Asheville ‘docpreneurs’ see health-care ministry as alternative to traditional health insurance


From left, Doctors Chad Krisel, Veena Somani and Brian Lewis. Krisel and Lewis founded Integrative Family Medicine of Asheville four years ago in the River Arts District.

Two Asheville doctors who are already pioneers in the field of direct primary health care have begun promoting what they believe is a viable alternative to traditional health insurance, something known as health-care cost-sharing ministries.

The faith-based groups operate outside the health insurance system, but offer cost-sharing plans for members in a system that is allowed under the Affordable Care Act. Doctors Chad Krisel and Brian Lewis of Integrative Family Medicine of Asheville say the health-care ministry they’ve chosen to work with, a nonprofit organization called Liberty Direct that’s associated with a Mennonite church, promotes preventative health care while offering a cost-sharing plan that’s affordable.

When Krisel and Lewis opened their practice on Depot Street in the River Arts District four years ago, they offered an approach that appealed to many potential patients still getting used to the new Affordable Care Act. The ACA included a number of key provisions, from prohibiting health insurers from refusing coverage based on patients’ medical histories to offering subsidies to help some citizens buy health insurance and requiring Americans to carry health insurance coverage. But the doctors eschewed traditional health insurance and opted for a monthly payment plan that covered basic health care such as check-ups and common lab tests.

By not dealing with health insurance companies, the primary care doctors spend much more time treating patients. The approach is allowed under the ACA, but patients still often seek a high-deductible health insurance plan to cover emergencies and treatment from specialists. The direct primary care model is catching on. One Seattle company in particular, called Qliance, is attracting outside investment dollars and gaining attention for its approach.

But critical issue is that deductibles for many health insurance plans continue to rise. And observers say the costs will continue to rise. (Here’s a look at current ACA enrollment and trends.) Krisel and Lewis say the Affordable Care Act and its subsidies work well for people who have an income of about $30,000 or less, while people will with enough money to buy pricey “concierge” plans go that route, while middle-income people are feeling the squeeze of increasing premiums and deductibles.

Enter the health-care cost-sharing ministries such as Liberty Direct. The faith-based organizations were grandfathered in under the ACA and offer their own approach to cost-sharing for medical expenses. Krisel and Lewis like Liberty Direct because it promotes direct primary care while also offering an affordable cost-sharing plan for big expenses.

Liberty Direct offers a plan that costs $199 per month for an individual over 30 ($149 a month for an individual under 30), a cost that hasn’t increased in four years, according to Krisel. That amount covers the cost of membership to the Integrative Family Medicine health clinic for direct primary care, Krisel says. It also covers major medical expenses of up to $1 million. There’s no in-network or out-of-network system, Krisel adds, so patients can see the doctor of their choice. The Liberty Direct “unshared” amount – similar to a deductible under traditional health insurance – is $500.

“What we’re showing with direct primary care is that it’s an innovative solution the not only works for patients and doctors, it works for the system. It saves the system money,” Krisel says.

“The end result is that people who are investing in their health are going to hopefully be mitigating risk and getting better care,” Krisel says.

Krisel and Lewis are now handing out Liberty Direct pamphlets to patients and encouraging them to take a look and consider joining. The doctors are up front about how the health-care ministries offer differ in some fundamental ways from health insurance offered by ACA exchanges:

-they have faith and lifestyle criteria for membership (Lewis says the Liberty Direct approach to the faith requirement is “palatable to an Asheville scene because it has no particular faith expression.)

-they do discriminate when it comes to pre-existing health conditions in that they generally don’t allow members to share those costs

-they can’t call what they offer health insurance because they can’t guarantee health care costs will be covered, though these health-care cost-sharing ministries have solid records of covering members’ eligible submissions for reimbursement.

State regulators also say health ministries disrupt the insurance market because they tend to attract healthier consumers, siphoning them from commercial plans that can be left with sicker or older customers. Insurance commissioners in some states have moved to shut down the ministries’ state operations. Enrollment in health-care ministries has risen in recent years, as consumers have discovered them. But some state regulators see the health-care ministries as a threat to the insurance system because they attract a healthier consumer base. The regulators are also wary because the ministries don’t have the same oversight as the traditional health insurance company.

Krisel and Lewis both say they feel an “urgency to innovate’ as the U.S. health-care system landscape continues to shift. They are strenuous proponents of the direct primary care approach and want to see it succeed, and teaming up with a nonprofit health-care ministry may be one way to do that, Lewis says. It’s a grassroots approach and “as it proves medical efficacy and cost savings, it will spread,” he says.

Image link for Integrative Family Medicine of Asheville.


Vince February 11, 2016 - 4:28 pm

Tomorrow’s AC-T Headline: Blue Cross and Blue Shield consider dropping ACA coverage.

Barry Summers February 10, 2016 - 5:32 pm

But some state regulators see the health-care ministries as a threat to the insurance system because they attract a healthier consumer base.

