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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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My First Bleet: The Fraying Employer Based Insurance

Bleet (blēt) n.

  1. A combination of a blog post (in depth analysis of an issue) with a tweet (spontaneous expression of a mental thought)

I typically attempt to write a thoughtfully developed, artfully crafted, and intellectually provocative post concerning current topic areas of interest. However, in the age of Twitter, I am finding that blogging has become increasingly laborious.  I get a ton of interesting stuff throughout the week but only have a finite time to hit my goal of two posts per week.

So, given my penchant for definitions, here’s to my first bleet (blog tweet):

Paul Fronstin from the Employee Benefit Research Institute puts out a California Health Care Foundation assisted study regarding the Fraying Employer Based Insurance paradigm (warning PDF). Essentially, we are down to 56% of population being covered through their employer, 60% of Latino’s are uninsured, and the young invincibles unconvinced they need insurance (18-24 uninsurance rate of 35%).

When can we move to a non-employee based insurance world – auto insurance, anyone?

2 comments on “My First Bleet: The Fraying Employer Based Insurance

  1. Dave says:


    You’ve got great stuff here man. I smiled as i read your High Deductible/Low Premium posting. I think you must have written it after trying to help me see the light on the HSA front 🙂

    Looks like I’ll be bringing us on to the HSA train finally next year. Do you have a ppt/pdf/.com that goes into a bit more depth into the pros and cons, frequently asked questions of the HSA model … you know, for “glazed eyes, open mouth, and cognitive flatline” types like me?

    Also … any concern about the HSA model for high turnover, low income employee population?

  2. David,

    I am impressed you have time to read this sort of sordid drivel . . . you must not have a camp out planned or a triathlon to compete it?

    I probably was speaking to you and my question remains: Can you anyone out there (who can do 2nd grade math) justify why they have not switched over to an HSA? No one took me up on the challenge . . . looks like you might have.

    Funny story – we spent THREE months trying to convince our previous CFO why this was good. After battling the guy on the chalkboard for months, he finally relented, and then he went all missionary zealot on us regarding the “tremendous advantages of HSA”. To the point that our company paid the full premium AND fully funded the HSA on January 1 and it was still cheaper than the plan we had before.

    You do raise a good question regarding a “transient” workforce in the type of environment you operate in. Most people who have stayed long enough to become eligible for insurance should be deemed appropriate to provide some form of matching funds into their HSA. The reasonable concern is that if they walk, they do so with you funds.

    A GOOD approach in this setting could be a matching monthy FSA contribution (company keeps excess funds), a BETTER approach would be to matching monthly HSA (employee has more options and can walk with the funds), and and the BEST approach is to move to a defined contribution where you consider their full “all in” compensation (including fully funding their HSA) as part of their overall package at the time of hiring.

    In terms of HSA for Dummies, there is a ton of stuff on the internet, from brokers, and simple things that you can create to highlight the simple concepts like “low premium/high deductible”, health insurance like car insurance, health as an asset that needs to be managed, and shared responsibility (employee incentives for improving health, ala Safeway).

    I know the model can and does work for all pay grades, all industries, and for all people who “lernt der addition!”

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