It's hardly radical to suggest that the current healthcare model is broken to the core and it's almost by design. Even with insurance, patients find paying for healthcare an unnecessarily stressful experience sorely lacking transparency.
Healthcare providers don‚t fare much better, having to deal with increasingly aggressive payers, mountains of paperwork, and tightening regulations.
Commercial Payer Volume On The Decline
According to the annual benchmarking report from the Urgent Care Association, visits related to commercial payers declined from 67% to 47% in only one year from 2017 to 2018.
Even more alarming, accelerating competition from external players like CVS, Walmart, and employer-sponsored clinics are chipping away market share from urgent care centers faster than ever. Telemedicine providers like Teladoc and DoctorOnDemand are gaining consumer adoption rapidly. And Silicon Valley investors are pouring hundreds of million dollars into a new breed of ‚Äú√† la carte‚Äù direct-to-consumer startups to compete with urgent care business.
The numbers are staggering. CVS Minute Clinic now commands over 55% of the retail health industry and is planning to convert their 1000+ locations into urgent-care-like health hubs. Blue Cross Blue Shield in various states have plans to open their own walk-in clinics. Ro, Hims, and LemonAid both raised a combined 400M from venture capital with less than three years in existence.
All of which left the already-fragmented urgent care industry in an awkward position: lower-priced compared to the emergency department but twice or three times more expensive compared to virtual care equivalents.
Privately insured patient volume has been declining in recent years
And Overhead Is Eating Up Your Margin
A system full of wastes. According to a 2019 study in JAMA, administrative complexity and pricing failure are the two largest categories of waste in U.S. healthcare, accounted up to 54% of the total $1T annual waste.
Pay to get paid. In a medical practice setting, like in urgent care, the Altarum Institute estimates one out of four dollars in revenue went into administrative activities. In which, billing and insurance-related activities contributed to over half (52%).
With the transition toward population health and value-based care, the burden of implementing new systems to measure process and outcomes are being shifted to providers without any additional increase in reimbursement.
Billing and insurance-related activities are now 52% of administrative spending
Will telemedicine solve this problem?
Virtual care has been a rising feature implemented by providers across the country. While virtual care benefits the patients greatly from a convenience point of view, it has been largely a payor-driven trend.
Some providers found virtual care an effective way for revenue recovery during COVID but also found it is harder and harder to compete with established players like Teladoc, AmericanWell, and MDLive due to the rocketing cost of online marketing.
To make it worse, since Google Ad is the main way to acquire new patients, having more providers bidding on the same keywords increased the ad cost by 2-3 times. We have seen reports showing the cost per click as high as $30-$50, this translates to a cost of patient acquisition anywhere between $100-$150.
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Furthermore, many commercial payors are in talks to reserve payment parity (higher reimbursement for virtual care) as soon as COVID ends.
But that's the system - you can't do anything about it, right?
Fortunately, there is a way out.
By now, you probably have heard of direct primary care, a rapidly growing trend among your family practice counterparts.
Mira aggregates supply and demand in real-time, connecting providers directly to patients who typically pay out-of-pocket, but often skip care due to unpredictable pricing and fragmented experience.
While some urgent care networks had attempted this, setting this all up themselves can be time-consuming, tricky, and worst of all, risky.
DCN can help you get out of payor dependency
How Mira Can help
Rather than an individual practice performing a major overhaul to offer fixed pricing and on-demand availabilities, urgent care centers could join a Mira network instead.
In technical terms, Mira functions both as a management service organization (MSO) and a payor.
In layman's terms, Mira takes care of patient acquisition, simplify payment, and reduce overhead - making pricing predictable to attract new patients and helping providers maintain a stable margin.
By using a global rate and leveraging the network effect, Mira allows providers to participate in bigger and more sophisticated contracts with demand aggregators like contractors placement agencies and gig-economy services.
All of this means more patients, better care, lower overhead, and most important of all, stay relevant in the new ultra-competitive healthcare landscape.
