by Sedera VP of Public Affairs and Strategy, Jenny Aghamalian
Medical Cost Sharing, the sharing of large medical needs with a community of like-minded individuals who share similar ethical or religious beliefs, has grown in popularity in recent years, with over 1.5 million Americans now members of Medical Cost Sharing Communities, including Health Care Sharing Ministries (HCSM). Medical Cost Sharing can be a good fit for many individuals and families, promote price and product transparency across the healthcare system and eliminate administrative red tape and surprise billing. It’s no shock that consumers and businesses are catching on.
With this increased demand, more and more organizations that facilitate Medical Cost Sharing are entering the market. When evaluating Medical Cost Sharing Communities, the number of options can be staggering, but not all of these organizations are created equal.
Want to see if a Community is trustworthy, reputable, and a good fit?
Considering asking these important questions:
1. What principles unite that specific Medical Cost Sharing Community?
Medical Cost Sharing Communities are just that — communities. As with any chosen community, it is important you find a group that aligns with your values and principles. Historically, many HCSMs only allow members of a certain religion or denomination to be a part of their community — effectively excluding those that support the model, but just don’t happen to be of the same faith.
When introducing potential new members to the Sedera Medical Cost Sharing Community (Sedera Community), we always lead with our vision and emphasize its importance to our everyday work. Imperative to the vision are Sedera’s core values: As solution shapers who are intentionally not status quo, we believe in the best idea in the room, no matter who it came from. As community builders and health champions, we care for each other’s physical, mental, emotional, and spiritual health through generosity and the sharing of burdens. And because we view everything through the lens of being rooted in love, we don’t hesitate to slow down, reflect, adapt, and change if what we do does not promote wellness and connectedness for our community.
These principles are central to a multitude of religions and ethical values systems, and they guide everything we do.
Above all else, we strive to educate and empower our members to be engaged participants in their healthcare choices and promote living healthy lives. We hope our core values can touch as many lives and families as possible.
2. How established is the Community?
Experience matters. Before choosing a community, you should be confident that it has the experience, knowledge, and a strong leadership team with clear direction. The best Medical Cost Sharing Communities take the time and initiative to invest in their people, platform, and policy.
Sedera has an experienced leadership team that prioritizes the member experience and has a strategy for navigating hurdles and advocating for industry best practices. Our leadership team continues to chart new territory carefully and responsibly to ensure that the disruption to the healthcare status quo results in a sustainable fashion. On the ground, this is evidenced by our commitment to transforming the patient experience through education and innovative services.
Thanks to our members’ commitment to balancing personal healthcare choices with the impact on the broader community, Sedera has fully shared every need that meets our sharing guidelines. Each and every decision we make is informed by our ongoing dialogue with our community members and other stakeholders.
3. How does the Medical Cost Sharing Community handle sharing and ensure all funds are being used responsibly?
Sharing guidelines and the means of facilitating sharing provide critical insight into a community’s values and commitment to financial accountability.
For example, many communities pool sharing dollars into a single account or trust managed by the sharing community or a contracted entity, making it difficult for members to determine if the community is sharing according to guidelines and handing over ownership of those dollars to another interest This mixing of member funds can make it difficult to understand where sharing dollars are going.
In contrast, other communities have invested in secure sharing platforms that enable direct member-to-member sharing, allow for the transparent reporting of the sources of all funds, administrative costs, and fees, and calculate the total of qualified needs according to sharing guidelines.
Sedera, for example, partnered with an FDIC-insured bank to establish a fintech platform that uses personal Medical Cost Sharing accounts to facilitate the sharing process. Members make monthly contributions to the Sedera Community that are held in dedicated savings accounts used exclusively for Medical Cost Sharing. Members know that Sedera Medical Cost Sharing funds are protected by an FDIC-insured bank rather than being pooled in an account that they don’t have visibility to or ownership over. This cutting edge innovation provides the highest degree of security and transparency of sharing funds, putting members, and other stakeholders at ease.
4. How does the Medical Cost Sharing Community actively protect against consumer confusion related to sharing vs. insurance?
Medical Cost Sharing is not insurance, plain and simple, and consumers actively need to be made aware of the differences. The best sharing communities go to great lengths to ensure that potential members are fully educated about the differences before they join the Community. Furthermore, sharing communities should avoid the use of the tools, tactics, and verbiage typically associated with the insurance industry and reinforce those differences between the two distinct industries.
Sedera believes that sharing communities have an obligation to make sure that potential members are familiarized with what sharing is and even more important, what it is not. The Sedera Community will continue to lead with integrity and a member-centric approach, using every opportunity to create points of differentiation. We do not use the usual tools of insurance like networks, ID cards, pre-authorization, or claims adjudication, primarily because we do not need them. Sedera facilitates sharing, but it doesn’t pay providers directly, doesn’t have a network, or ID cards, and members always remain ultimately responsible for their medical bills.
Sedera Certified affiliates are required to participate in a training and education program and pass an exam before being allowed to offer Sedera. Sales and marketing materials are carefully reviewed to make sure that the boundaries between insurance and non-insurance products are never blurred. In all collateral, Sedera requires the separation of the medical cost sharing component from any other products being presented to potential members to further eliminate the potential for confusion.
Education campaigns are designed to help Sedera Community members become engaged and savvy healthcare consumers. Our professional member services team provides the tools and expertise to support members throughout the process. Our goal is for Sedera members to commit to lead healthy lifestyles and actively work with the broader community of like-minded individuals in exchange for the cost savings associated with the Medical Cost Sharing model.
Sedera models excellence through pioneering this new healthcare option for individuals and families who are ready to take charge of their medical expenses, with an eye toward creating a secure, responsible, and consumer-centric framework that will pave the path for additional market entrants. Our growth continues to be both explosive and validating Sedera’s commitment to excellence. Sedera ranks #193 on the Inc 5000 list placing it in the top 4% of the fastest-growing private companies in America. Additionally, Sedera was named the fastest-growing company in the Austin Business Journal’s Fast 50 Awards small business category in Central Texas in 2019.
Jenny Aghamalian is the VP of Public Affairs & Strategy at Sedera. She joined the team several years ago and has played a major role in making Sedera what it is today. She has over fifteen years working in the healthcare space on behalf of physicians, insurance companies, and now Sedera. She lives in Austin with her husband, three children, and their new puppy.