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Direct Primary Care

Direct Primary Care

Rapidly growing Direct Primary Care model offers personal attention

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We’ve all encountered obstacles to good health care from a system that sometimes seems determined to put roadblocks in our path.

“I’m sorry but the doctor has no appointments available until mid-March.” “Unfortunately we do not take your insurance.” “Yes, you are covered, but there are copays and you have not satisfied your deductible.”

That’s where Dr. Kyle Rickner and his colleagues at Primary Health Partners come in. As practitioners in the rapidly growing field known as Direct Primary Care (DPC), they offer a simple arrangement: patients pay a set fee each month and receive immediate, personalized primary health care services year-round, with their assigned physician available 24/7 by phone, text, email, or video, and with office appointments usually scheduled on a same-day basis.

It took Dr. Rickner some time, with a detour to a war zone, to devise this simple formula. A native of Kingfisher, Rickner attended Southern Nazarene University and then graduated from Case Western Reserve School of Medicine in Cleveland, Ohio. His residency training in family medicine was back home in Oklahoma, and he also served a stint as an Army physician attached to the 82nd Airborne Division.

“I reported to Fort Bragg on September 19, 2001, so I was among the first to be deployed to Afghanistan and later Iraq,” Dr. Rickner said. He served as battalion surgeon to troops on the front line of the war on terror.

After his service, Dr. Rickner practiced medicine in North Carolina for a time and then returned to Oklahoma City, where he was affiliated with a local health system.

“Initially there was some autonomy and flexibility, but that was eroding,” he said, noting that each year, especially as mandates for electronic health records took effect, government, insurance companies, and other regulatory powers, figuratively if not literally, barged into the examination room between the physician and the patient.

“The free market of medicine had eroded,” he said.

In the fall of 2014, Dr. Rickner and a colleague, Dr. Robert Lockwood, learned about the new but growing concept of Direct Primary Care (DPC).

DPC physicians were independent practitioners who charged patients a simple flat monthly fee. In return, they were available any time, as often as needed, at no additional cost. They also kept their patient load within set limits to assure that they had time for each patient interaction.

The DPC model would only work for primary care physicians—internists, family physicians, and perhaps pediatricians—who care for patients long term.

“It was just like the light bulb went on,” Dr. Rickner said. In January of 2016 he and Dr. Lockwood founded Primary Health Partners with two other staff members and his own daughter as office help.

Today Primary Health Partners employs 13 physicians, three other health practitioners, and allied office and nursing staff, all working in four locations in Edmond, Yukon, Moore, and northwest Oklahoma City. Patients can sign up at any time for a flat monthly fee of $79 for adults and $49 for children. They can expect same-day or next-day appointment availability and have several ways to communicate directly with their assigned doctor.

“That is the beginning and end of our revenue,” Dr. Rickner said. The organization has contracts with medical labs to make tests available at wholesale, and each clinic stocks several hundred common medications that can be filled as prescriptions, again at wholesale costs.

“We do encourage our patients to retain their health insurance, because we are a primary care practice,” he said. “They would need that should they have a major medical need we do not provide, like surgery.”

Dr. Rickner said Primary Health Partners patients don’t file insurance for office visits, but he said as the DPC concept grows and gains acceptance, he would expect insurers to begin covering part or all of the monthly DPC fee, because of its economic efficiency.

Say a patient covered by standard insurance has a fever and cough on a weekend and might be concerned about possible COVID exposure. One visit to a hospital emergency room or even an urgent care clinic could result in a bill to the insurance provider of many hundreds of dollars—enough to cover almost an entire year’s fee at Primary Health Partners. That medical need could have easily been met at no cost by the patient’s DPC physician.

That is why a growing share of the clinic’s enrollments now come from businesses that see a monthly enrollment fee for each employee as a cost-saving investment. Dr. Rickner said fully 40 percent of his memberships are employer-sponsored today.

Cultivating the Doctor-Patient Relationship

The greatest value, he said, is time—the extra time and attention the DPC practice model affords the doctor-patient relationship.

“In a standard primary care practice, a physician may have 2,000 or even 3,000 patients,” he said. That means most primary care doctors are hustling through 25 or even 30 office appointments per day, giving at most 15 minutes per patient.

