Direct Primary Care
Open enrollment season is right around the corner and you may be making some important decisions for you, your family, or even your business. Here are some tips to think about when purchasing health insurance.
Whether you purchase your insurance through the state, government, employer or directly from vendors, this can be a daunting process. There are often many choices, with slight differences that are difficult to decipher. Beyond that, because price transparency is such an issue in healthcare, it is often hard to plan or budget for future costs when there is no way to find out how much these services actually cost! Below, I’ve tried to outline a couple tips while going through this process.
Nothing is free!!: Many patients get a large portion of their health insurance paid for by a third party (employer, government, etc). This creates the notion that health care is cheap or free in certain situations. Please remember that although you may not pay much in monthly premiums or out of pocket costs for your insurance, your employer is likely paying an exorbitant amount for health care services you may not even use. This cost has gone up considerably in the last few years
Understand premiums and deductibles: Just to review, a premium is the amount that you (or a third party) pay monthly for the privilege of being insured. The deductible is the total amount of out of pocket costs you and your family can incur during the year on top of the monthly premium you already pay. The lower your monthly premiums, the higher your out of pocket costs may be… though you still might save money this way! For instance, for a young family of 4 buying insurance from BCBS, the monthly premium for a $2,800 deductible plan is about $500 more a month than the $12,000 deductible plan… that’s $6,000 extra in monthly premiums over the course of the year!!! Why would anyone pay that much extra when good primary care can cover 85-90% of issues that will ever come up? Even the $2,800 deductible plan listed above leaves a family paying out of pocket for much of their costs in a year. Those costs are often inflated because of insurance and the amount is completely unknown to the patient prior to utilizing the service (try to think of another purchase you make where you do not know the cost prior to buying?!?).
So, if you have a relatively healthy family, ask yourself why you (or your employer) pay so much more in premiums for, what should be, cheap and comprehensive primary care services. And wouldn’t you want an affordable, budgetable, transparent monthly fee that will cover most everything that will come up during a given year including keeping you out of an expensive urgent care and or even worse, the emergency room.
- If you do have some chronic medical concerns, think about the specialists you are seeing and the different medications you're on. Is YOUR Primary Care Doctor putting all the pieces together?
- Is you current doctors taking your finances into consideration when prescribing and ordering expensive medications/tests without thinking about it?
- Is you current doctor part of a hospital system and only recommending specialists "in the system"?
- Does your doctor expedite changes in your treatment plan and save you trips to the office?
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Employers are often resigned to accept healthcare spending increases year after year, but via a local partnership with Texas Health Resources, Care ATC, and an innovative approach to health insurance, QuikTrip is bucking the trend.
In order to better provide for their employees and their families and save money along the way, QuikTrip processes and pays their own health insurance claims, effectively serving as their own insurance company.
There are several advantages for employers to make this move. They are able to easily access their employees claims information and design the health plan accordingly. They also have discounted direct contracts with hospital systems, including Texas Health Resources in North Texas (QuikTrip’s largest market in terms of stores), reducing costs along the way.
After connecting through a consultant, QuikTrip and THR entered a partnership to provide care. “The quality of our providers, our footprint and the size, and the results that we have demonstrated” were all factors, says THR Vice President of Strategic Growth Jay Beck.
“The ability of the employer to have better connectivity with the provider from the end user,” was essential, Beck says of the direct contract. “There has always been a wall out there.
”Using DPC means that employees are able to visit the clinic as much as they need without adding personal costs, which reduces the larger medical expenses down the line.
QuikTrip also saw the health claims side of their business as a way to keep their employees in the company as they gained more education and experience, essentially adding another industry to the business. “We have always had this mission to provide opportunities to grow and succeed,” says QuikTrip Benefits and Training Manager Brice Habeck.
The company contracts with CareATC direct primary care physicians in North Texas, and even has an onsite direct primary clinic at their headquarters in Tulsa. DPC clinics are incentivized to reduce costs while maintaining quality, as they receive a dollar amount per member per month, which moves incentives away from costly fee-for-service. They also distribute medication onsite in Tulsa at no cost to their employees. Using DPC means that employees are able to visit the clinic as much as they need without adding personal costs, which reduces the larger medical expenses down the line.
In addition to their primary care, QuikTrip utilized capitized arrangements with hospital systems for treatment that is beyond what a primary care physician can provide. This means that providers are paid a set amount for each employee for a period of time, whether the person utilizes healthcare every day or not at all. The arrangement incentives systems to manage the health in a more cost effective way, much like DPC for primary care.
What may be most surprising, is that employees at QuikTrip never see a hospital bill. The company pays all bills directly, and then employees pay the company back. Many of the bills are deducted from future paychecks in the case of larger expenses. Hospital systems have offered better discounts to QuikTrip, as they know they will get paid for the service right away, without battling insurance companies or waiting on patients to pay.
“The ability to collect prompt claims payments was very helpful,” Beck says. “As was the ability to promote our network and be the premier network in the QT member plan.”
