Cash-pay option expands care access

• Key Insight: Discover how debit-card cash-pay plans remove network barriers and reorient clinical decision-making.
• Expert Quote: "Access, not just affordability, defines sustainable coverage," says Sidecar Health CEO Patrick Quigley.
• Supporting Data: Members use ~11% more primary care and 50% more mental-health services under this model.
• Source: Bullets generated by AI with editorial review

At a time when traditional, legacy network-based health plans are focusing on solving the cost problem by narrowing access to care and saddling employees with cost sharing, one novel solution does just the exact opposite.

Sidecar Health, whose employer product was launched in 2022, broadens the aperture for care with a debit card cash-pay option that ensures employees can access whatever care they need without provider network restrictions, prior authorization, formularies and step care — all of which serve as barriers to care. As a result, members receive about 11% more primary care than a traditional health insurance plan with significantly fewer emergency room admissions and better adherence to prescription drug regimens, as well as 50% more mental health care.

This approach allows doctors to drive care decisions and is credited with reducing medical costs by at least 20% by empowering employees to shop for care like they would any other service through an easy-to-navigate app. 

It dovetails into a growing movement away from traditional group health insurance toward more affordable alternatives such as cash-pay options and subscription-based direct primary care services. Serving as a health policy backdrop are the promotion of ICHRAs (individual coverage health reimbursement arrangements) and QSEHRAs (qualified small employer health reimbursement arrangements) that enable employers to reimburse their employees tax-free for individual health insurance.

Read more: Included Health's new plan design improves employees' access to quality care

Making healthcare shoppable

"We're obviously all on this path where affordability is not sustainable," says Sidecar Health CEO Patrick Quigley. "But I would even go farther than that. It's really about how do we make access sustainable? How do we make sure that our families are being properly covered? It's more than just cost. It really is about care, and sometimes that gets lost in a lot of the solutions that are out there."

He says the Sidecar Health app makes about 85% of healthcare interactions immediately shoppable at a time when transparency on the cost and quality of care is not enough. It comes with a growing realization that lower-quality care results in costly re-admissions, while high-quality doctors tend to be more efficient and provide better clinical outcomes, which will lower cost. 

Sidecar Health's primary plan design allows employers to choose an annual deductible and have the option to add additional cost sharing above that amount. Quigley notes that employers resist the urge to cost-share because they recognize that employees struggle to afford care. Providers have embraced this model because they name their own price and are paid with no collection risk. 

"Our secret sauce is free markets," he says. "Providers get to decide what they want to charge, and then our members get to decide if they're worth it." 

Keeping clients happy

Brokers and advisers also see value in suggesting this approach to employers. "As brokers, part of our challenge is pushing clients to believe that we've got to look at the world differently," explains Rick Elliott, a consultant with Lockton Companies.

It was put to the test with a client that had bounced around between traditional health insurance approaches, tiring of fully insured market cycle health plan renewal increases. 

The company's CHRO at one point with a half of a smile on his face bluntly told him, "If you guys don't come up with something new and innovative, I will not be happy! We cannot simply keep absorbing big cost increases." 

Read more: UnitedHealthcare targets hourly workforce with flexible plan options

Empathetic to his frustration, the Lockton team came up with an alternative to break the chain of steady healthcare cost increases. The client went live with Sidecar Health this year as a slice option for the company's self-funded plan with third-party administrator under an administrative-services-only arrangement. 

"We still have many clients that aren't ready to dive into the deep end, which we understand," he says, "but for many organizations, when we talk about the future of healthcare, and we get into the room with the client's leadership team — CEO, CFO, and CHRO — their response is, 'Why wouldn't we want to try something new?"