Mira can help providers increase both revenue, margin, and patient experience
How Does It Work?
Healthcare providers and patients both sign up for a platform to connect. As there is no insurance involved, the concept of an out-of-network provider flies out the window. So long as a provider is signed up with the platform, a patient is free to get medical care from whoever they want.
This allows healthcare providers to increase patient volume by opening them up to more prospective patients than ever before. They don‚t lose out on large swathes of potential patients because they‚re not aligned with the right insurance provider; they get to see whoever, whenever.
Mira Keeps Costs Down For Everyone
More than that, for the patients, the Mira platform offers incredibly affordable prices, usually a monthly subscription, with a fixed copay per visit. This empowers more people than ever before to get healthcare even without insurance, again increasing the prospective pool of patients for a healthcare provider.
All of this is usually wrapped up in a system that streamlines all of the tiring administrative work of onboarding a patient, billing, and collecting payment. Most of the processes become automated, cutting overheads and speeding up workflows dramatically.
Mira Boosts Your Marketing - For Free
But offering convenient, streamlined payment systems and affordable prices is only half the battle. As any healthcare provider knows, the other half and perhaps the biggest headache is marketing.
Mira will also market your healthcare practice to our massive user base. You provide them the marketing material, and they‚ll get the word out for you. You just sit back, relax, and watch the patient volume increase.
How Much does Mira Reimburse?
Keep in mind Mira is not a payor but a platform for self-pay patients to get care. Mira has a flat case rate of $90-$120 depending on your location. This is 60% more favorable compared to the status quo because there is no collection and no overhead. On top of that, our data shows that because patients pay upfront, we have a 0% no-show rates. Matter of fact, we found Mira patients show up on average 15 minutes early.
A detailed financial comparison between Mira and other payers
At a surface level, it may seem that Mira's reimbursement is less than commercial payors. Here we take a comprehensive look into the details and found that though commercial payors reimburse significantly more, the administrative overhead associated with billing and collection can lower net pay by almost 24%.
On top of that, the days to get reimbursed are significantly longer, ranging from 30 to 76 days, compared to 5 seconds with the Mira streamlined payment system.
For cash patients, while the net pay seems great - largely due to cost-shifting, the time and risk of the collection can cost up to 4 months and require much more human effort to reach the patient post-visit.
Mira provides superior economics compared to all other payors
Mira is an official Partner of the Urgent Care Association
The world of healthcare is changing, competition is accelerating, and staying relevant is going to be a momentous task. That's where Mira comes in.
- Global reimbursement rate. Healthcare costs are completely transparent with Mira. Every visit type has a fixed fee attached; no matter where you are or who you see, you know that your urgent care visit, for example, will cost the same every time.
- Growth & retention. Urgent care has been historically transactionally and the cost to re-acquire patients is skyrocketing. Mira intelligently aligns each member with the preferred clinic overtime to increase care continuity and help providers maintain recurring revenue.
- Streamlined payments. Providers are assigned a virtual credit card as a form of payment when they get onboard to the platform. When an appointment occurs, a payment amount will immediately become available for processing. There‚s no manual billing, no chasing up unpaid bills ‚Äì payment is upfront, automatic, and digital, cutting your payment processing time from an average of 24 days to less than 5 seconds.
- Patient education pre-appointment. Mira will let your patients know what to expect before their visit, so you don‚t have to. This helps streamline your workflow so you can spend more time helping patients and less time going over administrative duties. You can also get patients to pre-fill forms before their visit by uploading them to the Mira platform.
- It‚s free to join. No billing, no administrative fee, no sign-up cost. Mira is 100% free for providers to join. Considering the average cost of each patient acquisition is $50-$80, your practice will save thousands very quickly.
How to list my practice with Mira?
Signing up for Mira is easy and simple. Email firstname.lastname@example.org with some information regarding our practice. We have a simple contract and onboarding process that can get you going in less than 30 days.