- Direct Primary Care Charges a Regular, Periodic Fee
- Direct Primary Care Does Not Bill Third-Parties on a Fee-For-Service Basis
- Direct Primary Care is Not Insurance
- Direct Primary Care Lowers the Cost of Care
- Direct Med Clinic Does Case Management of Workers’ Compensation
- Direct Primary Care Focuses on Preventive Care
- Direct Primary Care Increases Affordability
- Direct Primary Care Increases Accessibility
- Direct Med Clinic Personalizes Plans
- Direct Primary Care is Revolutionary
Patients and business owners are often confused about how Direct Primary Care, also known as DPC, differs from other models of healthcare, and how they can benefit. Some even think, the model is only for individuals and it will not suit their needs.
Contrary to this belief, DPC is a strong ally for companies for different reasons, and today we tell you why.
1. Direct Primary Care Charges a Regular, Periodic Fee with Your Membership
In Direct Primary Care, members are charged a regular membership fee that is usually monthly. In some DPC practices, this is the only charge to be seen. In other DPC practices, there may be a small charge for each office visit but this charge is always less than the monthly charge. At Direct Med Clinic, for example, the membership fee is only $79 per month which allows your employees to have unlimited access to a medical team, and free unlimited in-office visits to treat different health issues like lacerations.
Providing affordable and high-quality care for your employees can be a struggle, and this is without mentioning the complexity of the healthcare services in the traditional healthcare system. DPC makes it easy, convenient and customized, working around the needs of the employees, the employers, and the company.
For example, Direct Med Clinic can offer your employees individual and family plans, full membership, virtual care options, and even workers comp solutions. Direct Med Clinic is able to customize a plan that suits every company size, ranging from small to large, and includes ACA compliance.
2. Direct Primary Care Does Not Bill Third-Parties on a Fee-For-Service Basis
One of the main missions of Direct Primary Care is restoring the doctor-patient relationship and putting both at the center of the healthcare experience. This can translate to eliminating unnecessary third-party processes that make the care more expensive and complex.
Under traditional healthcare models, patients can be charged just for sitting in the waiting area before seeing their doctor. During hospital procedures in standard facilities, patients are even charged down to the minute. Every single procedure, exam, visit, or primary care service your employee gets will come with a price.
This is not the case with Direct Primary Care. On a membership basis, typically, patients only pay for the cost of supplies if an in-office procedure is involved, plus their regular, standard per-visit cost which is usually low (some clinics may charge $10-$20 per visit. In Direct Med Clinic the visits are free).
DPC and Direct Med Clinic charge a monthly fee and bills on a month-to-month cycle with a one-year term. This fee is invariable, and it will give your employees access to unlimited online and in-person visits for no extra fee, where multiple conditions can be treated.
3. Direct Primary Care is Not Insurance.
Direct Primary Care clinics do not require insurance for walk-in services or membership. Although insurance can still be combined with DPC, cash-based patients will never be turned away for not having insurance.
In traditional models of healthcare, special interest groups, including health insurance companies, financially benefit from a corporate model of healthcare. In many cases, the best interest of the employer comes second to financial gain. This is a delicate situation, and there are laws put in place to protect health insurance benefactors like the Consolidated Appropriations Act.
Since health insurance packages can be hard to understand, human resource directors often
seek help from independent health insurance brokers to guide and support them in their selection process. Unaware of the commissions and incentives some brokers receive by upselling higher premiums, they do not always choose the best option.
Dr. Moczygemba of Direct Med Clinic, however, believes that many benefits advisors who aren’t seeking commissions embedded within high-cost premiums work well with employers to find the best solution for their companies. “Employers, large or small, can still be accommodated with the help of knowledgeable brokers who strive to decrease the healthcare expenditure of their clients,” says Dr. Moczygemba. “Companies can save thousands when our DPC model is placed at the core of a benefits package by a knowledgeable broker who has the best interest of the employer at heart.”
