Tag: Michigan

Direct Primary Care Employer Healthcare

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16 September 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Direct Primary Care Employer Healthcare. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this blog post, I wanted to discuss an important healthcare option for employers that takes care of employees while reducing overhead:

Direct Primary Care Employer Healthcare

First, Direct Primary Care (DPC) Explained

Direct Primary Care isn’t insurance. Instead, it’s a unique high value membership that can be offered as a standalone employee benefit or used to supplement high-deductible health plans and catastrophic plans. At its basic level, DPC means the doctor works directly for the patient. No private insurance, no medicaid, no medicare, no middlemen. Since we are insurance free, DPC clinics contract with employers through a membership.

Think Netflix… but for Medicine.

In return for a flat monthly membership of $50 at Beyond Primary Care, the employees and their families are provided with an incredible level of personal care including virtually unlimited office visits, in-clinic dispensing of wholesale medications, and wholesale blood work done at the time of appointment when necessary. 

Discover Who Needs Direct Primary Care

With the advent of the gig economy– which encompasses a range of full-and part-time jobs done by the growing cohort of continent workers- nearly every U.S. industry will be employing a substantial amount of part-time and contract workers who won’t qualify for traditional health insurance coverage. These jobs include but are not limited to…

  • Real Estate workers
  • Drivers
  • Restaurant workers
  • Custodians
  • Healthcare workers
  • Accounting / Finance professionals
  • Software Development Experts

These are occupations with high levels of non-benefited employees. 

According the the latest 2018 data, nearly 160 million American’s received their health benefits through an employer. But premiums and deductibles are pushing employer-based coverage increasingly out of reach. Additional businesses that would benefit from Direct Primary Care include:

  • Businesses with self-funded health insurance
  • Businesses who see their health insurance premiums going up and up every year
  • Employers concerned about health benefits with regards to recruitment, retention, and workplace wellness.

Why Direct Primary Care Is Important to Employers

On average, employers are spending $6,715 per employee per year for healthcare. Employers are tired of sitting around their board table every year and wondering how much of the health insurance increase is coming out of the employees pocket.

This is important.

Why? With Direct Primary Care the less employers spend on a health insurance plan, the more they can put back into salary or additional benefits. Employers can focus on building community-owned healthcare versus building the archaic insurer-owned healthcare. Employers can take active management of their spending patterns and discontinue relying on the traditional “passive management” approach provided by the ‘BUCAH’ insurances (Blue Cross, United Healthcare, Cigna, Aetna, Humana).

Currently employers have no power over healthcare costs with health insurance as it’s a patchwork in access to your physician and a free-for-all in which the prices of life-or-death essentials like insulin or epinephrine are set at whatever the market will bear. Efforts to check those prices are routinely trampled on by interest groups that hold influence over our lawmakers.

This important.

Why? The goal is to maximize employee health and minimize cost to the employer. Your employees are probably being crushed by out-of-pocket fees and lack of physician availability. Innovate by subscribing your employees (and maybe their families too) as a group to a local Direct Primary Care office. At no extra cost- you will get.

  • deeply discounted prices for blood tests
  • deeply discounted prices for radiology studies
  • generic medications dispensed from the office at near wholesale cost

As example, at Beyond Primary Care, Dr. Jeff O’Boyle can get pretty much any generic medication for my patients at just a fraction of the cost. As example, we’ve had a patient paying $40 a month for a medication at Walmart and pay $8 for three months at Beyond Primary Care.

A Note For Brokers

Direct Primary Care has become a key enrollment strategy to fill the healthcare solutions gap. If you are new to the Direct Primary Care movement, the good news is that Direct Primary Care is an easy sell. Employees need accessible and personalized coverage, and employers are happy with how affordable it is. If you ignore Direct Primary Care during open enrollment, you are leaving thousands of revenue dollars for yourself on the table as Direct Primary Care is a key strategy

“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” – Buckminister Fuller

Direct Primary Care Employer Healthcare

Are you ready for some out of the box thinking on benefits? Don’t overcomplicate it. Qualifying for employer healthcare solutions at Beyond Primary Care offerings can be as simple as having at least 5 enrollees, and the cost can be as low as $50 per employee per month. Our clinic eliminates claims, pre-existing conditions, and other complications.

There are no losers with Beyond Primary Care. The employer can attract and keep talented members with great healthcare, reduce absenteeism, and brokers have a gap coverage product that can start paying off right immediately to assist in funding open enrollment. 

Educate Those Employers and Employees

If you think your business or you work for a place that would benefit from the services of Beyond Primary Care, send them a link to this post so that they can join the conversation. Many employers may have only a vague idea of what direct primary care is, believe it’s too expensive, and don’t understand how to introduce new benefits to employees who never had them before. Let’s change that!

