Insurance brokers who understand products for individuals and small employer groups under 50 in Colorado

(Jamie Glover MD) #1

At the CAFP facilitated DPC meeting on 4/23/17, Mary Mock discussed brokers in Colorado who might understand how putting a DPC in front of an individual plan could work. I guess there is a broker at Design Health that understands and can communicate this well. Anyway, Mary is currently working with Melody Health Insurance (soon to have a new name) who is going to acquire Colorado Choice Health Plan around the end of May from what I understood. Mary works for Melody Insurance but also has a second job helping with strategy for one of our big DPC players in the state, PeakMed. But anyway, Melody (or whatever Melody Insurance’s new name will be) apparently is trying to get this DPC plus individual wrap-around/catastrophic product on the market in 2019 or 2020. She is especially looking at building a Denver, C. Springs, &Pueblo network of DPC’s and they have looked at other areas (Boulder; Durango?). This is from my limited recollection of the discussion around the table at the meeting so I hope it is a pretty accurate recollection but I’m a doc, not a broker so anyway, that is my update on that part of the meeting.

(Robin Dickinson) #2

@j.glover1 That’s great! That could really make a difference for patients interested in DPC.

@rocky_mountain_group This is something for us to keep on our radar. Especially as we look at what being a “network” entails. From what I’ve heard about other states looking at DPC wrap around plans, what we have to be careful about is keeping our contracts as non-specific as possible. For example, they might want us to sign that we will “always see a patient same day for urgent concerns” but then that could be interpreted as someone who calls with 2 weeks of sinus symptoms on a Friday at 4:30 pm has to be seen rather than wait for Monday (you and I know that it’s not urgent but insurance companies don’t). Or they might want us to sign that we will maintain our own magical list of affordable specialists (which is outside of our control when the specialists have to contract directly with the insurance).

So…I’m optimistic but we just need to watch out for our own interests when the time comes. Ideally, they will simply let patients use any DPC.

(Stephanie Kraft) #3

Anyone with updates to this post? I would love to have the names of metro Denver brokers who understand DPC. More and more of my patients are signing up with closed-network plans in order to save money, but it makes it difficult/impossible for them to continue with me as their PCP.