Brose McVey is best known around town for his political activity. He ran unsuccessfully for Congress as a Republican in 2002 and again in 2010, when he ran to the right of Dan Burton. In 2012, he was deputy campaign manager for Richard Mourdock's unsuccessful Senate bid.
So it goes without saying that McVey isn’t a huge fan of Obamacare. When President Obama signed his health law, McVey called it a “health care boondoggle.”
But now, four years later, McVey is leading a new health care clinic company focused squarely on helping individuals and employers deal with the new health care reality that is emerging under Obamacare.
Expedite Healthcare LLC offers membership in its clinic at a flat monthly rate, which pays for all primary care, chronic disease management, most laboratory tests and discounted prescription drugs. For employers, the clinic provides workers compensation services and wellness programs. Expedite promises same-day or next-day appointments, as well as round-the-clock access to clinicians by phone.
Expedite has one clinic so far, in Park 100 on the far northwest side of the city. But after raising $350,000 in investment capital last month, it plans to open 2-3 more this year, most likely on the north side of Indianapolis, in Fishers or downtown. All its clnics will be open to multiple employers and any Expedite member.
Membership in an Expedite clinic costs $49 a month if you’re under 30 and $59 if you’re over 30. Couples can join for $99 a month. Dependents cost an additional $25 a month each.
Expedite encourages employers to subsidize the cost of the clinic for their workers, and has already signed up one 500-person firm.
But, in contrast to most other on-site clinic providers, who started with large employers and are now trying to move down to smaller employers, Expedite is trying to appeal especially to individuals and small businesses.
“When you break down the economy, you’ve got so many self-employed, so many small business and even micro business,” McVey said. “We’re a direct primary care physician group [for individuals] that is going to continue to strive to add value for employer groups as well.”
In particular, McVey wants to provide a predictable way for patients with high-deductible health plans to get the primary care they need.
It’s one of the ironies of Obamacare that the law has ended up promoting high-deductible health plans and the consumer-directed accounts that go with them—health savings accounts and health reimbursement arrangements.
HSAs were roundly criticized by most Democrats after they received tax-free status in President Bush’s 2003 Medicare Modernization Act. And the Obama campaign of 2008 told HSA supporters the accounts would likely go away under their plans.
But instead, Obamacare has supercharged the progress of HSAs and high-deductible health plans. It has done that in three key ways:
1. It provides tax subsidies to expand coverage in the individual and small business marketplaces, where deductibles were already high. Likewise, most of the silver and bronze plans sold on the Obamacare exchanges this past year had hefty deductibles, which leave individuals on the hook for the cost of their initial health care bills.
2. Many of Obamacare’s new regulations increased the cost of employer-sponsored health insurance, particularly for small businesses. The big thing here is Obamacare’s new community rating rule, which I explained here. The upshot is that costs are rising rapidly for many employers, leading them to shift financial exposure onto their workers or, in some cases, to drop coverage and send employees to buy one of the high-deductible policies on the exchanges.
3. Obamacare’s 2018 “Cadillac” tax—which is 40 percent on the value of health benefits that exceeds $10,200 for individuals or $27,500 for families—is forcing even large companies to slam the brakes on their spending on health benefits. A common way to do that is to switch to high-deductible health plans.
“We believe Expedite is perfectly suited now to fit into people’s lives and to complement those high-deductible plans, so that you can manage your costs for a fixed monthly membership fee,” McVey said.
But he’s not satisfied with simply scooping up customers that are put in play by the changes from Obamacare. McVey also wants to make one of Obamacare’s fundamental goals—patient-centered medical homes—a reality. The idea is to get patients to have a deep and long-lasting relationship with a specific health care provider, who then coaches the patient on how to be healthy, helps them manage their illnesses and helps them choose the best specialist doctors to meet their more serious needs.
“We’re trying to re-establish the relationship of the direct primary care provider and the patient,” McVey said. In the health care system generally, he contends, there are too many barriers between doctors and patients—either insurance protocols or enormous pressures on doctors’ time from insurers and hospital systems—all of which make it harder for patients and doctors to have meaningful relationships focused on keeping them healthy.
Expedite won’t place any restrictions on its members—they’re free to see any other doctor they choose. But McVey hopes to make access to Expedite's clinics cheap and convenient—via telemedicine and via some of the always-accessible tricks used by concierge providers—so Expedite's members make its clinics their medical homes.
“We’re trying to broaden the shoulders of primary care as broad as they can go,” McVey said. “We want to win the day-to-day relationship with our patients. Because that is what gets costs out.”
To that end, Expedite recently added Dr. Matt Priddy, head of the Indianapolis concierge physician practice Priority Physicians, onto its board of directors. It also signed up Dr. Alan Snell, the former chief medical informatics officer at St. Vincent Health, as a consultant who will help with physician recruiting and telemedicine.
Right now, Expedite members are seen by local physician Dr. James Pike and his staff. Pike and McVey met while both serving on the dean's advisory committee of the Marian University College of Osteopathic Medicine and decided to team up to launch Expedite in September.