While this all sounds ideal, the results are impressive as well. Over the past three years, employees have seen premiums go down, rather than the bending of the cost curve that most employers are hoping for. While they can’t control the cost of care, this model allows for flexibility and discounts that can help control how much the company and its employees pay for healthcare.
According to Habeck, the savings come from people getting care who are normally untreated. Annual physicals and the diagnoses that accompany them, as well as catching non-compliant employees, can reduce pricey visits to the emergency room or other hospitalizations down the line.
In addition, the company prioritizes communication with employees to make sure they are visiting the doctor frequently enough and maintaining their health.
QuikTrip keeps close tabs on their partnerships with providers and their narrow network, discussing at least quarterly how things can improve care and avoid high cost or low quality providers. Habeck sees their plan similar to what Kaiser Permanente has in California with a medical neighborhood, where you never really leave the neighborhood to keep costs down and quality high.
As self-funded employers pay more attention to their healthcare spending, Beck sees larger companies taking more of a role in the administration and payment of their claims. Amazon, Berkshire Hathaway, JP Morgan, and even the city of Fort Worth have made similar moves recently. “It allows for direct connectivity with the provider,”Beck says. “And that direct relationship is mission critical.”
For Habeck, QT’s benefits management line up with the culture of QuikTrip, which prioritizes integrity and serving its employees. Even when things aren’t perfect, the medical partners are able to take responsibility and make a change. “Every single person at the table has the confidence and humility to say I made a mistake,” he says. “It has been a huge step in accountability.”
Balanced Physician Care's complete solutions empower small employers to control health benefits costs, while providing Five-Star Primary Care that saves employees time and money as well.
If your company employs 5-300 people, you are in the sweet spot for a Balanced Physician Care Corporate Membership. Give us a call to schedule a FREE no obligation analysis to see if your business can save money, while taking advantage of better health benefits.
- Article from Florida Doctors Magazine, Spring 2019
For some direct care physicians, the idea of being available to patients around the clock may seem daunting. Who wants to be awakened every night in the middle of the night? However, most direct care physicians also find that they are able to develop a relationship with their patients that includes respect, boundaries, and established expectations.
The idea behind the direct care model is that patients pay a monthly fee and, in return, have access to basic primary care services during office hours as well as access to their physician after hours.
That is an enticement for both doctor and patient, that the patient interaction is not limited to a 10-15 minute visit during the day. The physician can spend more time during each visit, getting to know that patient more completely, and the patient feels free to ask follow-up questions and clarify instructions before and after the visit.
Direct care physicians have found that their patients do tend to respect their time and do not take advantage of their 24/7 availability, but it helps to establish expectations up front. Some direct care physicians will state that they are available by text or email – but not phone calls – between certain hours. They may also specify when it is appropriate to contact them after hours. For example, a question about scheduling or administrative issues must wait until office hours.
When the direct care physician offers 24/7 availability and the patient does call in the middle of the night, however, the physician should be responsive to continue that positive relationship. If the call went to voice mail, the physician should return the call. Likewise, a text or email should be answered promptly. Of course, all physicians direct their patients to call 911 when they have such emergency situations as a potential heart attack.
Balanced Physician Care Members appreciate the peace of mind of 24/7 care by our providers. Find out more at 904.930.4774
*Article written by Krystle Thornton | Elation Health - December 14, 2018
Direct Primary Care (DPC) challenges the very definition of healthcare in America.
More and more research has shown that DPC improves the access to and the quality of care, as well as reduces healthcare cost, mostly by reducing unnecessary healthcare utilization. Unnecessary healthcare utilization is a scourge: It is responsible for upwards of 10 percent of our nation’s healthcare bill. Certainly, the tests and procedures we perform in medicine saves lives, but unnecessary tests and procedures expose patients to unjustified risks.
In February 2016, I founded Balanced Physician Care to bring this emerging model of Direct Care to Northeast Florida. Since then, my love for my profession has returned. Having enough time to spend with each patient has invigorated my passion for medicine. I’m finally practicing medicine the way I always envisioned I could and should. I mention this because the joy I now feel in the practice of medicine is in fact what makes the Direct Primary Care model not just viable but essential.
Critics have argued that widespread adoption of the DPC model will only exacerbate the primary care physician shortage because by necessity it will significantly reduce the number of patients each physician sees. In the short run, this might indeed prove true. But unless a workable solution is found to reverse primary care physician dissatisfaction, a critical shortage is already inevitable. According to a survey conducted by the Urban Institute in 2012, 30 percent of primary care physicians between the ages of 35 to 49 and 53 percent of primary care physicians over the age of 50 want to quit medicine altogether.
Primary care physician patient panel sizes haven’t risen to their current levels of 2,500 to 4,000 patients because primary care physicians believe that these sizes are optimal for patient care. They’ve risen to these levels because insurance reimbursement for primary care hasn’t kept pace with the expense of running a practice, and primary care physicians have been forced to increase the number of patients they see to survive financially. This has resulted not only in poorer access to care, poorer quality of care and increased healthcare costs, but also in dramatically increased primary care physician dissatisfaction. What’s required is a new model that attracts physicians into primary care.