This is the crux of it. However well-meaning these folks are, siphoning off a healthier segment of the population just makes the much larger pool harder to insure.

Let’s just quit this self-destructive cycle and admit it: the only fair, sustainable, affordable solution is single-payer for all.

Ed Carroll February 10, 2016 - 10:26 am

Cannot say enough good things about the Dr’s and healthcare professionals at Integrative Family Medicine. I hardly ever comment or post, but I feel compelled to because of how welcomed I felt there after my first appointment (over a year ago).

I have a few friends that have been in health-care ministries and appear to like it well and keeps costs down, although I believe they all have high deductibles. If I was not covered through work, I would consider this option for my family.

luther blissett February 9, 2016 - 9:33 pm

“they can’t call what they offer health insurance because they can’t guarantee health care costs will be covered”

So, it’s really just a way for relatively affluent and relatively healthy middle-class people to pay to see their doctors as they would pay for the gym or yoga classes. It’s a lifestyle subscription plan, not a healthcare model.

It’d be laughable if they weren’t so seriously deluded about it being a model for anything other than their own bottom line.

Ron February 10, 2016 - 7:26 am

Ah, not laughable and not deluded.

You must have your health insurance through ACA (mostly or 100% subsidized) or through your employer (mostly or 100% paid). Those of us dual income married couples in the “affluent” middle class ($62,041 or more) who must pay market rates for health insurance are getting royally screwed. The lowest cost ACA plan for us is $1200+/month with a $5000ea deductible. That’s up 57% in three years. And, by law, it’s mandatory to purchase. Gotta love that.

With for-profit insurance companies and government bureaucracy out of the equation this solution would cut our monthly premiums by 75% and our max out of pocket by 90%. That might free up a couple $$ for us affluents to take some yoga classes to help stay healthy.

luther blissett February 10, 2016 - 8:48 am

“With for-profit insurance companies and government bureaucracy out of the equation this solution would cut our monthly premiums by 75% and our max out of pocket by 90%.”

So you think that a tiny special-yuppie-snowflake not-actual-health-insurance plan is the solution? The basic actuarial principles behind every other healthcare system in the developed world suggest otherwise. A few cancer diagnoses or difficult births will blow out a small cost-sharing risk pool very quickly. And chronic pre-existing conditions like T1 diabetes are your own problem at unsubsidized rates, so tough luck there.

Maybe you can barter some chickens for checkups.

Ron February 10, 2016 - 11:41 am

You must have missed this when you read the details: This “special-yuppie-snowflake not-actual-health-insurance plan” has a pre-existing condition clause, max dollar limits, and specific ailments that aren’t covered (I don’t have to pay for your Viagra).

It’s pretty cool that such a plan exists and that in America I am allowed to choose it over a government plan without being taxed or fined (it’s so hard to keep straight which it is.)

luther blissett February 10, 2016 - 11:54 am

You must have failed to comprehend my reply. Any small pool can get blown to smithereens by a few unlucky events. The larger the pool, the more likely it resembles the population in general, and the greater the efficiency. Of course, if you think of yourself as a precious unique snowflake, that’s going to be lost on you.

So you’re paying for the illusion of health coverage in a nice yuppie-friendly environment. Do you get a free can of tiger repellant as a sign-up gift?

Ron February 10, 2016 - 12:20 pm

I never thought of the Amish-Mennonite community (on which this plan is derived) as a group of “special-yuppie-snowflakes.” I think they would beg to differ with that characterization.

For now, I’ll take advantage of the 75%+ decrease in my premiums and take my chances on the small pool eventually blowing up. If it turns out worse than the 3-year 57% increase I’ve experienced swimming in the big pool, I’ll switch back to ACA with a pocket full of unspent premium $$,$$$.

luther blissett February 10, 2016 - 7:28 pm

‘I never thought of the Amish-Mennonite community (on which this plan is derived) as a group of “special-yuppie-snowflakes.”’

But Integrative Family Medicine of Asheville is definitely a special-yuppie-snowflake primary care practice.

Good luck. You’ll need it. Maybe in the meantime you’ll learn why developed countries with actual healthcare systems don’t ooh and ah over Tiger Repellant Non-Insurance.

(And for what it’s worth, ACA pools aren’t as big as they ought to be, because they’re divided by county and age cohort. They should be much larger.)

jtroop February 9, 2016 - 8:00 pm

Health insurance is a giant mess! While NC’s refusal to take Medicaid dollars is an unconscionable (and purely political) act, the Affordable Care Act itself is extra-double-super-duper flawed. The system that the ACA replaced was even more broken….

I like what these guys are offering, but it even sounds like it could be perilous depending on the right (or wrong) circumstances. If you are anything other than young/healthy/without children, I suggest doing your homework and make sure the math works…

Ron February 9, 2016 - 6:01 pm

The link “Image link for Integrative Family Medicine of Asheville” at the bottom of the article goes to the wrong website. Okay to delete this comment once you fix it. Thanks.

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