You can also contact Dr. O’Boyle directly. I look forward to hearing from you!

Why Insulin Costs So Much

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12 September 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Why Insulin Costs So Much. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this blog post, I wanted to discuss an important healthcare question that often gets talked about: Why Insulin Costs So Much

Why Insulin Costs So Much

First, What Is Insulin

The hormone insulin is produced by an organ in the belly called the pancreas, and insulin production is regulated through a feedback loop based on blood sugar levels in the body. Insulin assists cells in the muscles, fat, and liver to absorb glucose (sugar) in the blood, and that glucose acts as energy for these tissues. 

The most common problem associated with insulin is diabetes, and diabetes falls into two categories. Individuals with type 1 diabetes have a pancreas that no longer makes insulin and they need insulin injections to use glucose from meals. Individuals with type 2 diabetes make insulin, but their bodies have resistance to it and most individuals need to take pills or insulin injections to assist their bodies to use glucose for energy.

Insulin can not be given as a pill. Like other proteins, insulin would be broken down too much during digestion and thus it needs to be injected. For type 2 diabetes who need insulin or type 1 diabetes who require insulin, there is no alternative medication. 

The Insulin Supply Chain

In economics, inelastic demand occurs when people buy the same amount of a product, whether the price drops or rises. This occurs in many situations, from gasoline to food to medications- like insulin.

My demand for food is relatively inelastic—I will quickly die without it—but that doesn’t mean that any grocery store can extract hundreds of dollars- increasing prices from me each week. If they tried to do so, many other grocery stores will gladly win my business with lower prices and said previous grocery store will lose business (likely for good). 

Inelastic demand is only a problem for consumers if there is limited competition among the suppliers of a good. Notably, the lack of manufactures to produce insulin is one of the main culprits of out-of-control costs.

There are only three incumbent manufacturers of insulin serving the U.S. market: Eli Lilly, Novo Nordisk, and Sanofi. Pricing of insulin is very complex and involves many layers of middlemen including wholesalers, Pharmacy Benefit Managers (PBMs), healthplans, and pharmacies. Within the system, there is no agreed-upon price for any insulin formulation.

Kickbacks, Prices, and Middlemen Increasing Your Insulin Prices

According to the American Diabetes Association (ADA), the average list price of insulin has nearly tripled since 2002. In 1996, when Eli Lily’s Humalog first came out, the price for a one-month supply was $21. As of 2019, that vial is around $275, a 1,200% increase on the original price. Further data indicates when one insulin manufacturer increases the price for a given insulin preparation, the other insulin manufactures often increase their prices by a similar amount quickly afterwards. 

“Third parties and other barriers to care are not only increasing the prices of insulin, but physicians can’t really do what we believe is right and best practices for our patients and give our patients a voice in their healthcare.” ~ Dr. Jeff O’Boyle 

Worse, these manufacturers ruthlessly exploit the patent system to fend off competition. Pharmaceutical companies use lawsuits combined with incremental patent changes that enables the manufactures to extend the patient on the drug. These practices prevent insulin from going generic and other manufactures from producing more affordable versions.

In fact, insulin manufactures and pharmacy benefit managers (PBMs) such as CVS, Express Scripts, United Health, and OptumRx have been accused of artificially inflating prices for insulin in a class action suit brought in 2020. According to the suit, these manufactures aggressively increased the prices for insulin past what they would have charged had there been no scheme. 

Health Insurance Doesn’t Help The Insulin Costs

Why doesn’t competition among the BUCAH (BlueCross, United, Cigna, Aetna, Humana) health insurers force the manufactures to offer plans tailored to the different needs of patients? As example, the needs vary drastically from a person suffering from Crohn’s disease versus a type one diabetic). There are complex reasons for this- including the pharmacy benefit managers discussed above- but a major one is the tax privileged treatment of employer provided health insurance.

In 2018, nearly 160 million Americans got their health insurance through heir job, which at best puts a weak bargaining pressure on health insurers brokered through employers rather than employees. This lack of bargaining leaves the employed individual needing the lifesaving medication powerless and exposed to the expensive out-of-pocket costs. 

Moving Forward

We recognize that cost-containment for life-saving medications such as insulin is a human right. We also recognize that we, the people of Ann Arbor, greater Michigan, and this great nation must unite together to form meaningful solutions.

We commit to doing our small part here at Beyond Primary Care by continuously pushing the status quo of healthcare to seek out more affordable treatment solutions to offset the financial effects our current healthcare system has on those who are most vulnerable. 

