Innovation: Subscription-based health plan
About two years ago, Bradley Rieck, along with his wife and three children, was receiving primary care through the health insurance plan provided by his employer.
For the five of them, annual health care costs added up. And he found the lack of pricing transparency at local hospitals frustrating, he said.
“You have no idea how much it’s going to cost and no one can even tell you,” Rieck said.
He was tired of co-pays and getting new, unexpected bills from a doctor’s office or hospital months after he thought he was already done paying for a particular visit.
Then he heard about a new type of health care service and decided to give it a shot: direct primary care.
Direct primary care is an alternative health care model that aims to do away with the fee-for-service model championed by large hospitals and major insurance companies.
Through direct primary care, patients are charged a monthly or annual fee that covers the entire cost of basic primary care services – things such as checkups, clinical visits, urgent care, consultations and tests.
The first company to offer the direct primary care model in Wisconsin is based out of Oconomowoc. It’s called Solstice Health and it was founded in 2013 by Dr. Tim Murray.
Solstice Health works like a gym membership. Patients pay a monthly fee at different rates depending on their age – $39 per month for those younger than 20, $59 per month for those between 21 and 59 years old and $79 per month for those 60 or older – and have unlimited access to a primary care physician and certain basic services.
Patients can make appointments to see their doctors in person, or call or text them on their personal phones during the day, at night and over weekends. Perks include no fees per visit, unlimited wholesale lab tests, unlimited wholesale imaging services and unlimited wholesale medications.
While Solstice Health is not a complete replacement for traditional health insurance – patients are still required to have traditional health insurance coverage for catastrophic care like complex treatments, surgeries and emergency services – it can be a cost-effective way to receive routine care without dealing with an insurance company or worrying about meeting a deductible.
“There’s a risk involved, just because some of those months you might not have anybody need anything,” Rieck said. “But I found when I have a family of five, those months are rare. Whatever we pay, we would’ve paid more. I’ve had it for a couple of years and it just seems very predictable that I’m going to spend less to get better health care (with Solstice Health). With the high deductibles, insurance, co-pays, you never know what it’s going to cost you because you have to run through insurance.”
Solstice Health spokesperson Megan Zimmerman said the service is meant to shift the focus of health care toward preventative care – catching conditions early, when they’re inexpensive to treat, as opposed to later, when they become more dangerous and more expensive to treat.
“We want everyone to know that health care truly is affordable and can be accessible to all people,” Zimmerman said. “Someone who is on a high-deductible, high-premium plan, if they feel they don’t have the preventative care they need, our aim is to make people in charge of your health care. Your health is a personal thing, so you need personal relationships with your primary care provider to understand your history.”
Zimmerman said Solstice Health also works with employers to develop employee wellness plans focused on preventative care, in addition to offering traditional health insurance. She said adding a Solstice Health direct primary care package can encourage employees to seek out preventative care, which reduces the number of insurance claims filed by employees and can lead to reduced overall health care costs for employees.
“Direct primary care, really it’s going back to the old health care models in the past, when doctors would visit patients in-home and you’d have your lifelong family care provider,” Zimmerman said. “It’s really going back to the basics of what has worked in the past… direct primary care was born out of doctors feeling like they wanted to provide better care for patients without having to be part of the corporate health care structure.”
Solstice Health has locations in Oconomowoc, New Berlin and Mequon, and contracts local, independent physicians based in the area.