Can integrative pediatricians afford to stay in business? Practitioners are struggling with how to provide high-quality comprehensive care while maintaining access for those families who cannot afford cash-only services.
Most conventional pediatricians survive economically today by increasing the flow of patients they see per session. Seeing more patients in the same amount of time does not often lead to satisfactory relationship-centered medicine. Yet insurance companies generally reimburse poorly for time spent with families, especially for those practitioners caring for children with complex, chronic conditions. Integrative pediatricians determined to provide comprehensive, time-intensive care must decide: how can we stay in business? If I abandon traditional 3rd party payor plans, and accept cash only, will only the wealthy be able to afford my services? These difficult questions are starting to result in very unorthodox and interesting answers.
Bill Henry, President of ForeSight Strategy Associates, is working with the Bravewell Collaborative to help find solutions to this quandary. Bill kindly sent me this summary of the rationale behind his latest project, a study on the potential of consumer-directed health plans for integrative medicine.
Consumer-directed health plans are also known as “defined-contribution” health plans because they define the contribution that the employer makes to the plan, rather than the benefits that the employee receives – as in traditional “defined-benefit” plans. This rapidly emerging type of health insurance usually combines a) some form of high-deductible indemnity coverage with b) employer-subsidized individualized health accounts (“health savings accounts” or “health benefits accounts”), c) employee-funded flexible spending accounts , and d) access to web-based educational resources intended to coach employees in both the wise use of healthcare resources and more effective management of their health, especially the management of chronic health conditions.
Because these plans remove many of the limitations to access that are common in traditional health insurance, it might be assumed that people who are covered by them would be more likely to access integrative medicine services. However, in a company where these plans have been in effect for 5 years, less than 2% of expenditures from employees’ health savings accounts are for “non-traditional” services. And, in conversations with providers during the most recent phase of the mapping study, there was very little indication that providers knew about consumer-directed plans or that their services were being purchased through such plans.
All of this leads to the conclusion that consumer-directed health plans may hold significant opportunity for increasing access to integrative services in both adult and pediatric medicine, but that efforts may be required to convert the availability of consumer reimbursement for these services to actual purchases. One of the first steps is broadening the knowledge of pediatricians and their office staffs so that they are prepared to talk with people who are covered by these plans and/or to consider these plans in their marketing efforts.
For more information, I’d also recommend Michael Cohen’s posts on insurance issues on his outstanding CAMLAW blog.