4. Direct Primary Care Lowers the Cost of Care
One of the reasons why medical care is so expensive is because of the many parties and processes involved. As we mentioned above, DPC limits the participants in healthcare and focuses on the patient and the employer.
DPC can lower the cost in many areas and ways, one of them being access to discounted labs, medications, imaging, specialists, and urgent care visits.
Another example comes in the way of chronic disease management. Employees with chronic diseases or who are often in need of prescriptions for medications often benefit significantly from membership because of the unlimited number of visits they can make to the doctor without any extra charge.
And the third way is through lower claims. “We had a worker who came in by taxi with a laceration. He was stitched up with a splint and sent back to work the same day. This would typically generate a claim for an employer. In our model, there was no claim generated and the employer did not have to pay anything extra. If it’s possible, we try to get them to stay on the job but with modified work,” Chief Administrative Officer Deborah Maldonado, RN, BS, MHA says.
5. Direct Med Clinic Does Case Management of Workers’ Compensation
Wise employers recognize their employees as assets and want to keep them healthy and on the job. Employers are also mandated by the state to take care of injuries sustained on the job. Many employers struggle with workers’ compensation because when they send an injured worker to an occupational medicine clinic they are sending them into a system (fee-for-service) that is by nature looking for charges to bill the insurance carrier which increases the healthcare cost. High utilization drives up the work comp premiums and affects the experience modification rating (EMR). The EMR can literally affect the competitiveness of companies bidding for new jobs.
Direct Primary Care, by nature, uncouples treatment from the fee-for-service system and allows these often minor injuries to be handled on a pre-claim basis.
Just to give you an example, below are the 3 most common occupational injuries in 2020, and all of them can be treated at a DPC clinic, sometimes without extra-free, or with discounted exams and prescriptions.
Source: Bureau of Labor Statistics.
At Direct Med Clinic, by applying these concepts and combining them with Dr. Moczygemba’s experience in convenient access to virtual care, we are not only helping companies locally but all across the state with their work comp claims and EMR, while also providing quality care to employees.
6. Direct Primary Care Focuses on Preventative Care
Another main difference in Direct Primary Care is that DPC focuses on preventive care and health maintenance of the patient. DPC doctors are able to make a significant difference in bettering the population’s health for an employer by assisting with the health management of employees and decreasing claims in the future.
“With this kind of direct primary care relationship, we’re in a position to decrease not only the immediate cost of managing chronic disease but to also decrease the high cost of hospital claims in the future,” says Dr. Moczygemba.
Diabetes management and prevention are highly effective when doctors have greater access to managing the population’s health, and different clinics, including Direct Med Clinic, have found that members with chronic conditions go to the doctor more often with membership models and have their diseases managed better, ultimately lowering utilization.
A population with a high number of chronic diseases, including diabetes and hypertension, will have workers that need to be treated more often than workers who do not.
Chronic disease is a big problem in most states, but the prevalence in the state of Texas is worrying, as it ranks high in prevalence for diabetes (28,79%), Azlheimer’s/Dementia (12,62%), Chronic Kidney Disease (26,73%), and Arthritis (34,21%).
And this is the case for many areas in the state of Texas, including Bexar County which has a higher rate of certain chronic diseases than the rest of Texas that includes diabetes and heart disease, according to the Texas Department of State Health Services Center for Health Statistics. In 2014, 14.2% of Bexar County adults were diagnosed with type 1 or type 2 diabetes.
The preventive medicine approach through Direct Primary Care makes the doctor’s goal to keep patients out of the emergency room and hospital. Biometric screenings allow doctors to intercept and stave off serious health issues from occurring or growing worse with chronic disease management.
Since DPC clinics charge a regular periodic fee and patients, or members, pay a membership, doctors have more incentives for keeping individuals healthy rather than making a profit from their sickness. Members are kept out of the hospital and emergency room because patients are given treatment with continuity, having the same doctor who manages illnesses before they get out of control. Patients are kept healthy and do not need to rush to an emergency room or hospital when they have an accessible doctor.
