,000/Family Member Insurance Deductible vs a $500 Initial Unshareable Amount For Example, a family’s two year old daughter had a persistent ear infection. Their deductible was $5,000/per family member threshold Care for the child required: 1. A series of antibiotics and booster injections 2. Visit with an ENT specialist who inserted tubes in the child’s ear at a local hospital Cost of an average family insurance policy with a primary of 45 and a $5000 deductible is $1450.00 per month, a $500 IUA healthy care strategy is $783.00/mn
  • 23. Medical Cost Sharing in Real Life (continued) Members pay for visits and treatments up to the IUA, costs are fully shared thereafter.
  • 24. Pre-Existing Conditions Pre-existing Conditions: When well controlled, these conditions DO NOT have sharing restrictions • High Blood Pressure • High Cholesterol • Sleep Apnea • Non-Insulin Dependent Diabetes Pre-existing Conditions: Sharing Restrictions* A condition is considered pre-existing if a member had symptoms or treatment in the last 36 months at the time of joining the community. • Year 1: No Sharing for the Condition • Year 2: $15,000 sharing limit • Year 3: $30,000 sharing limit • Year 4: Fully Shareable * Standard sharing restrictions apply when joining the community for genetic defects and/or hereditary disease. There are also restrictions on existing pregnancies when joining the community. Please see the Sedera Member Access Membership Guidelines for more information..
  • 25. Prescription Drug Coverage Medications Cure Examples: Antibiotics, pain medications related to a car accident or post pregnancy, chemotherapy drugs + Same sharing rules apply Maintenance Examples: Blood pressure medication, cholesterol medications + Sharing eligible for first 120 days following a new diagnosis + After 120 days on a new diagnosis (or for an existing diagnosis): Our Pharmacy Consultant has good resources for securing discounted prices for maintenance medications (paid from pre-tax HSA or Health Matching Account HMA)
  • 26. In addition to sharing medical expenses, Sedera provides access to: • Counseling – Marital, Emotional and Spiritual • Medical Bill Negotiation • Telemedicine • Expert Second Opinion • Personal Member Advisor
  • 27. MPoweringBenefits.org info@mympb.com (855) 816-4650 ext.403 Take CONTROL of Your Health Care… THANK YOU FOR YOUR INTEREST Presented by John Kach