Healthcare consumers across the nation are bracing themselves for an impending increase in healthcare costs. According to a recent report from major consulting firm PricewaterhouseCoopers (PwC), the cost of treating patients is projected to rise by 7% in 2024, driven by providers’ expense growth and subsequent rate increases.

Background

At the heart of this crisis is the exodus of clinicians from the medical industry, a trend propelled by an unprecedented level of burnout and retirement. The Association of American Medical Colleges projects that by 2032 there will be up to 122,000 fewer physicians than needed, and a study conducted in 2022 by the nonprofit Physicians Foundation found that more than half of surveyed physicians did not have positive feelings about the current state or future of the medical profession - in fact, more than 1 in 5 wanted to retire within the year.

Burnout in the medical profession isn't a new phenomenon. The current wave, however, is notable for its scale and its timing. This significant decrease in the supply of healthcare providers has led to an inevitable increase in labor costs. For example, many hospitals are forced to hire staffing agencies to combat clinician shortages, which typically come with high contract price tags. Rising inflation also means less purchasing power both for physicians and hospitals.

This all translates to higher healthcare expenses for the patients. Why? Because when hospitals and healthcare providers aren’t being compensated enough, they traditionally lobby for higher reimbursement rates from health insurance companies in order to sustain their operations. This practice has historically resulted in an upward spiral of healthcare costs and increased premiums for insured individuals.

Despite this complex landscape, Sesame helps protect patients against the rising costs of healthcare by offering a radically simple - and radically effective - solution: put the clinicians in charge of their own rates and schedules, and cut out the middlemen (insurance companies, the government, and other third-party payors).

How does Sesame’s direct-pay model protect patients against rising healthcare costs?

With traditional health care, patient care and billing is a complicated process for providers. After the appointment, the provider must document the patient’s treatments and/or diagnosis, log into the electronic health record (EHR) to submit an insurance medical code for billing, submit a claim to the insurance company so that the patient can be charged and the provider can be reimbursed, review the claim to make sure the information is correct and appeal denials if necessary, and then prepare themselves for post-payment audits (instances in which 3rd party payors request documentation to ensure they’ve paid claims correctly) - and if providers want to be reimbursed more from those third-party payors, they are forced to negotiate for higher pay. If this operation seems extraordinarily arduous, convoluted and time-consuming, that’s because it is.

With Sesame, providers simply list their appointment price and availability, then assess patients who book with them. If necessary, medications can be sent to a pharmacy of the patient’s choosing with several clicks of a button. There are no claim submissions, denial appeals or administrative burdens to push providers towards paperwork instead of patients. This gives providers more flexibility, time and peace of mind (not burnout). And if a provider wants to adjust their rates, they don’t need to resort to lobbying - they can simply change their prices on the Sesame marketplace.

Additionally, Sesame’s telehealth options allow providers to work from home instead of incurring the operating costs of running a brick-and-mortar office( rent, insurance processing softwares, staff and more), which helps keep prices low. In other words, the absence of third-party interference in the Sesame model not only reduces clinician burnout but also eliminates the typical costs associated with traditional healthcare.

The reduction in labor and supply costs achieved through the Sesame model has an immense potential to revolutionize the way we perceive the healthcare industry. Instead of navigating through the bureaucratic maze of insurance companies, patients can avail themselves of affordable care and clinicians can maintain a balanced workload and fair compensation, reducing the risk of burnout and enhancing the overall quality of healthcare.

Sesame's ability to remain uninhibited by the countless complications and inefficiencies of the U.S. healthcare system is a testament to the simplicity of its solution: a direct-pay marketplace where high-quality care at an affordable price is the sole priority.

Sesame content is not intended to be a substitute for professional medical advice, diagnosis or treatment. If you have a medical concern, it is critical to seek the advice of your physician or another qualified health provider with any questions. If you are facing a medical emergency, call 911 or visit the nearest emergency room immediately.

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