Hospital Impact: It’s up to American consumers to disrupt the healthcare system

CVS pharmacy
With so few affordable healthcare options available, it's no wonder that millennials turn to retail health clinics like CVS Minute Clinics for care instead of a traditional physician practice. (Mike Mozart/CC BY 2.0)
Anthony Cirillo headshot
Anthony Cirillo

“In most revolutions, it’s the revolutionaries who die first.”

That was a quote by Thomas Goetz, co-founder and CEO of Iodine, a digital health startup, in an article in Inc. Magazine’s June 2017 issue.

His hope that digital health, and in turn, his product, would upend healthcare proved wrong. It did find a niche, but his conclusion is that healthcare is not going to be disrupted.

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

“Healthcare has proved allergic to upstarts that would emerge, uncork a radically new model and push the incumbents aside,” he said.

Which brings me to where the real revolution will or should take place—in the hands of you and me, the consumers.

Personally, I’m at a breaking point of frustration over healthcare costs and insurance plans. Here’s why:

My wife and I pay $2,200 monthly premium for health insurance for a plan that includes a $7,000 deductible for each of us. That means she and I have to spend $40,000 before the insurer will pay for our healthcare. What a deal—for the insurer. We have one plan in the state of North Carolina and the insurer is already predicting a 23% rate increase for 2018.

That makes alternate health plans, like health insurance consumer-operated-and-oriented plans (CO-OPs), attractive to me. These plans are designed to be operated by consumers who get to vote on key changes in policies. All surplus revenues go to reducing premiums or improving benefits.

One example of such a plan is Maine's Consumer Health Operative, which was able to offer consumers an alternative to Anthem, previously the only choice for Mainers. Oscar is a startup out of New York that is getting a lot of buzz. The problem: Neither of these options is offered in North Carolina, though I could move 30 miles to South Carolina where there is a CO-OP plan.

Another attractive option is a concierge practice. Despite some high-end practices, not all of them are expensive. One concierge practice offers a plan for $100 a month and promises its members receive unlimited access to qualified physicians. The practice says it has seen thousands of patients and prevented hundreds of thousands of visits to urgent care centers, emergency rooms and doctor offices.

It’s no wonder that millennials turn to retail health clinics like CVS Minute Clinics for care instead of a traditional physician practice.

Most of my local circle of friends, meanwhile, are self-employed and caught between those three to five years before Medicare kicks in. For many of them, healthcare costs are the reason they can’t retire while they have their health and the time to enjoy life.

Push my generation a little more, and I believe we will take matters into our own hands and start a healthcare revolution.

Anthony Cirillo is president of The Aging Experience. He helps organizations craft experiences and seize opportunities in the mature marketplace, and helps family caregivers thrive and individuals make educated aging decisions. A consultant and professional speaker, Anthony also is an executive board member of the Dementia Action Alliance.

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