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Mira Program Combines Online Health Scheduling and Flat-Fee Rates

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A New York-based startup has crossed an urgent care provider network with flat-rate pricing, cash payments and online scheduling to create what it hopes will be a new kind of “front door to health care.”

The company, TalktoMira Inc., recently began signing providers, consumers and employers up for the new, non-insurance primary care and urgent care access program.

To agents and brokers who sell dental discount cards, the program might look like a high-tech health discount card program that offers flat-rate pricing.

(Related: Aetna To Market Dental Discount Card To Students)

Khang Vuong, Mira’s founder and chief executive officer, said in an email interview that he sees the company as a “tech-enabled care coordination company,” or a Costco for sourcing primary care and routine urgent care, rather than as a discount program.

Discount programs that help users pay for conventional medical care “typically use a reference-based pricing model based on … Medicare’s fee schedule,” Vuong said. “We actually transform how providers are being paid to a value-based global payment system. ”

Adopting a value-based global payment system — a two-tier, flat-fee payment system — is more work than simply tying fees to a percentage of what Medicare pays, but it will help Mira make pricing predictable and affordable, Vuong said.

Vuong earned a master’s degree in health care administration from the George Washington University. He later spent several years working in management in Bon Secours Mercy Health, a nonprofit organization that runs dozens of acute care hospitals and hundreds of other health care facilities. He then worked for Canton & Company, a health care consulting and marketing firm, before venturing out on his own.

The Pricing Systems

Vuong has based the Mira system by paying for access to the G2BN urgent care network developed by the Urgent Care Association of Warrenville, Illinois.

The association offers a standard, three-price-their payment schedule on its G2BN web page. The rates are $130 per visit for basic services, $170 per visit for mid-level services, and $200 per visit for advanced services.

Mira has negotiated a separate, two-tier agreement that provides a payment of $40 per visit for basic services and $112 per visit for advanced services.

The association has posted a copy of the Mira provider agreement on its website.

The list of basic services includes wellness visits, vaccination visits, and followup visits.

The list of advanced services includes exams and testing for conditions such as suspected strep, bronchitis, flu, urinary tract infections, ear infections and pink eye, and for minor skin problems.

The list of advanced services also includes asthma treatment, burn care, foreign body removal, wound repair, ear washing, electrocardiograms, X-rays, and comprehensive physical exams.

“Covered services shall not include procedures that require the expertise of or referral to a professional specialist,’ according to the agreement.

The Program

Mira offers individuals a choice of paying $45 for access to the program on a month-to-month basis or $25 per month throughout the year.

An employer can sign workers or independent contractors up for the program for $25 per month per enrollee.

Mira’s site shows that the patients themselves pay flat fees from a list that’s different from the provider’s flat-fee list.

The co-pays are $55 for an annual checkup, $99 for an urgent visit, and $15 for a virtual followup visit.

Patients are supposed to use the program app to schedule appointments online and pay before they see the doctor.

In many cases, patients can get into a provider’s office within an hour of making an appointment, according to Mira.

The Provider Network

In the past, some medical discount program managers tries to provide member access to discounted care by simply paying to rent the kinds of big provider networks traditional health insurers use.

In some cases, doctors complained that they had no idea the provider network companies would be expecting them to see patients with discount cards, and no insurance, on the same basis that they would see fully insured patients.

Vuong said Mira is trying to avoid problems of that kind by signing up Urgent Care Association providers who are interested in Mira one by one, and sending a Mira team member to each incoming clinic to onboard the front desk in person.

“We only want to partner with those who have the ability to see the patients the same day,” Vuong said. “This is a huge task, but nothing we have done was easy.”

At this point, the company has relationships with 125 clinics and is starting by signing up members in New York.

“We will not be renting network from anyone anytime soon, because the way we transform payment is unique ,” Vuong said.

Mira is working on adding pediatricians, dentists and mental health care providers, according to the Mira website.

The Urgent Care Association site shows that Mira is building relationships with providers in Dallas and in California as well as in New York City.

Marketing and Distribution

Vuong said he’s hoping to have about 5,000 to 8,000 people using the Mira program in New York by the end of the year.

Mira aims to work with the payers and distributors that are already in the health care system, rather than trying to replace the incumbents, Vuong said.

Mira is encouraging public and private payers to offer the program as a complement to traditional health coverage programs.

For brokers, “we have a flat 5% referral fee,” Vuong said. “We are also in the process of setting up a ‘broker account,’ where everything is automated.”

— Read Surgeon Prescribes Cash for U.S. Health Problemson ThinkAdvisor.

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