Allen Okie MD Perspectives 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 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

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 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

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 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

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 Managed Care has merged and blurred the differences between Insurance and Finance We (providers and insurors) have made the system too complex We (providers and insurors) have made the system too complex 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 Managed Care has merged and blurred the differences between Insurance and Finance We (providers and insurors) have made the system too complex We (providers and insurors) have made the system too complex

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 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

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”

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

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

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

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

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

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

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

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 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

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 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

IDEALIDEAL 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 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

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 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

POTENTIALPOTENTIAL 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 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

Allen Okie MD Thank you for listening