“In that kind of environment the number of visits is inversely proportional to the quality of care,” he said. “We limit our patient panel to 600 to 800 per physician.” That allows his staff members to spend the necessary time with each patient.

Primary Health Partners patients can also email or text their physicians at any time through dedicated software.

“What we do,” Dr. Rickner said, “is bring common sense back to the chaos of medicine.” That, he added, brings “a high degree of personal satisfaction to the physician. I believe more young medical students will see primary care as a viable option under the DPC model.”

The Direct Primary Care model first surfaced in Seattle in the 1990s when two physicians there established practices that charged an annual fee for those in a limited patient base who wanted rapid and in-depth medical care. Later iterations of the concept included some that took partial or full payment from patient insurance plans, and others like Primary Health Partners that do not.

Direct Primary Care also has a national advocacy group, the Direct Primary Care Coalition, which did a study identifying 1,200 DPC practices nationwide serving more than 300,000 patients. Ninety-six percent of physicians joining DPC practices cited the opportunity to provide better medical care as a motivator, while 85 percent said they had too little time to spend with patients under the traditional practice model. Seventy-eight percent noted a desire to escape the paperwork burden associated with traditional fee-for-service practices.

According to a study by the American Association of Retired Persons (AARP), DPC grew by eight percent annually between 2015 and 2017. The Docwirenews website estimates that some 12,000 primary care physicians are involved in some form of DPC or concierge practice.

The field even has its own professional journal, Concierge Medicine Today, which was founded in 2007. Its pages carry many of the same articles one finds in most medical journals, like treatment trends in cardiac cases, but there are some striking differences. One recent issue suggested that DPC physicians should visit patients who are hospitalized under the care of a specialist since “when certainty is not an option, you can still offer the next best thing—your presence.” The article even suggests bringing along a gift basket, something one would rarely see in a journal devoted to surgeons or gastroenterologists.

The magazine has also noted that fully 33 percent of DPC physicians report zero wait times to see patients, while another 31 percent say their patients wait no more than five minutes—one of the primary attractions of the DPC system.

The AARP study also noted that while regular primary care physicians report spending an average of 15 minutes with patients, DPC doctors average 35 minutes. A 2014 survey of DPC patients showed that 90 percent were satisfied with their health care arrangement, compared with 67 percent who are treated by regular primary care doctors.

Balanced Physician Care is a Direct Primary Care practice located in Ponte Vedra Beach, FL (near Jacksonville, FL), according to a map maintained by the Direct Primary Care Coalition. Dr. Rickner said he expects DPC growth to continue and to accelerate as more patients and physicians become aware of its benefits.

 

article by MIKE BRAKE, Independent Journalist

Oklahoma Council of Public Affairs

Employer Healthcare

Top 5 Misunderstandings of Employer Sponsored Direct Primary Care

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Direct Primary Care (DPC) for employers is the practice of delivering high-quality, physician-led care through near-site, onsite or shared employer clinics that are independent of traditional fee-for-service (FFS) based insurance products. Compared to traditional FFS Primary Care, employers find that DPC offers their employees a personalized doctor-patient relationship, comprehensive preventive care, and lower costs.

As Direct Primary Care continues to transform the healthcare experience, there are a several misconceptions that many organizations perceive when they think about how DPC may or may not work for their employees.

To help, we’ll discuss the top 5 misunderstandings:

Keep in mind, the information provided within this post applies to Balanced Physician Care's DPC model and may not be applicable to other DPC types.

#1: DPC is a cost “in addition” to our current health insurance.

Specific to employer self-funded programs, the DPC investment is a redirection of once paid claims. Studies have documented a reduction in primary and specialty care claims as employees shift their healthcare consumption behavior. The convenient access combined with relationship-based care delivery also reduces long term care costs as well as urgent care and emergency room visits.

Therefore, DPC practices offer a better long-term healthcare investment with a focus on prevention vs. only treating patients after diagnosis.

 

#2: Employees are forced to change their Primary Care Provider (PCP).

