Allen Okie MD Perspectives

1. Allen Okie MDPerspectives • Provider – Private Practice-Board Certified-Allergy/Immunology;Pediatrics • Medical Administrator – CEO/Medical Director Vantage Health Plan; Medical Director Peoples Health Choice –Medicare HMO; • Consumer Advocate

2. Dr. Paul Ellwood who coined the term “HMO” has acknowledged that “Managed Care as we know it is dead.” Double digit premium inflation 5 Million people without health care insurance in the last two years Dissatisfaction by patients, employers, Drs. HMO Enrollment is falling

3. What do we need? • Consumer Driven (Centric) • Open Access • Market Driven • Quality Drivers • Financial Viability for all parties • Medical Management – Rational Rationing – Educate Consumer • State of the Art Information Technology

4. SIMPLIFY • Simple solutions Captain Underpants and the Perilous Plot of Professor Poopy-pants • Separate Insurance From Finance • Managed Care has merged and blurred the differences between Insurance and Finance • We (providers and insurors) have made the system too complex

5. Eliminate Intermediation that does not provide value to the system • Develop a Value-Based health care delivery system through Providers and Patients • Focus on the Patient-Physician relationship • Reward quality and value

6. Give power back to the patient • Change the patient status from user to consumer – Purchase Power • Educate and inform the patient • Universal participation – Product Offering – “Adverse Selection”

7. What Will Achieve These Goals? CONSUMER DRIVEN HEALTH CARE Discount Fee For Service Plans

8. Provider Perspectives • More Patients – More Revenue – Less Overhead • NO HASSLE FACTOR • NO CLAIMS (or Adjustors) • NO MEDICAL INTERFERENCE • NO ACCOUNTS RECEIVABLE • PAYMENT AT THE TIME OF CARE –ELECTRONIC TRANSFER OF PAYMENTs

9. The New Medicine • No More “Mommy May I” • No More Pended Claims • No More Costly Billing and Claims Submission • No More Accounts Receivable

10. The New Medicine • Reduce Overhead • Increase Revenues from More Patients and efficient operations

11. The New Medicine • This system will allow the physician to pass savings directly to the Patient instead of to the Intermediary

12. Can We Get There From Here? • Yes! • HOW? • Discount Fee For Service Plans - clearly separate Finance from Insurance

13. Discount Fee For Service Plans aligned with • Low cost limited benefit insurance products • Financial institution to provide finance options to allow access to care • Higher deductible HSA Product (Serves as the front end to assure cost effectiveness)

14. Shift to Consumer Driven Model • Shift from medical management to health care education • Develop Value and Quality Patterns for Provider Services • Provide Financial Services for Health Care Access • Sales and Marketing of Provider Networks – “Carve Outs” Medical E-Bay

15. Discount Fee For Service Plan • Provider Network – Proprietary Contracted • Vehicle for Service Selection • Providers are rated based on satisfaction results and Professional Certification and training • Swift Payment with out Hassle • Payment Authorized by Patient • Market the Professional services of network to patients and employers • Financial Resources for the patient to access services of the network

16. IDEAL • Explanation of Payment goes to Patient • Diagnosis and procedures are priced • Diagnosis is matched to evidence based practice notices which the patient checks if they were offered by the Provider – • Based on the score the physician would be paid or not paid or reduced • This is the quality criteria attached to Discount Fee for Service Plans

17. Statutory Oversite • Discount Fee for Service is NOT INSURANCE – Keep it Simple • Minimal Credentialing – no need for primary source verification • Marketing and sales over-site • Patient Education over-site • Audits of performance and satisfaction • Monitor complaints • Economic Credentialing

18. POTENTIAL • Discount Fee for Service Plans can provide reductions in operational costs which can be passed off to the patients and not absorbed by intermediaries • Can be attached to an indemnity insurance product • Can be the front end of a Health Savings Account • Provides the economies of group contracting

19. Allen Okie MD • Thank you for listening