By Katelyn Bush
A Healthcare Conundrum
Picture this: You're washing dishes when you nick your finger on a serrated knife. You splash cold water on the cut— it doesn’t look too severe, but it probably won’t close on its own. So you bribe one of your friends into chauffeuring you to the ER; you languish in the waiting area and weigh the cons of stitching the wound yourself. Finally, a professional ushers you into an examination room; as expected, the procedure takes minutes. Two weeks later, you receive the bill. A $300 copay for two stitches! And what on earth is a “facility fee?”
Every day, this scenario plays out in hundreds of healthcare facilities across the country. An employee jumps through hoops and hurdles to secure affordable care only to discover they can’t afford the 20% copay. Adding insult to injury, their provider tacks on a hefty fee that allegedly covers overhead costs but offers no value to the patient. It’s a tale as old as health insurance itself— and without intervention, this convoluted system of facility fees, deductibles, and premiums will continue to drive up the cost of care.
Dissatisfied with the status quo, many companies have adopted alternative solutions to control medical expenses. Direct contracting is one such strategy, though it was typically reserved for large corporations in years past. But thanks to operations like Coral, small- and mid-sized companies can now reap the benefits of direct contract relationships.
How Coral Enhances Benefits Through Bundling
First, some definitions: Under a direct contract, an employer purchases services from a provider instead of going through a carrier network. This arrangement eliminates downstream costs and PPO price games, which in turn allows employers to offer $0 out-of-pocket benefits.
And on Coral’s online referral platform, plan navigators can browse thousands of pre-negotiated, fully-executable contracts to determine the best fit for members. “The Coral Platform is easy to search by member zip code, CPT code, or diagnostic description to access pre-negotiated bundles,” explains Doug Geinzer, Head of Strategy. “With proper member education and navigation, employees and their dependents can begin saving money on everything from MRIs to labs, surgeries to organ transplants.”
Besides enhancing benefits, Coral’s direct contracting model eliminates the risk of surprise billing and overhead charges. Geinzer continues: “When it is time to contract, Coral’s bundles are pre-negotiated and fully executable.” Put another way, patients can know the total cost of a procedure before booking an appointment— a rare feat in today’s healthcare landscape. Coral also offers trusted alternatives to hospital-owned centers, ensuring patients are never subject to outrageous facility fees. “With 70% of the cost of a surgery embedded in the facility fee, hospitals are the most costly place to perform a surgery and have an average infection rate over 9%,” says Geinzer. “Coral brings cost containment and quality improvement to these elective surgeries by navigating them to an ambulatory surgery center (ASC) setting where the procedures should be done in the first place.” As a result of this approach, employers enjoy more transparency in their healthcare spend while employees receive higher-quality care.
Direct Contracting Bundles in Action
Mary was in her late 50s when she began experiencing hip pains at her manufacturing job. To help with symptoms, her local orthopedic physician recommended getting cortisone shots every 6-8 months. Though this treatment provided temporary relief, her osteoporosis worsened with each visit. She would eventually need a hip replacement— but under her old plan, she could not afford the procedure. Even after reaching her $7,000 deductible, her insurance required her to pay 20% of an estimated $70k surgery. Seeing no other option, Mary postponed treatment indefinitely. Her condition deteriorated further, leaving her unable to pick up or play with her new grandson. The pain also prevented her from attending work regularly.
Mary's employer was able to waive her financial responsibility using The Coral Platform. The Coral team promptly connected her to an independently-owned center less than an hour from her house; a board-certified surgeon performed the surgery, and Mary returned to work (and life!) in just 3 weeks. This bundled case arrangement saved the employer over $40k— and most importantly, the patient didn’t have to sacrifice her financial well-being to receive care. Geinzer concludes: “All the parties that matter won that day.”
We are proud to feature Coral on The Granite List.
Ready to learn more about direct contracting bundles? Start your journey with Coral today by contacting Doug Geinzer at doug@coral.io or 702.604.5627.