Employees are not forced to switch their PCPs under the employer shared Direct Primary Care model. Organizations can offer DPC as a voluntary benefit that employees can choose to utilize. Recent studies show that up to 44% of Americans admit to “skipping the doctor”[1]. Direct Primary Care offers a convenient, preventive care solution that removes the common barriers discouraging employees from seeking care. Aside from convenience, the benefits of their voluntary participation in Direct Primary Care are innumerable.

DPC clinics offer members:

Personalized, preventive care
No insurance billing
Chronic condition management
No co-pays
Treatment of ailments and illness
Same day urgent appointments
Referrals to specialists, as needed
No wait times
Relaxed appointment length
24/7 Access to medical care
Exams, labs and testing
And more...

Do you have an exceptional relationship with your PCP? If so…keep it! Sadly, up to 80% do not.

 

#3: DPC requires insurance plan integration and/or can only be offered at renewal.

Employer shared DPC models most commonly provide services independent of insurance and the FFS model. Employers may offer membership access at any time and employees may join at their discretion.

In general, DPC replaces insurance based, FFS products with patient-centric, relationship-based care where interests are 100% aligned with the patient and employer. Typically, DPC models charge a membership fee that covers all or most primary care services.

Please note, some DPCs are structure differently, each with a different insurance relationship. For more information on the different structures we invite you to consult with a member of our team.

 

#4: Our company is geographically spread out so DPC will not work for us.

Healthcare delivery is unique by market. Insurance carrier, network, hospital system(s), plan structure, location and demographics are some of the elements impacting delivery. These bear the greatest impact on access and cost. It’s confusing and creates barriers to care.

Many employers choose to offer a DPC practice in locations where they have the most employees in an effort to make the greatest impact on the health of their workforce. Virtual access to the “company doctor” also provides convenient access for remote employees. Employees may join the DPC clinic throughout the year and, on average, 60 to 80% of employees will sign-up in the first 1-3 years.  

Our staff and doctor can even come to your work site on appointed days.  For instance, We can offer physicals on the last Friday of each month or bloodwork panels on the 2nd or 4th Tuesdays for your employees. The options for care can be molded.

 

#5: Every DPC is the same.

It’s very important to know that no two DPC practices are exactly alike. doctors, location, delivery, scope of care and pricing are components that will all vary from one DPC practice to the next. The key is to find the right Medical Doctor (MD) that focuses on the patient relationship and care needed for each individual employee. The Doctor should be a licensed, independent physician who is free of hospital/health system ownership bias (and not largely beholden to insurance or fee-for-service revenues). The success of the DPC clinic and the impact it has on your employees will all start with finding a great Doctor.

 

Next Steps:

The most critical piece is finding the best physician.

Summary of important considerations as your company looks to implement a DPC model:

– The “right” Doctor is critical

– Care delivery is unique by market (health systems, carriers, payers, geography etc…)

– Scope of services can vary by doctor, model and practice

– Insurance may still play a role depending on the model you choose

– Membership fee structures vary

Primary care is the lowest care investment with the greatest impact on the total cost of care.

Access to high quality medical care is paramount for your employees and the health of your organization. Balanced Physician Care creates the customized Direct Primary Care solution that you need to stay ahead of an ever-changing healthcare landscape and ensure that your employees and your bottom line are as healthy as can be.

Get started by:

Contacting our membership team at membership@balancedphysiciancare.com or 904-930-4774.

Health Cost Sharing

Medical Cost Sharing Guide for 2022

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The very concept for and purpose of insurance is to protect one against unpredictable and large expenses, such as damage to your vehicle from an accident, or to your home from a hurricane. In health care where there is virtually no transparency, most health care costs are purposedly unknown, falsely creating a need for insurance for even routine care. Charges are frequently inflated, and “discounts” off these inflated charges by health care facilities are advertised by insurance companies as evidence that they are working on your behalf to get your value and savings for your insurance plan.

The Direct Primary Care (DPC) memberhsip model absolves the need for insurance for non-emergency care, from physician consultations to ancillary services, such as laboratory and radiology services. All costs are transparent, affordable and predictable with the all-inclusive monthly membership. Various private surgical groups are now publishing all-inclusive non-emergency surgical procedures so insurance is even not needed for them.

