Example patients
Here are some examples of healthcare costs using different models of care over 1 year
(all patients are fictional examples)
Don Francis
62-years-old - Master Carpenter
Don has Type II Diabetes, high blood pressure, and received a cardiac stent last year. He follows up every 6 months for his diabetes and has an episode of chest pain in July.
Direct Care
Membership Fee: $780 ($65 x 12 months)
Annual visit (1 hr): $0
Diabetes follow-up (30 min): $0
Diabetes diet counseling (RN): $0 (2 sessions)
In-clinic chest pain evaluation (including EKG): $0
Labs drawn for chest pain evaluation: $100
Specialist visits: 0
ER/UC visits: 0
Hospitalizations: 0
Total care cost: $880
Applied to deductible: $60
Premium cost (annual): $6000
Total healthcare cost: $6840
Hybrid Care
Membership Fee: $600 ($50 x 12 months)
Annual visit (1 hr): $0 (covered by insurance)
Diabetes follow-up (30 min): $60 ($20 co-pay waived)
Diabetes diet counseling (RN): $0 (2 sessions)
In-clinic chest pain evaluation (including EKG): $80 ($20 co-pay waived)
Labs drawn for chest pain evaluation: $100
Specialist visits: 0
ER/UC visits: 0
Hospitalizations: 0
Total care cost: $840
Applied to deductible: $240
Premium cost (annual): $6000
Total healthcare cost: $6840
Traditional Care
Membership Fee: $0
Annual visit (20 min): $0 (covered by insurance)
Diabetes follow-up (20 min): $100
Diabetes diet counseling (RN): $60 (2 sessions)
Chest pain evaluation - sent to ER due to no available appointments
Specialist visits: 0
ER/UC visits: 1 ($1500)
Hospitalizations: 0
Total cost: $1660
Applied to deductible: $1660
Premium cost (annual): $6000
Total healthcare cost: $7660
Ashley Jones
22-years-old - Systems Engineer
Ashley is in good health and usually only goes to the doctor for preventative care. This year, she developed a bad cold in February and a urinary tract infection in September.
Direct Care
Membership Fee: $780 ($65 x 12 months)
Annual visit (1 hr): $0
Pap smear/HPV: $0 (included in annual visit)
Pap/HPV lab cost: $0 (covered by insurance, $230 without)
Cold (10 min video call with meds send to pharmacy): $0
UTI (5 min RN phone call and walk-in for urinalysis): $0
Specialist visits: 0
ER/UC visits: 0
Hospitalizations: 0
Total care cost: $780
Applied to deductible: $0
Premium cost (annual): $4800
Total healthcare cost: $5580
Hybrid Care
Membership Fee: $600 ($50 x 12 months)
Annual visit (1 hr): $0
(covered by insurance)
Pap smear/HPV: $0 (included in annual visit)
Pap/HPV lab cost: $0 (covered by insurance)
Cold (10 min video call with meds send to pharmacy): $30
UTI (5 min RN phone call and walk-in for urinalysis): $0
Specialist visits: 0
ER/UC visits: 0
Hospitalizations: 0
Total care cost: $630
Applied to deductible: $30
Premium cost (annual): $4800
Total healthcare cost: $5430
Traditional Care
Membership Fee: $0
Annual visit (20 min): $0
(covered by insurance)
Pap smear/HPV (30 min): $100
Pap/HPV lab cost: $0 (covered by insurance)
Cold: Unable to be seen in 1 week, missed 2 days of work
UTI: Went to UC because she was unable to be seen within a week
Specialist visits: 0
ER/UC visits: 1 ($700)
Hospitalizations: 0
Total cost: $800
Applied to deductible: $800
Premium cost (annual): $4800
Total healthcare cost: $5600
Tess Brown
41-years-old - Leasing Agent
Tess has been in fairly good health, but noticed a lump in her breast in February and was subsequently diagnosed with stage I breast cancer. She had some complications with her surgery and radiation treatments and was admitted to the hospital.
Direct Care
Membership Fee: $780 ($65 x 12 months)
Annual visit (1 hr): $0
Breast lump evaluation (30 min): $0
Diagnostic Mammogram with biopsy: $3000
Surgical site bleeding evaluation (30 min): $0
Nausea evaluation (20 min): $0
Specialist visits: 12 including radiation therapy ($10000)
ER/UC visits: 0
Hospitalizations: 1 ($20000 surgery)
Total care cost: $7280
Applied to deductible: $6500 (rest covered by insurance)
Premium cost (annual): $4800
Total healthcare cost: $12080
Hybrid Care
Membership Fee: $600 ($50 x 12 months)
Annual visit (1 hr): $0
(covered by insurance)
Breast lump evaluation (30 min): $60 ($20 co-pay waived)
Diagnostic Mammogram with biopsy: $3000
Surgical site bleeding evaluation (30 min): $60
($20 co-pay waived)
Nausea evaluation (20 min): $40 ($20 co-pay waived)
Specialist visits: 12 including radiation therapy ($10000)
ER/UC visits: 0
Hospitalizations: 1 ($20000 surgery)
Total care cost: $7060
Applied to deductible: $6500 (rest covered by insurance)
Premium cost (annual): $4800
Total healthcare cost: $11900
Traditional Care
Membership Fee: $0
Annual visit (20 min): $0
(covered by insurance)
Breast lump evaluation (30 min): $80
Diagnostic Mammogram with biopsy: $3000
Surgical site bleeding evaluation: Sent to ER due to lack of availability
Nausea evaluation (20 min): $60
Specialist visits: 12 including radiation therapy ($10000)
ER/UC visits: 1 ($2000)
Hospitalizations: 1 ($20000 surgery)
Total care cost: $6500
Applied to deductible: $6500 (rest covered by insurance)
Premium cost (annual): $4800
Total healthcare cost: $11300
Lisa Rose
53-years-old - 3rd Grade Teacher
Lisa has rheumatoid arthritis (RA), hyperthyroidism, and some moles she gets checked annually. She was previously seeing specialists, but had difficulties getting seen after she moved. She had one flare up of her RA that lasted about 3 weeks.
Direct Care
Membership Fee: $780 ($65 x 12 months)
Annual visit (1 hr): $0
- moles checked and thyroid labs ordered
RA flare evaluation (30 min): $0
Labs (thyroid and RA labs): $200
Specialist visits: 0
ER/UC visits: 0
Hospitalizations: 0
Total care cost: $980
Applied to deductible: $0
Premium cost (annual): $4800
Total healthcare cost: $5780
Hybrid Care
Membership Fee: $600 ($50 x 12 months)
Annual visit (1 hr): $0
(covered by insurance)
- moles checked and thyroid labs ordered
RA flare evaluation (30 min): $80 ($20 co-pay waived)
Labs (thyroid and RA labs): $200
Specialist visits: 0
ER/UC visits: 0
Hospitalizations: 0
Total care cost: $880
Applied to deductible: $280
Premium cost (annual): $4800
Total healthcare cost: $5680
Traditional Care
Membership Fee: $0
Annual visit (20 min): $0
(covered by insurance)
Referred to Dermatology for mole evaluation
Referred to Rheumatology for RA management
Referred to Endocrinology for thyroid management
Labs (thyroid and RA labs): $200
Specialist visits: 4 ($800)
ER/UC visits: 0
Hospitalizations: 0
Total cost: $1000
Applied to deductible: $1000
Premium cost (annual): $4800
Total healthcare cost: $5800
