Membership Medicine

As the uncertainty surrounding health care reform mounts, health care providers and their patients are revisiting alternatives–grassroot options outside of the traditional health insurance realm. “Concierge medicine,” a health care niche originally meant to target the wealthier constituent seeking first-class service without all the traditional health insurance red tape, has been around for quite some time. Today, its footprint is expanding and varia tions of “membership medicine” as it is commonly referred to, are branching out to meet the needs of many Americans concerned about the rising cost of premiums and the possibility of becoming uninsured.

Traditional concierge medicine focuses on primary care services. Members pay a monthly membership fee to have direct, unlimited access to their primary care physician without additional cost per visit. Members of concierge programs must still protect themselves from unexpected health emergencies with some sort of catastrophic high-deductible health care coverage. Alternative membership medicine models, which also have been around for decades, expand on the concierge model by providing additional coverage beyond primary care. Given the political minefield of reforms to increase access to health care, these alternative models have become more appealing.

One model is a Christian driven approach to covering health care costs without the backing of a traditional health insurance plan. Organizations suchas Christian Healthcare Ministries, Medi-Share and Liberty HealthShare are ministry driven health care sharing entities that, while not insurance plans, are recognized as acceptable health coverage under the law, with religious exemption status from certain Affordable Care Act requirements. An estimated 625,000 Americans belong to health care sharing ministries, which is more than triple the number who belonged when the ACA legislation took effect in 2010. Now this cost-sharing movement has begun to explore corporate and organizational opportuni ties to expand their sharing reach.

How it Works

Basically, the ministries are health cost sharing entities through which Christians voluntarily share each other’s medical bills. Similar to traditional insurance plans, ministry driven programs typically require members to pay a monthly fee. The fee is generally based on the coverage type and/or a risk-adjusted methodology. Members also pay an annual deductible (known as an annual unshared amount) before their medical bills are eligible for sharing.

When members visit their primary care physician, urgent care facility or emergency room, they make a self-payment and then submit the bills to the health care ministry. The ministry then processes the bills for discounts and sharing eligibility. Bills that are eligible for sharing are published and the organization coordinates coverage of those bills among the members. A member’s monthly contributions are placed in that member’s share account until they are matched with another member’s eligible bills.Members contribute monies from their individual share account to another member’s account from which payment is made to the provider.

Administrative Ease for Providers

Health care sharing ministries encourage provider participation by reducing administrative burden with little to no referral or pre-certification requirements, often no timely filing limit and prompt payment, often within 30 days. Some ministries invite providers to join their network, but signing an agreement is typically not mandatory since members are free to see any provider they choose. If providers elect to sign a contract, they are agreeing to accept the program rates and not to balance bill the member, similar to other health plan networks. If a contract is not signed, the provider has no obligation to accept the rates as full payment for services rendered.

Will Faith Pay the Bill?

As a non-insurance alternative to health care cost savings, sharing ministries are exempt from insurance regulations, and thus these programs are built on faith and faith alone. They are not financially guaranteed programs; this can be unsettling to a provider used to working within the confines of an insurance program that is obligated to reimburse for covered services. Their viability is inherent in the moral and ethical obligations of its members and their spiritual belief in taking care of one another. Members are required to submit membership dues and contribute their monthly shared amount in order to benefit from the program’s cost-sharing approach.

From the provider’s perspective, the overall reduced administrative burden is appealing, although there may be other challenges in terms of back-office billing and collection. Nonetheless, the number of people participating in membership medicine programs continues to increase. Medi-Share and Liberty HealthShare have helped millions of people and saved billions of dollars in health care expenditures.

For this alternative to traditional health insurance, the mantra remains – “Have a little faith.”

Christina Claussner is a senior health care consultant at PBC Advisors, LLC, in Oak Brook. PBC provides business and management consulting and accounting services to physician practices and hospital systems. Visit the website at www.pbcgroup.com.