The DPC model allows members to purchase insurance or other plans purely for catastrophic needs at a much lower cost by forgoing inclusion of routine care in their plans. Unless you have chronic medical conditions that truly require the care of a specialist physician and expensive medications (about 15% of you), a health cost sharing plan may be just what you need. These programs dovetail with a DPC membership perfectly, at a combined cost that is usually half of traditional insurance offerings.

We hope this updated version will guide you to a solution to your health care needs.
Health cost sharing
Health Cost Sharing
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The Trends in DPC 2022

The Trends Propelling Direct Primary Care Into The Future

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The Hint Health Data Analytics team compiled data from over 3,500 Direct Primary Care clinicians and their 800,000 members into the 2022 DPC Trends Report to better understand how the Direct Primary Care movement has grown and changed over time.

Click to view report

What's in the report?

DATA. STATS. FIGURES.

  • Key takeaways
  • Growth metrics
  • Employer insights
  • Demographic details
  • Membership pricing
  • Regulatory updates

Why the Hint DPC Trends Report?

While both the supply of DPC clinicians and demand from patient members continues to grow year over year, relatively little data-driven evidence is publicly available to confirm this and provide insights into the DPC market. As a result, 68% of consumers surveyed in the 2021 Hint Health DPC Consumer Insight Survey had not heard of DPC. This report compiles available evidence to better capture the true impact and potential of DPC. 

Direct Primary Care

Direct Primary Care – Pandemic Tested. A Case Study

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Lee S. Gross MD speaks at the AAPS COVID Summit 2/11/2022, Venice, FL on the DeSoto Memorial Hospital and Direct Primary Care case study

Direct Primary Care Explained Header

Direct Primary Care Explained to Employers

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Direct primary care (DPC) is a solution many progressive companies are implementing to help save money on healthcare costs, while enhancing their benefits package for employees. Although the DPC model has been around for some time, many employers are just beginning to learn about its benefits.

Infographic Direct Primary Care Explained for Employers

Balanced Physician Care offers businesses membership plans for your employees.  To learn more, visit www.HealthcareforJax.com or call our membership specialist, Darren at 904-930-4774.

 

customize an employee health plan

A Better Way for Employers

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It's Open Enrollment season. Providing health benefits for employees is one of the highest expenditures for an employer. With such a significant amount of revenue devoted to keeping staff healthy, employers look to brokers for solutions that support their workforce while also helping their business remain profitable. As the costs of health care continue to escalate, employers and their workers are facing unprecedented challenges.

As businesses pass expenses onto employees, the skyrocketing costs of prescriptions, rising copays, and unattainable insurance deductibles have left many employees feeling neglected. It’s abundantly clear that traditional health plan offerings like high deductible health plans (HDHPs) aren’t enough on their own. A large segment of the population needs health care options that are more affordable and easily accessible.

Employers don’t know how to provide more cost-effective benefits for staff without taking a bigger hit to their bottom line. But by partnering with organizations that offer non-traditional benefits solutions, expert brokers and health care organizations can address clients’ needs for better care while also mitigating costs.

There are innovative ways to create customized plans that are utilized in the staffing service sector and within employer groups such as the three below, where fully-featured health plans aren’t offered.

A better way

Direct primary care (DPC) has taken the stage as an affordable and more accessible non-traditional health care alternative. Unlike traditional health insurance products, members pay a low monthly fee for unlimited primary care access and there are no premiums or deductibles to meet. There are also no claims for doctors to file or limits to the time they can spend with patients to meet insurance requirements.

DPC can help lower the cost of health plans by mitigating claims. Still, discerning brokers have learned the power of pairing direct primary care with other benefits to make an even more significant impact on health plans. Let’s examine some of these powerful benefit partnerships.

Limited benefit indemnity plans

One powerful ally to a direct primary care plan is an indemnity health insurance plan. This limited benefit plan pays a fixed benefit amount per day to help people cover the cost of standard medical services. Some even provide access to a national PPO discount network to help minimize out-of-pocket expenses.

This benefit is attractive to employees because it can cover services such as hospitalization, surgery, anesthesia, accidents, and other big-ticket items. They can still utilize their DPC membership for unlimited visits to a primary care provider, virtual care, and prescription discounts. Plus, they get the bonus of knowing there’s additional coverage from the indemnity plan if there’s an accident.

