Affordable Direct Primary Care Lee S Gross M

Affordable Direct Primary Care Lee S. Gross, M. D. Founder, Epiphany Health President, Docs 4 Patient Care Foundation 1

What was the Epiphany? • Primary care SHOULD be affordable! • Why is basic health care so expensive? • Third party disconnect from cost makes it expensive. • Outside factors drive cost – – – – Hospital Administrative costs Pharmacy Imaging Labs Specialty care Physical Therapy 2

Free Market Model Over time, new technology prices come down in a free market 4

What about health care prices? 5

Why is health insurance so expensive? • It’s not insurance, it’s health maintenance • Traditional insurance is for catastrophic care, not first dollar coverage – What would homeowners’ insurance cost? • Light bulb replacement • Landscape maintenance • Housekeeping • Routine repairs – Third party coverage drives up costs • “I’m paying for it, I’m going to use it. ” • Administrative costs 6

Balancing the cost of care Prima ry Car e $ All other care 7

Remove the cost drivers $ a Prim re a C ry All other care 8

Patient Practice A Patient Epiphany Health Practice B Other third party contracts Business Practice C Business 12

What Does It Cost? Member(s) Monthly Fees Individual $50 with Spouse / Domestic partner $100 Family of 4 $135 13

Examples of in-office savings Service Typical Charge Actual Cost in DPC Additional labs $50 -350 each $10 each Joint injection (knee) $150 $0 Skin biopsy $160 $0 Drain abscess $275 $0 Laceration repair $260 $0 14

Examples of network savings Service Typical Charge Actual Cost in DPC Savings Nuclear Stress Test $1, 470 $520 65% CT of the chest w/contrast $940 $211 78% Carotid ultrasound $425 $120 72% Colonoscopy $4, 028 $1, 127 71% Chest x-ray $220 $22 90% 15

Example of Itemized Hospital Bill 16

Hospital Charges vs. DPC Charges Hospital Charges Epiphany Charges Service Charge Lab charges $38. 14 $8. 00 Chemistry $3524. 14 $70. 79 Hematology $1, 782. 95 $15. 00 Urology $231. 79 $4. 50 Chest x-ray $490. 94 $18. 00 CT scan $10, 955. 13 $185 ER Level 4 $2, 700. 18 $0 TOTAL: $19, 723. 27 $278. 79 17

The Skyrocketing Cost of Healthcare How about our membership fees? 18

Savings with Epiphany DPC Family of 4 = $ 135 per month 2014 Average PPO Insurance* Family of 4 = $1, 935 per month Difference per year: $21, 600 *2014 Milliman Medical Index 19

10 year projection – Family of 4 $250, 000 [VALUE] Total Savings $200, 000 Traditional PPO Insurance Epiphany + HDHP* $150, 000 $135, 240 $96, 960 $100, 000 $50, 000 $0 1 2 3 4 5 6 7 8 9 10 *2015 Aetna Bronze Deductible Only HSA Eligible Savings Plus HMO PD ($12. 6 K deductible, $673/mos) 20

10 year projection – Employer of 10 $2, 500, 000 $2, 322, 000 Total savings $2, 000 Traditional PPO Insurance Epiphany + HDHP $1, 500, 000 $1, 352, 400 $969, 600 $1, 000 $500, 000 $0 1 2 3 4 5 6 7 8 9 Assumes middle aged employees with families of 4 10 21

Saving a Nation • ACA estimates 32 million newly “insured” • Many of the “insured” will be on Medicaid • Estimated 26 million remain uninsured • Current 10 -year CBO projected cost $1. 8 trillion

Saving a Nation • If ALL 58 million uninsured were enrolled in Epiphany Health… • All would have CARE but not COVERAGE • Total 10 year cost = $348 billion Net 10 year savings…

Saving a Nation $1, 462, 000, 000!!! $1. 46 Trillion

Any questions? 29