Dr. Cristin Dickerson: Building Whole Products Around Direct Care
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Cristin Dickerson, MD, radiologist and founder of Green Imaging discusses her 6 year experience providing innovative direct radiology services in Texas and now beyond and her subsequent co-founding of Lucent MD, offering DPC centric regional whole health plans to individuals and employers.
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Dr. Cristin Dickerson: Building Whole Products Around Direct Care
- 1. Cri st i n Di ckerson, MD Gr een I magi ng and Lucent MD
- 2. • Despi t e cont r i but i ng 15% of gr oss i ncome t o heal t h car e pr emi ums, hal f of Amer i cans ar e FUNCTIONALLY UNINSURED, and don' t have money l ef t over t o pay f or needed medi cal ser vi ces. • Aver age deduct i bl e f or an i ndi vi dual i n an empl oyer sponsor ed pl an i s $1505 and f or an ACA pl an i s near l y $4000 f or t he most popul ar pl ans. • 44% of adul t Amer i cans cl ai m t hey coul d not come up wi t h $400 i n an emer gency wi t hout t ur ni ng t o cr edi t car ds, f ami l y and f r i ends, or sel l i ng of f possessi ons. • Medi cal expenses ar e t he l eadi ng cause of per sonal bankr upt cy i n t he US. • Heal t hcar e f or a t ypi cal Amer i can f ami l y of f our i nsur ed by t he most common empl oyer - sponsor ed heal t h pl an wi l l cost mor e t han $28, 000 i n 2018 – Mi l l i ma n Me d i c a l Ind e x Re p o r t Too many Amer i cans ar e Funct i onal l y Uni nsur ed
- 3. I nt r oduci ng Gr een I magi ng’ s Di r ect Radi ol ogy Ser vi ces We p a r t ne r wi t h und e r ut i l i z e d o ut p a t i e nt i ma g i ng f a c i l i t i e s , buy e x a m t i me a t c o mp e t i t i v e r a t e s , p e r f o r m o ur o wn p r o f e s s i o na l s e r v i c e s r e mo t e l y , and pass t he savi ngs on t o t he pat i ent &/or empl oyer.
- 4. Gr een I magi ng Sampl e Savi ngs
- 5. The evolution to Lucent MD
- 6. Bui l d Your Whol e Heal t h Di r ect Car e Sol ut i on Par t ner wi t h i ndependent TPAs and benef i t s br oker s Par t ner wi t h an i nnovat i ve heal t hcar e pl an Of f er a whol e heal t h di r ect car e pr oduct . Si mpl i f y your pr act i ce
- 7. The Tool s You Need t o Bui l d Your Whol e Heal t h Di r ect Car e Sol ut i on
- 8. Advantages and Challenges of building a Whole Health Direct Care Solution
Editor's Notes
- Why a radiologist? Spent career with excellent multispecialty groups, relevant because as president of a group I managed a self funded health plan for 325 employees. In this plan we incentivized employees to use our own high quality lower cost care by offering them no OOP if they did so. Because of this experience and because health care reform at the governmental level has failed, I have spent the last 6 years trying to find solutions for patients and employers outside of the broken system.
- For Employees – Functionally Uninsured: Despite contributing 15% of gross income to health care premiums half of Americans are FUNCTIONALLY UNINSURED, and don't have money left over to pay for needed medical services. Resultant delay of care leads to worsening of condition prior to intervention, decreased work productivity, and more people in pain. Average deductible for an individual in an employer sponsored plan is $1505 and for an ACA plan is nearly $4000 for the most popular plans.* 44% of adult Americans claim they could not come up with $400 in an emergency without turning to credit cards, family and friends, or selling off possessions.** Medical expenses are the leading cause of personal bankruptcy in the US.***
- In 2012, the unemployment rate in Houston was hovering at about 20%. Deductibles were skyrocketing, indep docs, groups and facilities were being gobbled up by hospitals as had been the largest outpatient imaging provider, and most quality outpatient imaging centers were out of network or hospital owned. I decided to solve that problem by opening my own. Developed a proforma. The numbers didn’t work, especially given the volumes at the centers we were staffing which were at about 50% capacity. Then a light bulb went off, I decided to try to lease that unutilized capacity and GI was born.
