Health Insurance Options For Small Business Owners

As a businessman or would-be-entrepreneur, you face great challenges and take significant financial risks. Your health and medical care, however, is one department where you wouldn’t want to gamble. As a responsible manager, you should scope out the health insurance options available for small business owners like you.

Recently, managed care providers have been accommodating “Groups of One,” meaning you can buy a policy for yourself with premiums comparable to group insurance rates. The greatest plus of group health insurance policies is “guaranteed issue,” meaning they can’t exclude a person due to health problems.

You can also check if there are trade associations or chambers of commerce in your area that may offer membership coupled with health insurance.

If you wish to, get a plan to include your employees. Being an attractive benefit for prospective employees, a group health insurance plan can get you the best workers. In addition there are special tax deductions for businesses that offer health insurance.

To purchase the insurance plan that suits you best, you need to familiarize yourself with the basic types of managed care providers in the market:

Health Maintenance Organizations

Health Maintenance Organizations (HMOs) give you a range of health services for a set monthly fee. You pick your choice of a primary care physician from their list of affiliated doctors. With HMOs, you will not receive coverage if you go beyond their network, except for emergency cases. Most of the time, you become eligible for insurance benefits without a minimum payment (deductible), but you may be required a small copay per office visit and a steady monthly premium.

Preferred Provider Organization

The Preferred Provider Organization (PPO) is another type of care provider that extends health care through an approved group of providers, or through other providers outside the network. Usually, you have to pay a small copay and satisfy a deductible before benefits are paid. It’s less expensive to visit one of the providers in the network. You may seek out-of-network health care services, but your share of the bill will be higher.

Point of Service Plans

Similar to HMOs, your primary physician attends to you and refers to other in-network doctors in Point of Service (POS) plans. You may choose to see an out-of-network doctor and the plan will pay a predetermined amount of the bill; you will shoulder the bigger amount. These plans usually cost more, but your choice of attending physician is not restricted.

Health Savings Accounts

Health Savings Accounts (HSAs) are not part of managed care. It is a relatively new way to pay for health services. Savings accounts have tax incentives and can be accessed whenever the need for health care funding arises. Any surplus in the account earns tax-free interest.

Bottom-line, your own business is your source of income. You are its most valuable player and asset. Take care of your health and ensure your business’ smooth sail. Study your health insurance options and make the right choice.

Implementing a Population Health Management Program

Are you planning to focus on population health management at your site? If you are already focusing on population health management, are you planning to strengthen your focus? Wherever your location in population level management planning, be sure that you have first set goals to achieve for the plan. Every planning event that focuses on improving care at your site should first begin with goals.

I believe as do many healthcare professionals that the Triple Aim of the IHI (Institute for Healthcare Improvement) are very good goals. These goals are to improve the health of the population, improve the outcomes and experience of the patient and reduce the per capita cost of care for your community simultaneously. I like to add improve the bottom line of the providers. Fortunately, these can be achieved concurrently with the correct approach, although the work is very challenging.

Setting and achieving goals for population level health at provider sites is a fairly new focus in healthcare. Fortunately, health departments and epidemiologists have many tools which providers can use or adapt. Among these are collecting and analyzing data at an aggregate population level and then implementing evidenced based processes (standardized processes) that have an impact on the population. Other fields have also used population level management for their businesses or processes. Many of these are service based programs. I recently completed a population level study for the Salvation Army and an energy provider.

In the remainder of this newsletter I will describe two population level management programs and highlight some of their approaches. Before I do, let me point out that population level management can have an excellent return on investment for providers. In a recent online interview with Healthcare Informatics, Robert Fortini, R.N., M.S.N., and chief clinical officer of Bon Secours Medical Group based in Richmond, Virginia, stated that he has seen a 3:1 return on investment in Bon Secours population level health initiatives. I believe that this ROI is possible for many providers with a good risk management program.

One medical group working on population level health initiatives is Hill Physicians Medical Group in the East Bay area of California. It is a group of 3,500 physicians. This group has formed virtual care teams of pharmacists, social workers, case managers, etc. to support their physicians. Population health management requires a team approach to be successful. Hill Physician Medical Group works with the ACO model with several of its payers. This approach encourages team-work and breaks down traditional barriers in providing better care. As Darryl Cardoza, the CEO of this group, states, “And what the ACO model has enabled us to do is to begin to break down some of those walls, and to help us all work within the same system, and align incentives,” as stated in an interview with Healthcare Informatics.