Personalized, quality healthcare is not possible when physicians are handing patient panels of over 4,000 or more in size. No matter how many wellness screenings are being performed. Direct Primary Care has been proven to bring quality, personalized medicine back. According to an article in the British Medical Journal in October 2013, patients of DPC practices enjoy 65 percent less ER visits, 35 percent less hospitalizations and 82 percent less urgent care visits.
Primary care — and with it, all of healthcare — is in crisis. Access to personalized care is limited, the quality of care is poor (despite spending more per capita on healthcare than any other country in the world), the life expectancy of U.S. citizens ranks only 26th out of the 36 member countries of the Organization for Economic Cooperation and Development and costs are spiraling out of control. Though many view the new model of Direct Primary Care with skepticism, derision and even fear, new models that ultimately prove successful are often initially greeted that way. But if we can challenge our fear, personally changing to a direct primary care model might just prove in the big picture to be the single most effective solution for the most significant problems facing American healthcare today and even more importantly, ensuring the health of the ones you love.
Optimize Your Health, Simplify Your Life,
Dr Sharyl Truty MD
Dr. Sharyl Truty is the physician-owner of a Direct Primary Care practice called Balanced Physician Care located in Ponte Vedra Beach, FL. She has been in practice as both a board-certified Family Medicine and a board-certified Sports Medicine physician for over 15 years. She has completed a fellowship in Integrative Medicine from the University of Arizona with Dr. Andrew Weil. She has practiced Acupuncture for over 12 years after having trained in China and completed the UCLA physician acupuncture certification. Dr.Truty is committed to finding the best solutions to help you live the best-balanced life possible.
Here are 7 reasons why Direct Primary Care health coverage should be incorporated into your employee benefits package:
It saves money. Direct Primary Care can provide substantial savings and improved cost controls for employers in managing overall health benefit expenses. The goal is to reduce utilization of the insurance plan at urgent care and emergency rooms. This approach typically saves employers double-digits over traditional group plans, while delivering a far better care experience. Also it can minimize employees’ out-of-pocket expenses and helps solve their avoidance of care for financial reasons – workers should not have to forgo healthcare because they don’t want to pay their co-pay, or their deductible is sky high.
It reduces absenteeism and presenteeism. By taking advantage of the proactive, preventative nature of direct primary care, employees stay active in the workforce and keep out of the hospital and urgent care clinics.
It’s convenient. Direct Primary Care provides employees convenient and unfettered access to their primary care physician—enjoying prompt appointments, exceptional care, and easy utilization. By having direct cell phone and email access to the doctor, employees no longer have to wait hours in a waiting room to interact with the doctor to answer a simple question, get a shot of support, or even a prescription refill.
It helps employers retain their best employees. As competition for talented employees intensifies in the coming years, small businesses will have to find ways to attract and keep good workers. So, providing quality health coverage is an important bargaining chip to give you the competitive edge for attracting and retaining talented employees.
It boosts employee engagement. Whatever an employer can do to improve morale—and quality health benefits do that—makes employees feel more positive about their work and their employer.
It heightens job satisfaction. Health benefits communicate to the employee a concern for their physical well-being and shows them a desire of their employer to invest in their total well-being, helping them achieve a better work/life balance.
It sets a good example. Placing value on healthcare in the workplace can energize workers to place importance on it at home as well. This is important for busy adults who have limited free time due to job and family commitments. But when an employer places a lot of emphasis on healthcare, that helps place emphasis at home too.
So before your next renewal, or if you’re interested in starting a health benefits program for your employees, let Balanced Physician Care provide you with a free, no obligation analysis of your current (or future) health benefits’ plan.
Many employers are converting their health insurance policies to high deductible, often with a deductible as high as $10,000 per person or family per year. For a family with members that have chronic illnesses, the costs of healthcare will be very substantial indeed at this level. Employees will arguably feel that their employer has walked away from them and saddled them with costs that they simply cannot bear. The company can partially offset the inherent anger this generates among its employees by paying the fee for a direct primary care practice. It is especially valuable for the individual with multiple chronic illnesses since quality primary care can mean much better health, many fewer tests, prescriptions, specialist referrals and hospitalizations. I suspect that employers will be the major reason for direct primary care membership/retainer-based practice growth in the coming years as they will essentially demand that level of service for their employees — and in so doing they will be reducing their company health care costs as a result of high quality primary care.
As a bonus service, we can potentially reduce your worker’s compensation costs by treating some worker injuries within our Balanced Physician Care plan, which reduces the overall costs of claims filed. Over time, lower claim costs could reduce your workers’ comp premium costs.
Optimize Your Health, Simplify Your Life,
Balanced Physician Care Membership
Give us a call at 904-930-4774 and we will setup a free, no obligation analysis of your current, or future health benefits program.
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Dr Sharyl Truty of Balanced Physician Care presents Direct Primary Care to the patrons of the Ponte Vedra Rotary