Hospitals Begin to Explore Direct Primary Care Plan Models

What’s new

As the primary care field continues to undergo rapid change and hospitals and health systems experiment with new business models to improve access, reduce costs and boost patient satisfaction, care delivery models are evolving. Some large employers — Apple, Intel, Amazon and others among them — have hired primary care providers and set up clinics inside the companies’ largest facilities. The employers see the model as a way to make care more convenient and minimize time lost to medical office visits while they measure the impact on health-benefit costs. Elsewhere, some companies, such as Boeing, have directly contracted with health systems to provide specialty episodic services to their employees.

And in a rapidly growing model known as direct primary care, physicians are setting up subscription-based care plans directly with patients. About 900 physician practices now participate in these plans, states the Direct Primary Care Coalition, which offers a mapping tool of these offices. The Centers for Medicare & Medicaid Services is exploring a DPC reimbursement model.

What’s Happening?

It’s too early to tell whether these ventures will yield the intended results, but some are now asking: Would providers benefit by experimenting with DPC programs for their own employees? Many health systems initially began modeling population health offerings with employees before rolling out larger-scale programs. Could the same approach provide a proof of concept for DPC?

Catholic Health Initiatives has been exploring this issue since last year on a small scale, and there have been positive early results, according to a report in HealthLeaders. CHI in 2017 launched its first DPC office in Omaha, Neb. The CHI Health Clinic began with one salaried doctor and an advanced practice registered nurse. Together, they cared for about 1,100 CHI Health employees in the first quarter of 2018 — a small percentage of the organization’s 20,000 beneficiaries but enough to begin gathering insights on whether the program is worth scaling up.

CHI Health CEO Cliff Robertson, M.D., told HealthLeaders that the DPC model frees primary care physicians to take a needs-driven approach to patient interactions rather than being driven by a reimbursement model. The employer or patient simply pays a monthly subscription fee directly to the practice. Employees pay no deductibles or co-pays for primary care visits. If they need specialty care, they can access the same coverage as their co-workers with PPO coverage. This eliminates the incentive to require patients to make an office visit, when a webcam, phone call or email would suffice. Robertson added that he believes DPC plans are the future of primary care.

Early returns show positive results for the program. First-quarter facility and specialist claims for those in the DPC plan were about 20 percent less than average costs for PPO members during the same period, and patient satisfaction scores were stronger than for traditional primary care settings.

4 Key Questions to Ask

For hospitals and health systems evaluating the DPC model, experts suggest asking these four important questions before deciding to participate:

1. How will you effectively capture, measure and interpret data from participants in these plans?
2. How will the compensation package and incentives for physicians in DPC plans differ from contracted or employed physicians?
3. How will DPC plans affect the affordability of care — for both patients and plan sponsors?
4. How will you engage participants in understanding the many facets of DPC plans?