Employers like this partnership because it can help them attract and retain talent for a lower cost. They can offer primary quality health care at a minimal cost, and the plan requires minimal administration on their part. These products are also relatively easy to find and implement, as there are already bundles on the market. Check with your direct primary care source to see if they have any DPC/indemnity products available.

Skinny medical plans

Skinny medical plans are group plans that usually cover non-catastrophic health events. These plans can include routine preventive care and wellness benefits. Minimum essential coverage (MEC) plans also fall under this category.

Although far from comprehensive, these plans may appeal to young, healthy consumers because of their lower premiums. Unfortunately, these plans sometimes limit people with preexisting conditions. That’s where pairing them with a direct primary membership can be extremely helpful. Most DPC memberships include maintenance of chronic diseases within manageable ranges, including those with preexisting conditions.

These plans are attractive to companies that employ low-skill workers with high turnover rates. Restaurants, retail operators, hotels, and other hospitality companies can benefit from combining direct primary care with a MEC or another skinny plan.

Hospital indemnity plans

Even a minor trip to the hospital can be a major financial setback for some. HDHPs offer coverage, but the average family often struggles to meet high deductibles in today’s economic climate. Paying a large portion out of pocket for hospital stays can add more hardship to an already stressful situation.

Hospital indemnity plans offer benefits for things like hospital admission, intensive care, and emergency room treatments. There are no deductibles to meet, and employees can also cover their spouses and children under these plans.

By pairing a hospital indemnity plan with a DPC membership, employees can get day-to-day health care for themselves and their dependents for little to no out-of-pocket costs. By utilizing unlimited primary care, people can also catch disease states and other acute conditions before they escalate to the point of requiring a hospital stay. In an emergency, having the added hospital indemnity can provide peace of mind for families already living paycheck to paycheck.

High deductible health plans/self-funding

Companies of all sizes have adopted high deductible health plans (HDHP) as a strategy to reduce the costs of providing health care. A great way to lessen the blow of an HDHP is to insert direct primary care.  Others are looking to self-funding/level-funding options coupled with DPC to deflect claims and limit their overall premium expense.

With DPC, employees get day-to-day benefits for routine care. When employees use their DPC membership for primary and preventive care before engaging their HDHP or self-funded plan, they can minimize their out-of-pocket costs and avoid meeting costly deductibles for primary care. It’s also a win for the employer, because the fewer employees that use the health plan for routine care, the fewer insurance claims the employer must pay. Minimizing the cost of primary care for staff and lowering employers’ claims expenses make DPC an ideal partner.

Medical Cost Sharing

Medical cost-sharing plans are sometimes called healthcare ministries. They are not run by insurance companies; they are run by nonprofit organizations. Members pay a set amount into a group fund every month. When a member gets a large medical bill, the fund pays some or all of that bill. Plan guidelines spell out which expenses are shareable.

Before the plan pays out, though, the member must cover some of the cost first. This amount, called the member’s “personal responsibility” or “annual household portion,” works just like a deductible does for health insurance. 

People choose these plans instead of health insurance because the monthly charges are usually lower. To control costs, some plans urge members to to join a direct primary care practice. 

Times have already changed

Providing equitable and easily accessible health care for employees is no longer optional. Businesses are facing unprecedented challenges to recruit and retain quality talent. In addition to better pay, better benefits will be a determining factor to differentiate one employer from another. As a result, organizations focus on strategies that will help them stand out to candidates without exhausting their resources.

Now more than ever, it’s imperative for brokers to customize solutions for clients. Brokers who lack the savvy to build more cost-effective and robust health plans will lose to their more innovative competitors. Direct primary care is one of many non-traditional benefits that can add value to any health plan. It’s essential to educate yourself on the new options available in the health care marketplace so you don’t get left behind.

Creating custom solutions for clients is easier than you think. There are many options and product bundles available if brokers take the time to look. By expanding the resources available to employers, brokers can foster a partnership in which employers and their employees feel a greater sense of satisfaction with their benefit offerings. Working productively and strategically to offer more, while remaining cost-efficient, strengthens the entire health plan and, hopefully, the organization.

