Pearl | October 28, 2015 | Payers, Patients, Pearls, Physician Compensation, Revenue Cycle Management

By Susanne Madden

Originally published at: http://www.physicianspractice.com/payers/physicians-contract-self-funded-employers

Some medical practices are cutting out insurance companies and providing services directly to employers (direct care), thereby reducing overhead and cost to patients.

First, let me define what is meant by “direct care.” Similar to charging patients cash for your services, the difference here is that you are charging employers directly for services delivered to their employees. There is no middle-man insurance company; simply two parties exchanging cash for services. So “direct” here means that you, the physician, are selling your services directly to the purchaser of healthcare, the employer.

This is not as novel an approach as you might think. Employers, particularly those that are “self-funded” (meaning those that carry the financial risk for employee claims rather than the insurance company), have already been investing in medical tourism for years. They contract directly with providers of care overseas (or through medical tourism companies) and send employees for such services as bariatric surgery, knee and hip replacements, and hernia operations, which are far less expensive than here in the United States. Even some insurers, like Anthem Blue Cross and Blue Shield, are exploring the idea of including medical tourism as a part of their coverage.