“Conversations we hear every day when we talk to businesses are all about the cost of health care,” said Christine Bekes, executive director of Powell Economic Partnership, as she opened the meeting.
Bekes said some of those conversations led her to “realize there are other options, and there are options that work for businesses.”
Options summarized by the Nov. 28 panel include direct primary care through 307Health in Powell; an insurance policy designed for Wyoming businesses who are members of chambers of commerce; and health savings, reimbursement and flexible spending accounts.
Brad Johnson, of Covenant Insurance Group in Casper, said chambers of commerce in Sheridan and Gillette approached him several years ago, asking him to come up with an insurance product that would meet employers’ needs.
The result is the Wyoming Chambers Health Benefit Plan. That plan now has a reserve fund that is 350 percent overfunded, he said.
“That means the longterm stability is very good. It’s not designed to be the least expensive; it’s designed to be the most stable,” Johnson said. “It’s done very well at achieving that goal,” with the average coverage to date remaining for seven years — much longer than the 17-month average, he added.
Chris Skiver of Blakeman Propane in Cody said his company provides the Wyoming Chambers Benefit Plan for its employees.
“It’s a Wyoming company,” he said. “There’s one person to deal with for questions — just one person. The previous insurance company we were with, I could spend hours and hours with multiple people in multiple departments trying to help employees. I haven’t had that experience with this company.”
“Probably the biggest negative with them is, they’re not the least-expensive health insurance out there — but we prefer employees who aren’t looking for the least-expensive option,” Skiver said.
Meanwhile, Reanne Wolff and Kevin Buss from SBW & Associates in Cody and Powell explained several options for employers or employees to put aside money for health care expenses. Those include health savings accounts, health reimbursement accounts and flexible spending accounts. All three pre-tax accounts are owned by the employer.
With health savings and health reimbursement accounts, employers and/or employees deposit money to cover future health care costs. To qualify for a health savings account, employees must be covered by a high-deductible insurance plan. Money in those accounts rolls over if it is not used within the year.
Employers and/or employees also may deposit money in a flexible spending account, which can be used for both health care and child care costs. However, that money must be used within one year.
“It’s a use-it-or-lose-it plan,” Wolff said.
Klay Nelson of GDA Engineers in Cody said they use a health reimbursement account “to make our benefits package look shinier.”
“That’s probably most advantageous for them; we tailor them to our needs,” Nelson said. “We’re going to give this class of employees X amount of dollars every month, and this amount to this class every month.
“We’ve got employees that have no families, and they’re making insurance payments larger than their mortgage payments. We utilize the HRA, and our employees seem to like it,” he said.
“I see us continuing with it,” Nelson added. “We know every month how much will be coming out of our pockets, then we’re pretty much done with it.”
Direct primary care
Dean Bartholomew, a doctor who joined 307Health in August, said he’s seen health care and insurance from three different viewpoints. As the previous owner of a small rural practice, he experienced the overhead costs for insurance processing and paperwork, and as a small business owner, he provided costly health insurance to his employees.
Now, he is a doctor practicing under the direct primary care model. That model provides physicians’ services for a monthly fee and does not accept insurance, Medicaid or Medicare.
“We’re able to have a relationship with the patient that’s not driven by insurance demands, and we’re able to meet patients’ needs in a timely manner,” he said.
That is facilitated through the use of technology. Patients can reach their doctors by texts, email or phone.
“The revenue is up front, so we don’t have to generate revenue,” Bartholomew said. “When there’s a fixed cost, a fixed revenue, you don’t have a problem with texts.”
For example, Dr. Mike Tracy, also of 307Health, said he had no appointments scheduled for a period of time on a recent day, and he was able to help several people through texting so they didn’t have to leave work.
Another patient wasn’t able to leave work, “so I walked down there to visit with them.”
JaDell Hovander of Continental Crest Insurance in Riverton said he and his wife subscribe to 307Health, and the distance between Riverton and Powell hasn’t been a problem.
“We have only been up here once,” he said.
As for what led Hovander to sign up for 307Health, he recalled how his wife took their 5-year-old daughter to the emergency room in Riverton at 6 p.m. one day. The girl had fallen and deeply cut her chin. After hours of waiting, his wife, a nurse who works at the ER, agreed to clean the room and do the charting for the girl’s visit in order to get her daughter seen; otherwise, they still had hours to wait.
“She got home at 1:30 a.m. It was a $3,400 bill,” he said. “So, when we were in the evaluation process, we called up 307[Health] and said, ‘Hey, ... could we have called you and met you at 9 o’clock at the clinic?’ And they said, ‘Yeah, absolutely.’”
“The total cost probably would have been about $12 to $15,” Hovander said, much cheaper than the ER visit — even with a restaurant meal and the cost of gasoline to get to and from the clinic in Powell.
As an insurance provider, Hovander said combining a subscription for direct primary care services, along with a major medical insurance policy and partially self-funded stop loss coverage, can lower the cost of health care while still providing good coverage. He said that results in an 80 percent decrease in the number of claims.
Greg Wilson said Heart Mountain Farm Supply now pays for subscriptions to 307Health for its employees.
He told of an experience the company had in the 1990s when an older employee became sick with cancer.
“Their only form of insurance was through us,” Wilson said. “We continued to pay him as a consultant while he was dying on his deathbed so he could continue to be on the insurance. That’s a horrible situation to be put into as an employer, to literally hold an employee’s life in your hand, and their care.”
Additional health problems experienced by other employees resulted in the company’s health insurance premiums escalating so much that it was more expensive to cover the employees through the company than it was for them to obtain insurance on their own.
“We just dissolved our health insurance coverage for our employees and increased everyone’s salary at that point to enable everybody to go to health insurance,” Wilson said. Heart Mountain Farm Supply decided to go with direct primary care two years ago, seeing it as a good solution.
Since then, “We’ve had employees say, ‘I cut my finger and sent a picture to the doctor and he said, “Come on in and I’ll put some stitches in it.”’ Another says, ‘I sent a picture of a rash to him, and he said, “Don’t worry about it,”’” Wilson recalled, adding, “We haven’t had anyone who has had to miss work because of illness for a long time — not because we wouldn’t let them, but because they didn’t need to.”
One man in the audience asked about 307Health’s plans for growth; Wolff added that more and more of the people she works with are going to 307Health. “You’re going to need to have that expansion,” she said.”
Dr. Bob Chandler said 307Health has capacity for about 1,000 more patients now that Bartholomew has joined the practice. Bartholomew said he expects direct primary care to grow.
“This is not a model they just cooked up two years ago,” he said. “It’s a nationwide model. ... I think it’s going to start taking off. Once that nut gets cracked open a bit, I think a lot of doctors are going to go to this model. That’s why we went to medical school ... to take care of our patients.”