DECEMBER 19, 2014 – There’s a small but growing trend in healthcare–a trend where doctors are paid differently, so they can focus on a relationship with their patients, and where patients are able to see doctors without worrying about the cost.
On the first Friday of the month, Mike Hoon leads a staff meeting at Emerald Care, a small, non-profit nursing home in Wapato, Washington. There’s one announcement he wants employees to hear every single time: Wash your hands!
“Why does she say that every single month over and over again?” Hoon says, gesturing at the facility’s director of infection control. Keeping a healthy staff is a top priority at a facility with 24/7 care.
As co-pays and deductibles have gone up over the years, Hoon often found his staff couldn’t afford to use their health insurance when they got sick.
“I had staff that were coming in with colds and flu-like symptoms, and they weren’t going in to see the doctor because they didn’t have the $30 or $50 bucks to get in the doctor’s office.”
A year ago, Emerald Care signed up for direct primary care, or DPC: it’s medical care that works like a gym membership. The company pays $75 a month for each employee to get unlimited access to basic services like office visits and writing prescriptions. Employees only use insurance for major illnesses.
“It’s made access a whole lot easier, and it’s got them going to the doctor when they need it,” Hoon says.
Erika Bliss is President and CEO of Qliance, one of the first DPC providers in the country, with six clinics in and around Seattle. “There’s a big opportunity for insurance companies to start designing plans around this that capture the value,” Bliss says.
Bliss says that value comes from seeing a doctor whenever you want, and from having appointments that last 30 or 60 minutes, instead of 15. That might mean fewer chronic conditions and expensive trips to the hospital.
But so far, most insurers don’t make provisions for DPC. “When you buy an off-the-shelf insurance plan and pay for something like Qliance, you’re actually double paying for primary care,” she explains.
That’s beginning to change. This year, Qliance partnered with one insurer to offer a plan for individuals on the state healthcare exchange.
The bigger change is coming from big employers with the muscle to design custom plans: anywhere from 500 to several hundred thousand employees.
“Those employers tend to be what’s called self-insured,” Bliss explains, which means they pay the claims themselves. “So whatever savings accrue to the plan, that’s theirs, that’s money that goes to their bottom line.”
For Qliance’s institutional customers, Bliss says the savings have been in the neighborhood of 20%. Expedia uses Qliance for the 2500 employees at its Seattle heaquarters.
But Arnold Milstein says DPC providers are still too small to appeal to companies that are more spread out. “It’s very difficult to create a different solution for employee benefits in every single locality.”
Milstein directs the Center for Clinical Excellence at Stanford. As DPC does become more common, Milstein expects uneven results. “Like so many things in American healthcare that theoretically could save money, my guess is that some forms of this will be highly successful at saving money, and some will not only not save money, but cost more money,” Milstein says.
Copyright 2014 Northwest Public Radio