Cardoza states that population health management is quite different from earlier managed care. According to Cardoza, “It’s not a matter of just preventing people from using certain kinds of resources, but rather, of managing the entirety of their care. And we were doing it by the seat of our pants, because we didn’t have the tools. It was just very, very difficult to use data, to consolidate it and evaluate it and draw meaning from IT; but those tools are available now.” Further, Cardoza states that it is very important to integrate HIT across the provider networks so that teamwork is more effective. Plus, Hill Physicians Group needs to be very good partners with other providers in the area, with local hospitals and with health plans. They work very hard at being a good partner to others.

The result of their investment in virtual teams with physicians and the connecting of its HIT internally as well as with its partners through health information networks has been a positive financial return and improved health for its patients because of improved delivery of care.

Another group that is delving into population level health initiatives is Bon Secours, mentioned above. This group had 530 employed physicians. Robert Fortina stated that “The major bulk of our work has been around supporting our medical home project, and that has involved delivery system redesign, more robust use of technology, and then good old-fashioned nursing-based case management using those tools, so the development has been multi-factorial.”

One component of Bon Secours population management is community (patient) outreach powered by software from Phytel. This software generates about 75,000 contacts a year. This outreach is based upon 20 chronic disease protocols and 15 prevention protocols. This is a good beginning for providing better care for their patients but Fortina foresees the time when their analytics will become much better and they can do a better job of stratifying patients into risk categories. Doing so will enable them to provide care that is better aligned to the needs of the individual patient.

As one can see Bon Secours Medical Group and Hill Physicians Medical Group are working hard at deploying an effective population level health model to both the benefit of the patient and to the providers. Both use team based approaches. The return on investment is positive for both groups. Contrasts do exist between the two groups too. Hill Physicians is a much larger group and can use its scale to fiscal advantage. The two use different models for their approaches. Hill Physicians uses an ACO model, contracting with several different payers, which makes its approaches to care more complex as different payers have different requirements in their contracts. Bon Secours bases its population model upon the patient-centered medical home, a long established chronic care model.

I believe that because the patient-centered medical home model is well established and well adopted in the primary care environment, it makes good sense to expand its case management model to include population level patient management. Recent data released by the Medical Group Management Association shows that although the total general operating costs of a medical home are greater than non-medical home practices–$126.54 versus $83.98 per patient-the total medical revenue after operating costs are much higher–$143.97 for the medical home versus $78.43 for the non-medical home per patient. Thus, whether using the ACO model, the PCMH model or other model, it seems that population level health management presently provides better care at a lower cost per patient and increased revenue for the provider if a carefully created risk management plan is developed.

What to Expect at a Reproductive Health Center

A reproductive health center is a facility that is designed to help individuals and couples experiencing infertility find relief. This may be a troubling condition for many experiencing it, making counseling important along with the treatment process. Many reproductive centers now offer stress relief treatments and exercises as well as counseling services along with the fertility treatments and procedures that are normally available at many clinics.

When you first seek consultation at a reproductive health center after experiencing infertility, you will likely be asked several questions regarding your health and medical history, as well as personal questions about your attempts at conception. Be open with the fertility specialist and make sure you find one with whom you feel comfortable discussing these matters. Keep in mind also that these specialists deal with these issues every day and understand patients’ reluctance or hesitation to discuss personal matters.

In many cases, tests may be performed in an attempt to pinpoint the problem so that a solution may be worked out. Ask your specialist about the different tests being performed to help you understand the process. Diagnostic tests such as semen analysis, ultrasounds and cycle monitoring may be used to help determine the cause of infertility for many individuals and couples. Clinics may also investigate the possible causes of recurrent pregnancy loss if this is an issue. If the tests reveal the cause of the infertility, the specialist may recommend various treatment or procedure options and explore these options with the couple or individual.

Some of the more common fertility treatments available at many reproductive health centers include in vitro fertilization (IVF) and intrauterine insemination (IUI). In vitro fertilization involves the combination of sperm and eggs in a dish in a laboratory to create embryos, which are then transferred to the uterus where they may implant in the uterine wall and develop. Intrauterine insemination involves the direct injection of sperm into the uterus where it may fertilize the egg to create an embryo, which may then implant in the uterine lining and develop.

A variety of treatments and procedures may be available to treat various possible causes of infertility. These include endometriosis, polycystic ovarian syndrome (PCOS), among many others. Male infertility may also be treated at many clinics. To help patients through what can be a difficult time, many clinics now offer counseling or stress-relieving exercises such as yoga or fertility massage to help patients relax and manage their stress.