A Houston-based medical cost-sharing company is out to provide small and large employers a better way to provide health care to employees, despite ever-increasing insurance costs.

Scoop Health, powered by Austin-headquartered peer-to-peer health care sharing company Sedera, offers an alterative to health insurance with no network restrictions and no limits in members' eligible medical bills.

"At Scoop Health, we are part of the movement to help put informed consumers back in the drivers' seat of their own healthcare and to help them secure better ways to pay for the big stuff," company CEO and founder Art Goetze told Texas Business Daily.

Scoop Health is not your grandmother's insurance company.

"Scoop Health is a bundler of alternative health benefits for employers, families and anyone that feels rejected by traditional health insurance," Goetze said. "We help average employers design affordable health benefits that are tailored to unique needs and resources of individual employees."

There are a lot of employers who could use that help. Employer-sponsored insurance covers almost 155 million "nonelderly people," those 64 and younger, according to information from the Kaiser Family Foundation.

Kaiser also finds that employers struggle with increasing health premiums for their employees' cover and total annual health insurance costs last year averaging $7,700 for single coverage and $22,200 for family coverage. Over the past five years, premiums have increased 22% and went up 47% over the past decade. About 20% of employees in small businesses pay at least $12,000 a year for their share of family premiums and a worker's average deductible is $1,700, an increase of 68% over the past decade.

Despite those cost increases, employers are still offering health benefits at a very high rate, with employees enrolling in plans their companies offer. The federal Agency for Healthcare Research and Quality's Medical Expenditure Panel survey for 2008-2019 found that more than half of small employers offer coverage. The survey also found that 88% of medium-sized employers, those with 50 to 99 workers, and almost all large employers offered health benefits in 2019. In total, 72% of employees offered health benefits enrollment that year, despite the rising costs.

Goetze said he witnessed much of that need before he founded Scoop Health. In those days, he worked in the freestanding emergency room industry and, with others, he pioneered the membership model for urgent and primary care services, often called "Direct Primary Care."

"In my my ER, I learned a lot about patients, customers and fee-for-service medicine, where the sicker you are, the more money the doctor makes," Goetze said, estimating that almost 80% of emergency room patients are not suffering clinical emergencies.

"They could have been treated in an urgent or primary care setting for a small fraction of the price," Goetz said. "They didn’t know but they still got hit with a whopper of a bill, because health insurance declined the ER visit."

Goetze said that observation is what helped him realize "that we have a huge customer problem in health care."

"Ninety years of employer-paid health insurance had scrubbed the traditional customer of concerns about price and quality," Goetze said. "People had been indoctrinated to believe that health insurance is health care."

Scoop Health rejects those assumptions and others, including the notion that high deductibles and care limitations of traditional health insurance is somehow the way to do business.

"We took a fresh look at the ordinary care needs of average people," Goetz said. "The reality is that around 85% of people consider themselves to be generally healthy. Conversely, only 15% are getting any benefit from high deductible group health insurance."

Instead of providing real benefits for most employers' workers, traditional health insurance punishes healthy people by forcing them to pay for the relative few who are sick.

A big change in the market came when the Individual Coverage Health Reimbursement Arrangement (ICHRA) was created in 2020 to create a level playing field for average employers. The program came to be called "the 401K of health benefits." The comparison arose because traditional 401K retirement accounts replaced employer directed retirement plans that were unfair and inequitable. ICHRA now is seen as a way to replace group health insurance that have become unfair and inequitable.

"With all this in mind, we split the problem of group health benefits into two parts and solve them separately and more affordably using the latest innovations instead of insurance," Goetze said.