Direct Primary Care Begins to Change the Mindset Behind Healthcare

 

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A new kind of doctor's office that doesn't take insurance and charges a monthly fee is 'popping up everywhere' — and that could change how we think about healthcare

Bryan Hill spent his career working as a pediatrician, teaching at a university, and working at a hospital. But in March 2016 he decided he no longer wanted a boss. Soon after, Hill learned about a different way to run a doctor's office. "It's the most fun I've ever had," Hill said. Now almost 18 months into his practice, he said, "I couldn't imagine practicing any way else." Hill's practice is something known as direct primary care. Instead of accepting insurance for routine visits and drugs, these practices charge a monthly membership fee that covers most of what the average patient needs, including visits and drugs at much lower prices. Hill is part of a small but fast-growing movement of pediatricians, family-medicine physicians, and internists opting for this different model. It's happening at a time when high-deductible health plans are on the rise.

A survey in September 2016 found 51% of workers had a plan that required them to pay up to $1,000 out of pocket for healthcare until insurance picks up most of the rest. That means consumers have a clearer picture of how much they're spending on healthcare just as they're having to pay more. At the same time, primary-care doctors in the traditional system are feeling the pressure under the typical fee-for-service model in which doctors are pressured to see more patients. The direct primary-care movement — in which practices are set up on a doctor-by-doctor basis — has been slowly but steadily growing over the past few years, adding about 170 practices in the past year despite some larger practices shutting down.

Direct primary care has the potential to simplify basic doctor visits, giving doctors time to focus just on the patient and care for them in ways they might not have had time for otherwise. But there are also concerns from insurers about what separating insurance from primary care will mean for people who still ultimately need insurance. Members of direct primary-care practices pay a monthly fee, which, depending on the practice, your age, and the number of family members you have on the plan, can run from $50 to $150. Included in that monthly fee are basic checkups, same-day or next-day appointments, and — a boon to patients — the ability to obtain medications and lab tests at or near wholesale prices.

Direct primary care also comes with near-constant access to a doctor — talking via FaceTime while the family is on vacation, or taking an emergency trip to the office to get stitches after a bad fall on a Saturday night. Because direct primary care doesn't take insurance, there are no copays and no costs beyond the monthly fee. Doctors can also take the time to keep in touch with patients in between visits to see how they're doing. Paul Thomas, whose practice in Detroit has grown from 50 members to 250 in the past year, will text his patients once a week working on long-term goals like losing weight, eating better, or quitting smoking. He'll check in with the patient, initiating a conversation and keeping the goal in their mind in a way that an infrequent visit to the doctor's office might not. The number of people in a particular practice who have insurance varies, according to the 17 direct primary-care practices Business Insider spoke to. At some practices, all but a handful had some form of insurance, while at others a little more than half didn't have insurance. To describe how coverage functions under direct primary care, doctors use the example of car insurance.

You don't use your car insurance for small transactions like oil changes, but it's there for you if you get in a car accident. Likewise, health-insurance plans — especially those with high deductibles — can be there if you require healthcare beyond just a standard checkup. While the number of direct primary-care practices is growing, it's not exploding in the same way a national chain might be able to. For the most part, doctors build their own practice, which keeps it local.

—businessinsider.com


Could These 3 Reasons Be Behind Your Failing Employee Engagement?

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Encouraging employee engagement with health benefits

In a competitive economy, a robust package of employee health benefits is one of the key elements that employers need to attract and to retain a skilled, experienced workforce. In fact, according to statistics gathered by Collective Health and Harris Poll, 78% of adults in the U.S. say healthcare benefits strongly factor into their decision on where to accept a job. However, once employees have these benefits, most do not take full advantage of the complete range of services and support available. Only 25% of employees questioned in one survey said they have used all the preventive care benefits offered by their employer.

Another survey, conducted by the American Psychological Association, found that only 33% of employees report participating in employer-provided health promotion programs. The failure to engage with and use the benefits available can have an especially significant impact when employees or their family members face serious or complex medical issues, such as a cancer diagnosis or recommendation for surgery. When employees don’t use the full spectrum of benefits available to them, such as second opinions and case management, the risk of poorer health outcomes and higher employer and employee healthcare costs increases, with more than $210 billion a year spent on inappropriate and unnecessary treatment according to an Institute of Medicine report. Several factors contribute to employees’ failure to use all the health benefits available to them:

Problems with the benefits selection process: Although the choice of benefits can have wide ranging effects on both physical and financial health, 77% of employees spend 60 minutes or less choosing benefits, while 46% spend 30 minutes or less on this important decision, according to an Aflac poll. Another survey noted the high stress levels associated with making benefit decisions, finding that 49% of employees say making benefits decisions is always stressful.

Not understanding the options: A survey by the International Foundation of Employee Benefits Plans found that approximately 80% of organizations reported that employees do not have a high level of understanding of their benefits. This lack of understanding comes at a financial cost. According to 42% of employees in the Aflac survey, the estimated cost of errors employees make understanding and choosing benefits can cost them up to $750 per year.

Complexity of benefits: When faced with multiple benefit providers and contact points, employees often do not know where to find the information they need to understand the benefits available to them and how to access them. As a result, employees fail to access the information, resources and support that can help them make informed medical decisions. This can have a negative impact on health outcomes and healthcare costs.

—benefitnews.com