 

portion of this article from "Partnering on customizable benefit solutions yields powerful results" from Andy Bonner of Healthcare2u

Family Health Plan

More families abandoning health insurance for monthly medical memberships

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With health care costs on the rise, a growing number of Americans are throwing out the old way of seeing a doctor and turning to a membership model. A monthly or annual fee gets you direct access to a doctor, no insurance needed.

This concept called Direct Primary Care (DPC) simplifies health care delivery, taking the focus away from visit volume and reimbursement, and allowing doctors to focus on patients and their needs. When reimbursement is not tied to individual visits, patients and physicians are free to have as much contact as required, whether in-person or virtual. Problems can be followed and resolved in real time instead of fragmented, spaced-out visits.

Physicians become invested in people, and patients learn to trust their physician again. This translates into significantly decreased ER and urgent care visits, decreased hospitalizations, increased patient satisfaction, and increased physician well-being, as found in a recent study done through Milliman by the Society of Actuaries and attested to by the hundreds of physicians already in DPC practices.

Using the DPC monthly membership model, physicians can decide how much time and attention their patients need without the onus of check boxes and insurance-based decision making. Each patient and the context of his or her ailments can be evaluated and treated on an individual basis:

■ The single mother whose child is sick with pneumonia can come to the clinic, receive a diagnosis, and get access to antibiotics without even having to stop at the pharmacy.

■ The 80-year-old patient who needs more time to move from the waiting room to patient room can now be seen and heard without the rush.

■ The 40-year-old with a broken ankle can get an x-ray, pay only $35 for that image, get a boot ordered from Amazon, and see a physical therapist on a cash basis, all for a fraction of what insurance would charge.

Patients can meet with the DPC doctor at the clinic or consult with him or her through email. Healthcare happens outside the office as well as inside, and patients with quick questions can simply avoid the drive to the office and speak to their DPC doctor on the phone or even email them.

Patient satisfaction, therefore, is fostered through convenience, instant-access to care, and safe discussion. Furthermore, with Direct Primary Care, physicians can realize efficacy and find purpose in their day-to-day interactions with patients, trusting that patient satisfaction will be the natural outcome.

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. Dr. Truty is committed to finding the best solutions to help you live the best-balanced life possible.

Doctor Google

Paging Doctor Google

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You may think Doctor Google is great.  You maybe in a pinch. No one is available to answer your medical question.  You just can’t wait until Monday at 9am to call the office. If you could wait, you know you’ll be put on hold and won’t get a call back for hours - if you’re lucky.  You know if you do get a call back, it will likely not be from YOUR doctor. So, why not just Google it?
You may think Dr Google is great when you’re in a pinch and need a quick answer.  But, despite what many people think, Dr Google isn't as good as a real doctor.  You’re twice as likely to get the real diagnosis when you talk to your doctor versus when you Google.  That means, many times Google searches will bring up all kinda crazy answers that are definitely wrong. These things might be scary (creating more anxiety instead of calming your fears), inaccurate (causing you to start a treatment that is incorrect and may have side effects that you don’t need), or miss the real cause (leading you to falsely believe you are fine, when you have something more serious happening). 

All that being said, we get why patients don’t see the doctor.  In this world of quick technology and easy answers, it’s tempting to go the Google route.  But, what if you COULD have a doctor who is available to answer your question. What if she WAS available before Monday at 9am?  What if he COULD call you back instead of one of his colleagues? What if it DIDN’T TAKE HOURS to hear back? Would you still Google?

While the answer for some of you may still be a vote for Dr. Google, we’re certain many others would prefer the expertise of a Board Certified Physician!  To each, his/her own - BUT if you’d rather have the opinion of YOUR doctor right at the tip of your fingers, give Balanced Physician Care a try and find out why patients love the 24/7/365 access and connection to their Primary Care Doctor!

Balanced Physician Care is a Direct Primary Care practice located in Ponte Vedra Beach, Florida and serving all of Jacksonville's First Coast. Our physician-owner is Sharyl Truty MD. Visit BalancedPhysicianCare.com/membership for more information on how to become a member.

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