Having a primary care physician is one of the most important things an individual can do for their health, as it helps ensure they receive regular check-ups, aids in preventive care and allows for intervention before more intensive treatment is required. However, according to a recent study by nonprofit organization Kaiser Family Foundation, 17% of women and 28% of men in the United States don’t have a primary care physician. And many say they have one but have not had a visit in years. Compounding concerns, there is a scarcity of primary care physicians across many regions of the country, which the Association of American Medical Colleges expects to worsen this decade.
Many organizations recognize the value of primary care for their health plan members, and therefore have adopted Direct Primary Care (DPC) arrangements to increase employee/member (and often times dependents) access to such care. In addition to improving primary care access, DPC enables organizations to manage their rising health care costs without shifting these expenses onto members, all while ensuring high-quality care.
This article provides a general overview of market challenges and the solution Direct Primary Care offers, including its potential benefits and other considerations for health plans to keep in mind.
The Aging Physician
Have you noticed how difficult it is to get timely access to a primary care visit? And trying to get a pediatric visit is even more challenging. There have been plenty of industry articles talking about primary care physician shortage tied to medical students opting for higher paid specialty careers, or primary care physicians leaving patient practices for corporate or academic careers. However, an issue tied to physician shortages that is often overlooked is the fact that physicians retire.
In 2019, 44.9% of active physicians in the United States were age 55 or older (AAMC.org). Not only is there currently a national shortage of physicians, but many physicians leave the field every year. Across the United States, there are approximately 936,500 active physicians. Of these, 16.3% are under the age of 40, 50% are aged 40-59, and 33.7% are aged 60 or older. This equates to more than 315,400 physicians across the country who will be retiring possibly this decade.
Urgent Care is Not the Answer
With access to primary care becoming a bigger challenge, many Americans are either avoiding care or relying on urgent care centers and Emergency Departments. Urgent care has its place managing “urgent” needs, but it is not a replacement for primary care.
Primary care physicians take a holistic approach to healthcare, considering not only physical health but also mental and emotional well-being. They address a wide range of health concerns, including acute illnesses, chronic conditions, brain health issues, and lifestyle factors that affect an individual’s overall health. They can provide counseling, lifestyle recommendations, and support for managing chronic diseases.
What is Direct Primary Care (DPC)?
DPC is an alternative health care payment model to traditional fee-for-service insurance that’s intended to improve health care affordability and access to primary care for a flat fee. This is mainly a strategy for self-insured health plans. Under this approach, organizations pay fixed monthly fees for their eligible members, and in some cases their families, which are typically less than $50 per member per month. These fees generally cover all primary care costs, including lab work, generic prescriptions, and even some occupational health needs.
Under DPC arrangements there is no third-party billing or fee-for-service payments. Instead, these arrangements center around the relationship between employees/dependents and their health care providers, eliminating the need for insurance companies to act as intermediaries to approve procedures and medications. This allows DPC health care providers to have more autonomy in determining treatment options for patients, allowing DPC clinicians to deliver the attention and care they believe patients need. Access to these centers is not open to the public, only to those organizations paying for their members to use.
What are the benefits of DPC?
Employers and multi-employers can consider the following benefits when evaluating whether to adopt DPC arrangements:
Reduced Health Care Costs
DPC arrangements can help reduce health care costs. Instead of paying for each service provided over the course of a year as self-funded plans do, health plans pay a flat fee per member. Additionally, DPC capitated fees are generally much less expensive on an annual basis than just a handful of office visits. Well run DPC health centers have proven returns and can manage annual healthcare trend to low single digits.
Strengthened Recruiting and Retention Efforts
DPC is an attractive benefit because it improves access to healthcare and, in many instances, it costs patients nothing to visit these centers. What’s more, the improved access and extra time eligible members have with their physicians can allow them to build strong, trusting relationships which can ultimately improve long-term health. By offering DPC arrangements, organizations can demonstrate their commitment to member well-being and bolster recruiting and retention efforts.
Improved Employee Productivity and Wellbeing
Employees have improved access to primary care under DPC arrangements, reducing the amount of time they must spend away from work to receive treatment. In addition to offering 24/7 virtual access, DPC arrangements generally permit eligible members to visit their health center the same or next day when issues arise. Many DPC locations are located near worksites, directly on-site, or at shared locations, thus preventing individuals from having to miss work or spend excess time traveling for care. Most DPC providers have significantly fewer patients than other physicians; in many cases, they have less than half the average number of patients. These smaller patient panels allow providers to spend more time with their patients, enabling them to unearth possible health issues before they become chronic or catastrophic. Subsequently, patients are less likely to require emergency room or urgent care visits and specialist services. With more time, clinicians can better coordinate care and advocate for individuals when referring them to outside providers.
What Employers Can Do
There are several third-party direct primary care organizations that offer virtual and in-person patient care focused solely on employer and multi-employer populations. Contact your Bolton Consultant today if interested in exploring Direct Primary Care solutions.
Please Note: The information contained in this article is not legal advice and should not be relied upon or construed as legal advice. This article for general informational purposes only and does not purport to be complete or cover every situation. Please consult your own legal advisors to determine how this article may affect you.