As the healthcare landscape continues to evolve, few believe that we’ve reached perfection in the way we provide for the health, and the health coverage, of anyone—employees or citizens.

Fortunately, brilliant minds continue pushing new and innovative ideas forward. And even as we’re looking for the best and trying to improve the rest of the Affordable Care Act (ACA), we continue to search for the ultimate answer.

Earlier this year, we told you about Direct Primary Care, a model for delivery of health services that, in the opinion of many, holds great promise for controlling costs. Another idea that encompasses an entirely new way of thinking has come to light in recent months, and that is the topic we'll cover here.

Sprig Health, a member of the Cambia Health Solutions family of companies, came on the scene a few years ago as a way for the uninsured to gain access to quality health care in their local Portland, Oregon, and Seattle, Washington, areas. More recently, Sprig realized that the changes in the overall healthcare and health insurance marketplace revealed a natural niche for their strategy, and so they are refocusing efforts on the employer market and taking it nationwide.

Shop and pay for health care as you would airline tickets

In short, Sprig Health is a new way of paying for healthcare services. Marcee Chmait, president of Sprig Health, says, “With some of the trends in the marketplace, we think that the ability for people to shop for healthcare services really now expands to all people who have high deductible plans.”

Similar to the Direct Primary Care model, Chmait says that Sprig’s approach is about routine, expected medical expenses—the oil changes and wheel alignments, in automotive terms, rather than the major collision repair.

According to industry experts, this kind of routine care accounts for roughly two-thirds of all medical expenses, so finding a cheaper way to pay for it can make a real difference in the cost of insurance. Let the insurance cover engine overhauls and transmission repairs.

The strategy is simple, says Chmait. Go online, find a provider for the service you need, whether an office visit, a dental cleaning, or a mammogram. Schedule and pay for it up-front, and receive a significant discount for doing so. It’s much like the way we now buy airline tickets.

Even low deductibles can be tough to fund

One factor behind the concept is acceptance that the days of a $100 (or even a $500) deductible are mostly gone. Even today’s “low” deductibles of $1,000 or $1,500 can leave someone who is insured wondering how he or she will come up with the cash to cover a visit to the doctor. You may offer a Health Savings Account or a Flexible Spending Account, but many people have not accumulated enough in them to pay for the services they need.

What to do? In one example, a physician recommended a test to an insured patient who had a $5,000 deductible, none of which had been met. At the recommended provider hospital, the test and cost of physicians who review and interpret results came in at about $1,100. By logging onto Sprig’s site, the patient located a reputable imaging center that could do the test, including the physician review, for $375, or about one-third the price.

Note that the patient took these steps only because she didn’t want to pay $1,100 out of pocket. Yet she knew the service was necessary. On the other hand, because the mammogram she also needed was covered 100%, it didn’t occur to her to shop for the best price. A little pain in the pocketbook can be very motivating.

How do employers and providers feel?

Providers love the idea of up-front payment because it takes the complexity out of the system for them, too. “One of the reasons providers are willing to post their prices—and, by the way, we don’t dictate or mandate any pricing—is because we are paying the provider directly in a much shorter time than if they have to submit an adjudicated claim,” Chmait says. “They are much more willing to post a cash-pay price, and have us bring that patient to them, so they can take out all their overhead.” Overhead, of course, includes claims processing, billing, rebilling, and so on.

“Under the ACA, people are going to have a lot of financial accountability if they select a Bronze plan,” says Chmait. “They might have a $5,000 deductible in the Bronze plan; how are you going to pay for that $5,000 underneath that deductible? We have found that fewer than 11% of all consumers ever meet their deductible, so those folks are paying cash. They need to make their limited health- care dollars go as far as they possibly can.”

It’s also in the employer’s best interests to maximize the value of employee health care dollars, whether they are insured or self-funded, Chmait says. “As a self-funded employer, that’s really important because you don’t want your employees to max out their deductibles, because that’s where your liability as an employer starts to kick in. So understanding price and quality is very important.”

Goal: Simplify how healthcare services are purchased

“Our whole goal is to truly simplify how healthcare services are purchased. That’s our primary mission,” Chmait continues. “There is no other way to do it than for people to be able to shop, compare, and pay. Even if it’s a covered service, we're saying to employers, ‘Encourage your employees to shop because if you can have a better healthcare consumer, your plan actually starts to save money.’”

Under the ACA, there will be people who choose to pay a penalty rather than purchase insurance they don’t feel is necessary. Chmait says that such individuals are actively using Sprig Health.

“If you’re a young male, there is no reason to buy an ACA plan,” she says. “And if you think about how the penalties are structured, it’s still less expensive, even at the highest penalty, to not have insurance. Those are the folks we’re calling the strategically uninsured. They may buy a catastrophic plan, which are really geared for the folks who are under 30, then use a pay-as-you-go model for the routine services.”

Lessons learned becoming national

Changes are coming for Sprig. Among them is a push to go national. “We are in a build mode right now,” says Chmait. “We trying to take what we’ve learned in Portland and Seattle, and build a national, online marketplace for planned and predictable healthcare services.

Our thought process is that insurance should really get back to the basics. The negotiated fee schedules that plans have today are often hidden. When you start to expose price and quality to consumers, not only do behaviors change, but the way people shop for those services also changes. What we’re trying to do is, say, take everything out from behind the counter and put it over the counter, and make everything transparent.”

“Mark Ganz, the president and CEO of Cambia Health Solutions, is an incredible visionary,” Chmait says. “He is very much a proponent for the patient/provider relationship, simplifying all the complexities the system brings, and that’s one of the reasons innovative companies like Sprig are being spawned: So we can get back to insuring people for the major events and working with patients on managing their day-to-day health with their providers.”