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With health care costs on the rise, a growing number of Americans are throwing out the old way of seeing a doctor and turning to a membership model. A monthly or annual fee gets you direct access to a doctor, no insurance needed.Twenty years into her career, bogged down by red tape, too many patients and long days, Dr. Shaila Pai-Verma was looking for a better way to practice medicine.“I was just miserable,” she said. “The joy of medicine is gone and then you're just doing paperwork.”So, a year ago, she started a new primary care practice with a new business model.“The patient basically has a direct contract with the physician and they take insurance companies out of it,” she explained.Patients pay a flat monthly or yearly fee. In exchange, they receive a broad range of primary care services and quick, unlimited access to their doctor via in-person office visits, phone or by text.“Everyone wants everything immediate. And so, I think this is it. It's good, especially in this time for people to have access,” said Pai-Verma.Membership fees range from about 5 to 0 per month on average – about 0 less than having typical health insurance. Most patients still carry catastrophic coverage for emergency treatments and hospitalizations, but that insurance is usually only -100 a month, so patients still save money.For Bonnie Micheli and her family, it was all about access.“With this, it's just so much easier to just know that I can contact directly here within a few hours for any issues that I'm having,” said Micheli.In late September, a bipartisan proposal was introduced in Congress that would expand access to the model and allow people to use their health savings account for direct primary care (DPC).Because they see fewer patients than traditional practices, some critics say the model could worsen the shortage of primary care physicians, a trend that’s already driven by burnout.But according to a recent study, DPC members had 25% lower hospital admissions and the cost of emergency room claims was reduced by 54%.“There's less ER visits and you know, better health care for the patient,” said Pai-Verma.While there is still debate, for a growing number of Americans, like Micheli, it’s becoming a simplified health insurance alternative.“Honestly, it’s just so nice to know what I'm paying every month or if you do the annual, what you're getting for that money, and you know exactly who to go to when you have a problem.” 2467

When cruise lines begin sailing again, the Centers for Disease Control and Prevention has some guidance. The health agency issued their “framework for resuming safe and responsible cruise ship” operations Friday, ahead of the no-sail order expiring Saturday.The no-sail order, which originally began in April, prohibits cruise ships from carrying 250 passengers in waters subject to US jurisdiction.The CDC said it has identified at least 3,689 coronavirus-related illnesses, and 41 associated deaths, connected to cruise ships. Although the CDC cautions these figures are likely an underestimate.The framework urges a phased approach, and applies to ships that have the capacity to carry at least 250 passengers in waters subject to U.S. jurisdiction.“A phased approach is necessary because of the continued spread of the COVID-19 pandemic worldwide, risk of resurgence in countries that have suppressed transmission, ongoing concerns related to restarting of cruising internationally, and need for additional time for the cruise industry to test the effectiveness of measures to control potential COVID-19 transmission on board cruise ships with passengers without burdening public health,” a statement from the CDC reads.During the beginning, cruise line operators will have to demonstrate adherence to testing, quarantine and isolation plans, as well as social distancing requirements for passengers and crew members.The CDC says they will help by “establishing a laboratory team dedicated to cruise ships to provide information and oversight of COVID-19 testing,” updating instructions and creating a system to track ship status and passenger cases.Meanwhile, cruise lines will need to build out the capacity and ability to test crew and passengers on a regular basis.In their framework, the CDC says there may be simulated, or mock, voyages with volunteers to test cruise ship operators’ ability to apply COVID-19 mitigation measures.Although the no-sail order will be lifted, Carnival, Royal Caribbean and other cruise lines have already cancelled sailings until 2021. 2083

When we hear our phone go off and see an unknown number, we're not very likely to answer, but that habit is creating some issues for contact tracers.People are hired to get in touch with anyone who's been in contact with someone who has been diagnosed with COVID-19.With people not answering calls from contact tracers, controlling the coronavirus becomes more difficult.But it doesn't mean contact tracers give up.“In some cases, when contact tracers call someone, and that person is uncomfortable talking to them on the phone, in some counties, they will actually send someone to that person's home to conduct an in-person interview, if they're more comfortable doing that,” said Steve Waters, founder and CEO of CONTRACE.Even when contact tracers do manage to get someone on the phone, it can be difficult to get information from them. This is a result of all the spam calls trying to scam people.That's why contact tracers say it's all about establishing trust in that cold call.“If you have a cultural understanding of the people that you are calling, that goes a long way to begin with,” said Waters. “I think you are more likely to be trusting of someone who has the demeanor and cultural understanding of your region, than somewhere across the country.”CONTRACE was founded when coronavirus cases started popping up in the U.S. It helps public and private groups with contact tracing efforts.The group encourages every state and local government to work with phone providers to help people know that calls are coming from contact tracers.Ideally, the call would be identified as the local health department or contact tracing program. 1650

White House press secretary Sarah Sanders privately berated the White House communications and press staff Friday after a leak the previous day of comments by aide Kelly Sadler about Sen. John McCain, according to several sources familiar with the meeting.In discussing McCain's opposition to CIA nominee Gina Haspel, Sadler,?a special assistant who handles surrogate communications for the White House, said in a private meeting Thursday that it doesn't matter "because he's dying anyway." It was a joke that fell flat, a White House official told CNN. 571

Wings and wagers? Buffalo Wild Wings thinks they're a natural fit.The sports bar chain, which has about 1,200 restaurants in all 50 states, said it is exploring the possibility of offering sports wagering now that the Supreme Court has opened the door for states to legalize sports betting."As the largest sports bar in America, we believe Buffalo Wild Wings is uniquely positioned to leverage sports gaming to enhance the restaurant experience for our guests," a company spokesperson said Thursday. "We are actively exploring opportunities, including potential partners, as we evaluate the next steps for our brand."Three states -- New Jersey, Delaware and Louisiana -- have legalized sports gambling since the Supreme Court decision in May. Before the ruling, Nevada was the only state where it was legal to bet on sports.Many other states are considering legislation that will allow for sports betting in the hopes of cashing in on what could be a multibillion-dollar industry."We're still waiting for state legislatures and regulators to hash out licensing rules, so it's unclear how they'll [Buffalo Wild Wings] have opportunity to participate," said John Decree, head of North America equity for Union Gaming, a boutique investment bank that focuses on the gaming industry.Current there are 43 states with some type of legal casino. But even states without casinos could move to allow sports gambling.Decree said that he thinks it's likely that Buffalo Wild Wings will partner with an established casino or other sports betting entity, rather than try to get licenses on its own as states move to allow sports wagering."It'll be hard for them to try to get licensed in every state that allows it. There's a lot of legal costs and time involved," he said.Much of the coming boom in sports gaming is expected to take place online, especially on mobile apps, meaning that many customers watching games at a Buffalo Wild Wings will be able to place bets at a variety of sports books in their states.Decree said it's likely that some states that allow online wagering will require people to put money on their account in person and using cash, rather than using a credit card.In that case, Buffalo Wild Wings could reach an agreement with some sports books that would allow people to put money on their account in one of their restaurants."That alone can generate a lot of foot traffic," he said.Buffalo Wild Wings was purchased for .9 billion earlier this year by privately-held Arby's. 2533