By Dr. Samir Qamar, CEO, MedLion – CEO, MedWand
1.“Insurance is not necessary for all healthcare.”
2.“Not all healthcare is expensive.”
3.”Employers can use Direct Primary Care to lower healthcare costs.”
Apr 14, 2016 –In times when employers are challenged with ACA compliance, high healthcare costs, and dissatisfied employees, the above statements have a lot of power. Even more important, the meaning of these statements is the essence of Direct Primary Care, America’s newest healthcare model, and one that is helping employers nationwide navigate traditional challenges.
To effectively strategize a good healthcare plan, savvy employers should first dissect the American healthcare behemoth to understand and figure out the needs of employees to offer meaningful benefits. In the United States, we use insurance for all healthcare needs. This is where the problem begins. Insurance was originally designed for expensive catastrophic events, such as heart attacks, cancers, and strokes. In fact, insurance is still used for catastrophes in all other industries, such as automobile, home, and life insurance. Healthcare is the only field where insurance is not only used for rare events, but also common and frequent events. However, “insurance is not necessary for all healthcare”.
MAY 24, 2016 (ATLANTA, GA) — INDUSTRY EXPERT PANEL DISCUSSION Specifically for EMPLOYEE BENEFIT MANAGERS re: DPC (Hosted by: IHC/DPC Journal) “Outlook for Employers Privately Contracting With Physicians In Direct Primary Care and Concierge Medicine Offices.”
Today, we use insurance for everything because visits to doctors for even minor issues can cost upwards of $100. When health insurance claims are filed routinely, health insurance premiums rise. Therefore, the only logical way to decrease insurance premiums is to reduce the frequency of claims filed. To reduce frequency of claims, a large segment of medical care has to be affordable to render insurance unnecessary. Thankfully, “not all healthcare is expensive.” This is where Direct Primary Care makes its grand entrance.
Healthcare can be divided into those services which are used often, and those which are used rarely. Primary care, with its routine physicals, acute care, chronic condition management, refills, and lab orders fall into services that are used often. Direct Primary Care takes this majority of healthcare, and caps the cost into an affordable, manageable, flat monthly fee, typically less than $90 per month. As a result, insurance use (and cost) is minimized to rare occurrences. “Employers can use Direct Primary Care to lower healthcare costs.”
How do employers make Direct Primary Care work for them?
Simply put, Direct Primary Care, plus an appropriate supplemental insurance plan, can save employers up to 40% on healthcare costs compared to the traditional insurance alternatives, yet stay in compliance with Affordable Care Act mandates. For self-insured companies, Direct Primary Care can control downstream catastrophic costs by providing high-access, quality care upstream, and can be inserted strategically as part of the total plan offering. There are numerous other advantages Direct Primary Care provides for employers – telemedicine to keep employees at work, reduction of unnecessary worker comp claims, active management of employee health conditions, and so much more.
In today’s new and unprecedented healthcare climate, it’s vital to know the latest healthcare models that could keep an employer’s costs down while increasing quality and coverage. Direct Primary Care is such a model, and smart employers are taking notice as they design employee benefits.
Direct Primary Care – a new force in American healthcare
There have been many attempts to “fix” the healthcare system. Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMHs), “value-based” reimbursement programs are such attempts to attain the elusive goal of the Triple Aim: better care, better health, better cost. Unfortunately, these efforts merely serve to help a system that is already broken. If a vehicle’s axle is broken and the wheels fall off, changing the oil or getting new tires does very little – the entire vehicle has to be replaced.
Direct Primary Care achieves the Triple Aim better than any other model in primary care. In terms of better care, outcomes from studies done in DPC practices outperform those of their insurance-dependent colleagues. Second, access to providers is enhanced by removing the barriers of co-pays and visit limits, yet adding same/next day visits along with telemedicine, improving community health. Finally, cost is lowered due to removal of unnecessary insurance from the primary care equation. Direct Primary Care, in fact, also solves for the fourth goal of the newer “Quadruple Aim”, that of physician satisfaction. After all, without primary care physicians, there is no healthcare system to fix.
Direct Primary Care is supported by the American Academy of Family Physicians, is included as a non-insurance healthcare model in the Affordable Care Act, and is in the legislation of more than a dozen states with practices approaching existence in all 50. The healthcare model is the fastest growing model in primary care today, outpacing PCMH and concierge medicine growth.
It’s time insurance was used for what it was meant – catastrophic events. In time, employees will be making two healthcare decisions: 1) who they will use for routine primary care, and 2) who they will use for insurance. It’s already happening with employers and employees nationwide.