By Samir Qamar CEO, MedLion – CEO, MedWand
MAY 16, 2016 – Direct Primary Care (DPC) is no longer a movement, it’s an industry. Supported by the Affordable Care Act (ACA) and the laws of at least a dozen states, DPC appears to be growing in popularity nationwide.
What is Direct Primary Care? Much like pre-World War II, DPC is when consumers pay for routine healthcare directly to the medical establishment, minimizing insurance use for catastrophes and specialty care. The cost to join a DPC practice is typically less than $100 per month, and covers both access and primary medical care services.
Elusive, however, is how DPC can be paired with various insurance plans. The following summarizes four insurance strategies that employers and insurance brokers/advisors can use to lower healthcare costs when making DPC a part of the benefits package:
1. DPC + HDHP
Perhaps the most common strategy among solo and regional DPC providers, DPC is paired with High Deductible Health Plans (HDHP). Doing so not only provides employees first-dollar coverage, but also reduces out-of-pocket costs. Without access to covered medical care below the deductible, employees avoid healthcare due to cost. DPC provides a solution.
2. DPC + MVP
A requirement of the Employer Mandate is to provide employees with a plan that meets “Minimum Value” (MVP), covering the employer against the dreaded Penalty B. Such plans can also be HDHP plans, and typically have higher deductibles and/or premiums if employee participation doesn’t meet minimum requirements of the insurance carrier. Adding a DPC plan to an MVP plan keeps the employer in compliance with Penalty B, yet adds additional first-dollar coverage that can be used for actual care.
3. DPC + Self Insured PlansLarger companies with bigger budgets can afford to “self insure”, although smaller companies are also beginning to join the ranks with robust protective reinsurance added to the plan. In essence, the company assumes and manages the insurance risk, which in turn necessitates effective risk management. DPC is an excellent tool in this case. By providing better access, telemedicine, and more intense primary care, frequency of costly downstream claims, unnecessary specialist referrals, and unneeded tests are lowered.
4. DPC + Limited Medical Plans
Limited Medical Plans and Indemnity Plans provide much less coverage than traditional insurance plans, but can be effective when augmented with various kinds of benefits. In this case, DPC is an excellent addition due to no co-pays, unlimited (or higher-limit) primary care visits, and high-quality care. Limited Medical Plans on their own typically partially cover a very limited number of doctor visits. The aforementioned examples of DPC-insurance pairing are merely summaries to spark the innovative employer’s mind and help brokers/advisors realize there are new, cost-effective solutions in existence. The strategies all require a thorough knowledge of employer benefits, the ACA requirements, employer objectives, and most of all, expertise in Direct Primary Care through companies like MedLion.