We have access to a number of research grants related to Health Care Reform. The advantage of these grants is that they provide cash stipends to individuals willing to participate in studies related to the new payment methodology being implemented by the federal government. Typically, individuals with increased likelihood of incurring high medical expenses are eligible.
In most instances, these study grants reimburse all of the out-of-pocket expenses and premiums of the insured in exchange for a longitudinal study that traces provider-billing practices during the episode of their care. The data intelligence gathered in these studies is used to negotiate fair market pricing. Participants benefit from savings, employers benefit by reducing their overall risk profile.
Bottom Line:
Employees win as they do not have to change doctors, no longer contribute to the employer plan, and erase the deducible and out-of- pocket exposure by using independent third-party dollars.
Employer wins as “high risk” individuals are removed from the plan. Best of all, the source of funding is independent of the group or the plan participant and the group “risk profile” is greatly improved, thereby reducing group premium.
