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Retirement Center’s Partnership With Insurer Eases Healthcare Concerns

Stanley Feld M.D.,FACP,MACE

It is my belief that innovative entrepreneurs are going to develop systems that will provide consumers with control over their healthcare dollar. These systems will provide the infrastructure to help patients prevent the complications of chronic disease and also result in decrease in cost to the healthcare system.

If patients have control of their healthcare dollar the decrease in cost will be an extra dividend to patients. Other innovations will be stimulated by a consumer driven system. We are starting to see some good ideas.

Here is an example of a good idea: Dallas retirees J.T. and Phyllis Dunkin, both 78 years old, are paying more for their health insurance (MediGap insurance) but enjoying life more. They live in a retirement community in North Dallas. Like many seniors, the Dunkins have supplemented their basic Medicare coverage by purchasing a Medigap insurance policy. Medigap reduces their sizable potential out-of-pocket health care expenses not covered by Medicare. Mr. and Mrs. Dunkin pay $250 per month each in premiums for the added coverage. Medicare has deductibles and co-pays that can be a great burden. I will provide more details on these deductibles and co-pays in the future. The Dunkins pay about $90 a month more than the typical Plan F Medigap insurance but the added benefits of chronic disease management more than compensate for the increased price.

“ Dr. Mary Norman, Highland Springs’ medical director is instantly available to patients in the retirement community for acute medical illness. “

“When Mr. Dunkin underwent bypass surgery in March, the health plan provided transportation to the hospital, sent a nurse to his bedside to check on his care and then, when he was about to be discharged, arranged for a home health aide.”

“Afterward, Mrs. Dunkin didn’t have to make sense of the bills by herself or spend hours on the phone with a customer service representative. Instead, she sat down with the health plan’s benefits counselor, who answered her questions right then and there. “

Interpreting bills and figuring out liability on the ocean of hospitals’ and physicians’ charges is a stress that many elderly patients cannot handle. The stress often leads to depression.

“Best of all, the couple live just a three-minute walk down the hall from their doctor’s clinic in the Highland Springs senior-living community”

“When we tell our friends, they don’t believe us,” Mrs. Dunkin said. “Medicare isn’t supposed to be this easy.”

It is common knowledge among seniors that Medicare is an extremely confusing system.

“Medicare is usually not so easy. The Dunkins, who are in their 70s, are part of a pilot project in which their senior-living company has teamed up with a health insurance company, with Medicare’s approval, to provide supplemental coverage.”

Their supplemental insurance is not the garden variety supplemental insurance.(Medigap) The goal of their supplemental insurance is to teach patients how to manage their chronic disease. It also provides instant physician availability. The idea is that they will avoid costly hospitalization. Ninety percent of the Medicare costs for seniors are spent on the complications of chronic disease. With this goal in mind this entrepreneurial system is already working to decrease complications of chronic disease.

Experts say the project may become a national model for improving the care of chronically ill Medicare beneficiaries while holding down costs. Early cost savings have been promising.

It is obvious to me that one of the keys to the Repair of the Healthcare System is to effectively teach patients how to manage their chronic disease. The result will be a decrease in the complications of chronic disease and a decrease the cost of care enabling the seniors to live a happier and healthier life.

This innovation can easily be incorporated into my ideal medical savings account plan. The cost savings must be shared with the patient to make them even happier and stimulate further compliance with treatment

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