insurance

2 prescriptions to lower medical bills

If you're looking for a membership-based medical home, be prepared for a little confusion. While clinics like Qliance are known as medical homes in some circles, the term "medical home" is also used to describe "a new way of branding all primary care practices (that) build on making primary care the natural entry point to the health care system, rather than emergency rooms or specialists, for everyone for nearly all health care issues, except for truly urgent emergencies," says Carl Cooley, a pediatrician and medical director at the Center for Medical Home Improvement, in Concord, N.H.

This model still relies on payment by insurance companies rather than direct payment by consumers and includes incentives from insurers for primary care practices to provide more proactive, coordinated care. This broader use of the term "medical home" has been mentioned in congressional health care reform discussions and may mean a search for a direct-care, membership-based medical home will turn up many clinics that don't fit that description.

Health care cooperatives

Consumers who want to take charge of their own health care while saving some money have another option -- to join a health care cooperative. Some consumer-owned health care co-ops provide prepaid health care services to their members, while others may pool resources to purchase health insurance at a better rate.

When you join a co-op, you become an owner, so each member can participate in decisions about how the co-op is run. "Any savings of the co-op are returned to the consumer in the form of lower costs or better services," says Mary Griffin, senior policy adviser at the Washington, D.C.-based National Cooperative Business Association. "The focus is on their needs rather than the needs of outside shareholders."

There are several types of health care co-ops, Griffin says. They include:

  • Consumer co-ops, which are made up of consumers to provide goods and services otherwise not available to them at a reasonable price and quality.
  • Producer co-ops, such as farmer co-ops, which include producers of a like product who pool their resources and market member goods in order to leverage greater bargaining power with buyers.
  • Employee-owned co-ops, which are businesses-owned and controlled by their employees, who are also the members.

While each co-op is different, the right mix of ownership and strategy can offer financial savings for members of the group. "But the level of savings depends on the type of co-op, the state and the market," Griffin says. "For example, 51 percent of the farmers who joined the Farmers Health Cooperative health insurance purchasing cooperative in Wisconsin saw their premiums for health care drop and two-thirds have a better policy than before because of the group purchasing power of the co-op. On the other hand, GroupHealth in Washington reports their premiums are lower but not significantly lower than the competition."

And different types of co-ops are more readily available in different parts of the country. If you're looking for consumer health care co-ops, "you will have more luck in the Midwest and Pacific Northwest," Griffin says.

Before joining a co-op, "make sure there's someone who can explain all the benefits to you," says Rapport Benefits' Perkins. "You don't want any surprises on fees."

Also make sure you understand what will be covered in case of a catastrophe. "Some co-ops will offer care by a primary physician, but may or may not have specialist or hospital coverage," Free says. "If those things aren't covered, you may need a combination of a co-op and a catastrophic insurance plan."

Griffin also recommends looking into how the co-op is governed, which insurance companies the co-op purchases from, what services are available, and what the premiums and deductibles have been over the past few years.

"As with anything, you need to comparison shop," Griffin says. "Of course, the nicest thing about being a member of a co-op is that if you don't like their policies, you can do something about it."

You can compare health insurance quotes on Insureme.com, a Bankrate company.

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