A funny thing happened on the way to our becoming a mandate-heavy, confirm-your-health-insurance-on-your-1040 nation. The doctors started to rebel.
“It’s become so burdensome to be in primary care practice … to the point you’re just a cog in the wheel,” explained Lee Gross, a family doctor in southwest Florida. Between insurers, policy makers and the like, “there were so many people in that patient interaction, it wasn’t really patient interaction anymore.”
Then one day, Gross had an epiphany: “What we do in primary care is cheap. Why does this have to be so expensive?”
Now he has Epiphany, the health care “club” Gross and three colleagues started four years ago.
A single person can join Epiphany Health for $83 a month, a family of four for $230. “Members” get an annual exam plus up to 25 office visits per year; annual tests for cervical, prostate, breast and colon cancer; lab tests including cholesterol screenings; flu shots; and more — all at no additional cost. Epiphany has also negotiated steep discounts with local specialists for services such as ultrasounds and CT scans.
It’s not health insurance. But then, neither is what we call “insurance” today, said Gross, who was in Atlanta earlier this month for a health-industry conference.
“It’s health maintenance,” he said of the typical health plan, “as if your homeowners insurance covered light-bulb replacement, landscape maintenance and housekeeping.”
The idea, Gross said, is for Epiphany members to also buy a high-deductible, catastrophic plan, plus a health savings account to help pay for an emergency. Altogether, these patients can save hundreds, if not thousands, of dollars per year compared to typical health insurance.
Gross can usually see members “within the hour” because he no longer needs to run dozens of patients through his office each day. And it’s been good for his bottom line: Last year, he said, Epiphany accounted for 10 percent of his patient volume but 50 percent of his take-home pay.
That dynamic — fewer patients and better pay for the doctor, better care and lower prices for the patient — could transform the practice of medicine. Today, the number of physicians using this business model nationwide is thought to number only in the hundreds. But that appears to be changing.
It could also change the approach of policy makers.
In Georgia, for example, it could offer a superior alternative to expanding Medicaid. A widely cited study on Medicaid expansion under Obamacare put the cost of covering more than 600,000 Georgians at $44.3 billion from 2015 to 2023.
Imagine if the state could instead give those Georgians an Epiphany-type plan — with doctors who, unlike with Medicaid in many cases, would actually see them. The state could tack on a catastrophic plan, like the Obamacare-compliant one I found on Esurance.com, with added coverage for accidents, dental, vision and critical illness.
Even with generous inflation estimates for both plans, Georgia potentially could cover the same number of people as a Medicaid expansion for only half the cost. Use some of the leftover money to fill in any gaps, and we'd still be billions ahead.
Such a bout of creative destruction is long overdue in the health industry. It can’t happen overnight, but it’s the direction our state’s leaders should try to take.