- These are Bill H’s most shoppable imaging codes based on price and volume. His rates are facility only without interp, our are bundled. This model: Eliminates unnecessary middle men Improves care through easily available communication and collaboration with other healthcare providers Provides referral analytics to support best practices and demonstrate appropriate utilization Decreases duplicate and unnecessary testing by providing web portal access to centralized care management Provides out-patient affordable options for high-cost imaging and procedures many of which aretraditionally performed in hospital settings
- Once we developed our initial model for holding down imaging costs, we still had a problem. When the imaging demonstrated a significant health issue, we had little access to low cost specialists and surgeons for these limited resource patients. A woman in my womens’ business forum in Houston heard me express this frustration and introduced me to a like minded physician, GG. Dr. G is a Yale trained pulmonary intensivist who founded a DPC practice to try to help fix the excruciatingly broken healthcare system he experienced working in the Houston Methodist ICU. He, like I was having issues with where to go next. Where to get quality affordable care for the 10% of his patients who needed care beyond the primary care level. He showed me a 15 thread of 15 emails that were required just to get pricing for an outpatient surgery. He and I saw the success of the new healthcare market we are trying to foster is dependent upon the ready availability of surgical and specialty providers who are not just willing to work in this market, but who are educated, empowered, and aligned. We co-founded the Houston FMMA chapter to further this effort and began to recruit a few quality physicians with transparent pricing, but we quickly saw it was going to take more, we needed to create an infrastructure. By contracting with ASCs , surgeons, and medical specialists we have launched a regional network for patient and employer access. Challenges include contracting with one or 2 docs in a larger entity, compiling database of wide range of services and pricing and facilities, retraining physicians to collaborate effectively, and dealing with payors who frequently want or need payment solutions that operate more like traditional care than direct care.
- Simplify your practice and decrease your administrative overhead. Great for DPC with full roster Find an optimal catastrophic coverage/network option among your current patient base. Incentivize your patients to use that payer or narrow down to one or two plans to simplify your workflow and expedite patient care. Make sure this payor works well for referrals…. Partner with an innovative healthcare plans that see the value of direct care to serve your patients and build your practice. Great for growing DPC practice looking to add volume Offer your services as a direct care practice to an innovative healthcare plan, become a checkbox for DPC on their cafeteria plan, and market for each other. Incentivize your existing patients to use that plan for catastrophic coverage. Partner with innovative TPAs and benefits brokers that will include your services in their plan and build your practice. Great for scalable DPC practice looking to add volume Offer more ways to save your enrolled self-funded employers money in their health plan. Help educate both employers and employees Become a reform and transparency advocate Finally, if it becomes important to eliminate overlapping coverage and coverage gaps, Create a network of like minded providers and white label a creative plan to offer a whole health direct care product.
- Customer service and flexible availability (make your team available by as many communication routes as possible to your patients)- not a front desk level job. Electronic interfaces for transmission of PHI between direct care entities. For incoming and outgoing material. Differing technologies. Task management software and database of available services. Flexible payment management, that allows interfacing with patients, plans, TPAs, and employers with individualized algorithms. Content rich website with salient patient information and accessible tools Subscription and onboarding software
- Advantages Fewer intervening third parties Time savings from decreased bureaucracy Eliminate laborious insurance credentialing and over-regulation, PHCS 60 pages Collect more, and collect in full. No more diminished and discounted collections. 30% spend to collect 70%. Command of your own reimbursement rates Prompt cash reimbursement Creativity and flexibility in creating workflows that optimize patient care and match your practice Challenges Loss of uniform and established workflows – pioneer your own Initial investment of time in education, courting new relationships, and establishing original operations Dramatic variation in flexibility that TPAs and employers request or require Fine tuning profit margin Defining cash. Avoiding “cash” deals that require traditional administrative overhead.
- Simplicity is the challenge. If we are going to work regionally with independent providers and not commoditize medical care, we have to find tools that make their practices work better and decrease bureaucracy. Simpler and more favorable contracts Simplified credentialing Simplified invoicing Prompt and simplified payments But in exchange we have to ask them to spend more time with patients, improve collaboration, and become healthcare advocates again