7. Direct Primary Care Increases Affordability
The high cost of healthcare prevents people from seeking specialty, surgical, or, inpatient care in a timely fashion, and have less access to affordable medications. The rising out-of-pocket costs, co-payments, and deductibles in traditional insurance have increased dramatically, making even a regular doctor’s visit expensive for the average American.
As a result, uninsured employees sometimes visit community health centers and hospital emergency rooms as an alternative to healthcare access and to combat affordability issues, disrupting the continuity of care. Patients visiting the emergency department for treatable conditions by their primary care physician exacerbate the crisis in the US healthcare system. Emergency rooms are flooded and overcrowded, doctors spend even less time with patients, and Americans pay more money.
One of the main missions of Direct Primary Care is to increase the affordability to a doctor by giving back to Americans fair and affordable care. Members are not sent for duplicate tests by different healthcare professionals and redundant tests mandated by insurance companies when they have the same primary care provider and trips to the emergency room substantially decrease. At the same time, up-front prices are always the rule in DPC, for primary care services and specialists.
8. Direct Primary Care Increases Accessibility
Direct Primary Care allows for a closer patient-doctor relationship. Doctors become more accessible to their patients when they are not limited and controlled with time caps averaging 11 minutes per visit with patients.
Doctors are free from the constraints of large healthcare systems that dictate the way in which services are provided. In DPC, doctors are free to leverage technology and incorporate innovative tools such as virtual care into their practice.
Patients sometimes travel, have time constraints, or prefer to communicate virtually through text, video, or chat about their health. With HIPAA-compliant apps, such as Spruce, patients see that technology through text messages has the power to improve health outcomes and improve the availability of care. When members are referred to specialists, medical records and test results are not at risk of reaching doctors late for surgeries and appointments because doctors are accessible and communication is regular. The increase in accessibility leads to a stronger doctor-patient relationship where patients see continuous care and develop trust with their primary care physician whom they can see regularly.
9. Direct Med Clinic Personalizes Plans
Direct Med Clinic exemplifies its passion for direct care by offering customizable and ACA-compliant DPC plans for small and large employers, regardless of the employee population, in its clinic as well as onsite and virtual care options. The aim is to provide quality primary care, wellness, and prevention services on the spot allowing employees to return to work immediately and avoid many healthcare challenges.
Direct Med Clinic provides preventive services including biometric screenings, occupational health, annual physicals and check-ups, group education, personal wellness coaching, and diabetes management counseling. The risks are mitigated by creating personalized action plans for employees and providing disease management through Direct Med Clinic’s Health and Wellness Outreach programs.
With free, unlimited visits, onsite clinics, and 24/7 phone or virtual care technology, the clinic has changed utilization by decreasing expenditure, while also reducing health care costs, and providing care for employees.
10. Direct Primary Care is Revolutionary
The Direct Primary Care model part of the Free Market model, and endorsed by the AAFP, encourages healthcare practitioners to challenge the status quo by prioritizing the doctor-patient relationship and preventive care over profit-driven medicine.
Focusing on preventive care through Direct Primary Care makes the patient visit more efficient. It lowers health costs, and gives patients more time with doctors, adding quality and value to their patient experience. Direct Primary Care treatment contributes to better health outcomes. Preventive care encourages a continuous, ongoing relationship with the doctor, lower costs as there are no hidden fees or surprise bills, and enhanced patient experience, with the ability to contact your personal healthcare practitioners through HIPAA-compliant telemedicine tools. These are the primary characteristics of Direct Primary Care that make this truly a revolutionary healthcare model.
Bottom Line
Everything that we explained above is possible for every company under the DPC model. We have seen the outcomes and benefits in small employers with 1-5 employees, to mid-sized companies with +400 employees.
Everyone can benefit from DPC, and you can too. Contact our Doctor Program Liaison to learn more or sign up.
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