It’s small, but it’s what we can do well and what we promise to do for those in our care.

Thank you for reading.

– Dr. Jeff O’Boyle with Beyond Primary Care

Where To Get The Flu Shot In Ann Arbor

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9 September 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Where to Get the Flu Shot in Ann Arbor. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this blog post, I wanted to update my patients and any prospective patients…

Where To Get The Flu Shot In Ann Arbor

Flu season is just around the corner and according to the Centers for Disease Control (CDC) for the 2019-2020 cycle there have been upwards of 56 million Americans affected by flu-like illnesses resulting in nearly 25 million medical visits, a half million hospitalizations, and nearly 50,000 influenza deaths. 

This is why we advocate for getting a Flu shot before the start of the Flu season- we want to prevent people from going to the hospital and potential serious consequences, i.e- death from the Influenza virus.

The flu shot is a little bit of a booster to remind your immune system what may be coming ahead. A similar process is going on with the coronavirus vaccine trials. The vaccine reminds people’s immune system what that virus looks like, so that when they are exposed they either 1) don’t get the virus or 2) get a very mild case.

Flu and Covid-19

Now more than ever, it is important to get your Flu shot. We do not want to see a Flu season with a Covid season together. Flu and Covid-19 are both respiratory illnesses, but are caused by different viruses. The Flu is caused by infection with influenza viruses, and Covid-19 is caused by a new coronavirus (called SARS-CoV-2).

It is possible to have the Flu and Covid-19 at the same time. At Beyond Primary Care we can test for both the influenza virus and Covid-19 at the same time. 

How can the Flu shot help me?

There are many reasons to get the Flu vaccine each year. Here is a summary of the benefits of the Flu vaccine.

  • Flu vaccine protects yourself from getting the flu
  • Flu vaccine can reduce the risk of flu-associated hospitalization for children, working age adults, and older adults
  • Flu vaccine helps prevent serious medical events associated with some chronic conditions such as heart disease, diabetes, and chronic lung disease.
  • Flu vaccine helps protect women during and after pregnancy
  • Flu vaccine can be life saving in children
  • Flu vaccine has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick

If you’re on the fence about a flu shot, here are five arguments to see if I can change your mind.

Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious Flu illness, like babies and young children, older people, and people with certain chronic health conditions.

What are Flu Symptoms? What Should I lookout for?

Symptoms of the Flu and Covid-19 are similar, which makes it extremely difficult to tell the difference based on symptoms alone. Common symptoms that the Flu and Covid-19 share include:

  • Fever or feeling feverish/chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue (tiredness)
  • Sore throat
  • Runny or stuffy nose
  • Muscle pain or body aches
  • Headache
  • Some people may have vomiting and diarrhea, though this is more common in children than adults

Different than the Flu, Covid-19 may include a loss of taste or smell. While a person typically develops symptoms one to four days after an infection, with Covid-19 typically develops symptoms 5 days after being infected, although time range can vary.

Is it too early to get the Flu Vaccine?

Once the flu vaccine is administered, it takes your body about two weeks to develop antibodies to the virus. The vaccine should confer about 6 months of immunity. So, the earlier the better in terms of administration. We do see the flu start peaking in October with another peak in March every year. 

Reasons to NOT to get the influenza vaccine?

Truthfully the only individuals who should not get the Flu shot are infants younger than 6 months of age or people who experience a severe (life threatening) allergy to a prior dose of a seasonal Flu vaccine.

People with egg allergies just need to be monitored for the influenza vaccine, as an egg allergy is not an absolute contraindication.  A 2012 review of published data, including 4,172 egg-allergic patients (513 reporting a history of severe allergic reaction) noted no occurrences of anaphylaxis following administration of the Flu vaccine. 

This suggests that severe allergic reactions to egg-based influenza vaccines are unlikely. On this basis, some guidance recommends that no additional measures are needed when administering influenza vaccine to egg-allergic persons 

People with a cough or cold can still get the flu shot. 

The Flu shot is an inactivated virus and cannot cause influenza, Flu shots given may cause injection site soreness and pain, redness, swelling, fever, malaise and muscle aches- all of which are usually mild and go away on their own.

Where To Get The Flu Shot In Ann Arbor

Protect yourself and your family (and friends and co-workers) from the Flu this year! To make an appointment with Dr. Jeff, head over to our scheduling link to view our availability. Just as a reminder, we will be offering our patients opportunities to get their vaccines on select Saturday mornings, in which case an email will be separately sent to all Beyond Primary Care members.

Thank you for reading.

  • Dr. Jeff O’Boyle with Beyond Primary Care