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.
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.