"Combining Direct Primary Care, voluntary, and a high-deductible health plan for your employees could be a win-win-win."
Combining Direct Primary Care, voluntary and a high-deductible health plan for your employees could be a win-win-win.
Concierge Medicine sounds elitist and expensive -- we'd rather call it Direct Primary Care because it can be affordable for all.
Three examples of primary care providers that like to think of themselves as "blue collar" concierge practices prove our point:
AtlasMD - Kansas City, MO
AtlasMD physician Dr Doug Nunamaker says, “We realized that insurance paying for primary care is akin to using car insurance to try to pay for gasoline. ‘It’s something that’s otherwise fairly affordable until you try to pay for it with insurance: My premiums would be much higher because they wouldn’t know how much gas I would need, they would tell me where to get gas, and I’d have to preauthorize trips out of town.”
AtlasMD physicians have 600 patients each.
20 to 44 years - $50 a month,
45 to 64 - $75 a month,
65 and older - $100 a month,
children to 19 years - $10 a month.
Generic medicines are available at wholesale prices.
Izbicki Brothers - Erie, Pennsylvania
The Izbicki brothers began a similar membership practice after being frustrated working for another physician and the local hospital -- they weren't getting to spend the time they wanted to with each patient. They started their own practice, but were quickly back to not enough patient time. They were using the traditional insurance-based, fee-for-service business model and quickly grew to 4000 patients.
Dr. Jon Izbicki said, “We were bitter, frustrated. We were in a failed profession. It was so bad that we really had to take a risk. We knew that what patients want more than
anything else is uninterrupted time with their PCP and with that to build a level of confidence. They want
They took the leap and converted in June, 2013. Erie is rather conservative, so they chose to refer to their new model as a "direct primary care practice." It was definitely a risk. Only 20% of their patients were initially willing to join. It has taken time, but their practice numbers have climbed.
Unlimited primary care - $780/yr or $65/mo
They have made a commitment to their patients of visits that are as long as necessary, with same to next day appointment bookings.
To keep costs down, they have negotiated discounted contracts with labs for testing and radiology, and purchase generic drugs at wholesale, selling them to their patients for the same price they paid. Since patients with multiple chronic illnesses can easily save as much or more than the annual membership fee, this, plus unlimited primary care, are big incentives for Medicare enrollees to join.
"Hmmm...now, how can we convince primary care providers in our local communities to take the leap from fee-for-service to direct primary care?! I'm willing to have a couple conversations -- how about you?"
NeuCare - Lawrence, KS
Physicians just starting out have a tougher go than those converting an existing patient base, but that didn't stop Dr. Ryan Neuhofel. He began a membership practice called NeuCare right out of his residency training in 2012.
He said, “I saw that most PCPs did not have fulfilling careers; they spent enormous time in
administrative tasks rather than actually working with their patients. I knew I wanted to do primary care
but it had to be in a model that let me earn a decent living yet let me give real quality care in a compassionate manner.
“It was a real gamble to go straight into this. I had no patients and no reputation in Lawrence. My practice built slowly at first but is gaining momentum now.”
Most people in Lawrence make less than the national median income, so his practice offers "more like a safety net clinic." About 70-80% are uninsured and a very large number have complex, chronic illnesses – “a lot more
than I anticipated.”
$30/mo - $50/mo over 60
$100/mo - family of four, $10/mo per extra child
He also buys medications from wholesalers, again, find the savings for some of his patients requiring multiple prescriptions pays for their monthly membership fee many times over.
Some Lawrence employers have taken notice and indeed are pairing his services with a high-deductible policy for their employees.
“I see this as a real source of growth for my practice and the real long term growth for the whole direct primary care concept. It allows employers to initiate a high deductible policy yet give the employee access to quality primary care at no added cost. This is especially important for the person with lots of chronic illnesses personally or in the family.”
For physicians wondering how direct primary care revenue compares to fee-for-service, “I will be earning about average for a family practice physician in this area and that is just fine with me," Neuhofel said.
How much money could you save in your benefits plan design implementing this model for your employees?
These three practices demonstrate that direct primary care by whatever name can be affordable to most
employees and their families and in many cases actually save money – not to mention a return to relationship-based medicine. From an employer standpoint, it also means an empowered employee and reduced benefit costs.
I had experience early on in a similar setting with a membership-based Complementary Care center. I took a break from college to be Operations Manager for this start-up center in Old Mandeville across Lake Pontchartrain from New Orleans.
It took some educating in this small, conservative area -- but we were continually growing, and the majority of our clients were actually medical providers - doctors and dentists who "got it." Yet we also had a diverse blend of clients, from young athletes to construction workers to housewives, who understood the value. Word was getting around, and we were just beginning to reach out to the employers in the area -- until Katrina...
It was a great experience, and gives me hope that we can turn this health care titanic around.
It's certainly not the only thing that needs to happen -- but it's a start.
Hmmm...now, how can we convince primary care providers in our local communities to take the leap from fee-for-service to direct primary care?!
I'm willing to have a couple conversations -- how about you?
Source: Stephen Schimpff 7/15/15 "Concierge Medicine Can Be Affordable" |Healthworks Collective; http://www.healthworkscollective.com/stephenschimpff/314167/concierge-medicine-masses-or-elite
Rylan Klaseen & Associates
Rylan Klaseen & Associates
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