Another approach to consumer driven healthcare is unfolding in Raleigh-Durham, NC. There, a company, WellPrime, is offering small business employers a unique opportunity to help employees.

Essentially, by building a network of doctors, hospitals and healthcare providers, the company is able to provide employers with a cheaper way to implement a health benefit plan, while helping employees have a stronger say in using their funds. It attracts providers by offering settlements within five to seven business days

Employers and individuals sign-up for the program and agree to put a specific amount in employee accounts each month. These monies build up and are used in the network to pay providers who have agreed to a specific fee schedule, usually much lower than an individual can obtain and equal to or less than what insurers pay.

Using WellPrime’s systems through the Internet, the programs are administered by employers much like such consumer directed plans as FSAs, HRAs or modified HSAs. Employer contributions are tax-deductible and depending on how employees contribute, their funding is tax-deductible.

Because payment is made immediately, providers get funds quicker and are opted into an additional patient stream. Patients get to choose their providers and are subsidized by their employer’s contribution.

If funds in the account do not equal the payment needs, the patient pays the difference.

By creating a direct-to-employee system and linking it to a wide variety of providers, this program can eliminate much of the overhead that goes into traditional plans.

Overall in the nation, it is estimated that one out of three fee dollars is paid for administrative functions, according to healthcare experts.

WellPrime, based in suburban Cary, NC, offers a proprietary health benefit that’s designed to provide access to primary and preventative healthcare services for uninsured workers including urgent care and pediatric services. WellPrime clients receive their WellPrime Card to be used for preventive and wellness care visits, disease management for chronic conditions like diabetes and hypertension, standard lab tests.

According to Sean Harrison, President and CEO, uninsured employees have access to services that enhance their quality of life and help prevent healthcare problems from becoming healthcare crises. Employers that dropped coverage or offered no benefits have a powerful, affordable alternative at their fingertips. And physicians in the WellPrime network have access to new patient populations and timely reimbursement at competitive rates. Wellprime is Internet-based and through the use of a Web services portal - the WellPrime Exchange - employers and their employees can pay for their basic healthcare needs for themselves and their families. 

Harrison said “this plan is innovative because the pay-as-you go and prepaid system allows employer and employee to control how the health dollars are allocated and spent.”

Providers in the WellPrime Network can easily verify funds are available and request reimbursement for the visit using the WellPrime Exchange.  Their WellPrime Card and a few mouse clicks is all that is required for employers to allocate funds for providers to request and confirm rapid reimbursement.  Best of all, there are no pre-qualifications, insurance applications or paper filings required.  Getting patients “caught in the gap” back in the healthcare system in a simplified and affordable way. 

Firms Have Access To All Services

Adds Harrison, “the WellPrime Benefit System provides a member employer with the processes, administrative and financial services, support team, and relationships that enable employers, employees and providers to participate in this innovative and affordable health benefit plan.”

Using its online portal, individual, employer and provider accounts are administered, funds are managed and eCards are allocated and redeemed.

Its network of primary care, internal medicine, pediatric and urgent care centers contract with WellPrime to provide services at network rates.

The ultimate clients and beneficiaries are employers and individuals participating in this unique prepaid health benefit plan .

According to Harrison, the primary beneficiaries are blacks, Hispanics and other lower wage groups who may fall between the cracks of medical and healthcare offerings. The program also works for employers by allowing them to tailor programs for part-time, seasonal and temporary employees.