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L C M E D S O C .O R G

to utilize these benefits, there is no need for pre-authorizations and there
are no denials of care although the patient may still use insurance for
ancillaries. The model works extremely well with HDHPs. It harkens
to the era of the major medical policies which covered catastrophic
medical conditions. DPC believes that primary care does not have to
be an insurable health cost. It should not bankrupt anyone and can
be done with attention, access and affordability. By focusing on these
three points, patients can stay healthier which in turns leads to less
down-stream health care costs. One analogy is that an individual's car
or homeowner's insurance does not cover routine maintenance such as
oil changes, tire rotations, or the need for common household care. But
if there is consistent maintenance, there can be less risk for major issues.
A frequently asked question is, "Doctor, how can you survive on those
fees?" By removing the third parties and the associated bureaucratic
burden from daily proceedings, office overhead drops, often by up to
40 percent. And because of less paperwork and a smaller patient panel
size, the staffing requirements are decreased.
Direct Primary care offices have seen a healthy influx of patients with
multiple chronic conditions. Quite often these patients have "fallen
through the cracks" and require more time, attention and coordination.
Alternatively, the less chronically ill also find value as DPC patients
with the knowledge that they will see the same physician(s), know
the staff, and have terrific access to appointments and after-hours
concerns through texting and email virtual visits, and be afforded
the value-added services of wholesale labs, imaging and medication.
There has been a growing national interest in the DPC model from
employer groups looking to lower the cost of healthcare for their
employees. Approximately 61% of covered workers are participating
in a self-funded plan according to the 2016 Employer Health Benefits
Survey from the Kaiser Family Foundation. Brokers may couple selffunded, or partially self-funded/level funded plans, with Direct Primary
Care. By adding DPC to these plans, it is possible to save thousands
on primary care services for employees. Additionally, the employees
obtain services that strive to keep them as healthy as possible.
One excellent example is from Union County, North Carolina. In
2015 there were 30 DPC physicians in the state. Union County decided
to offer DPC as an option to its workers as part of their health care
benefits while still offering a traditional health plan as the other option.
At the end of 2015, this public employer saved $1.28 million in health
care claims which amounted to $260.00 per employee per month in
the DPC group. Only 44% of Union County's employees subscribed to
the DPC option, utilizing a large-scale direct care company for services.
Total medical and prescription claims were analyzed in both groups.
The direct care company provided further analysis of the level of
chronic illness in the DPC group for Union County: 50 percent had
one chronic illness; 35 percent had multiple chronic illnesses; while
over 90 percent of 55 percent that were classified as "moderately to
severely chronically ill" had heavy engagement with their health care

provider. There was an average of three visits per year for patients with
more than one chronic condition and an average of more than five visits
per year for patients with more than three chronic conditions. Not only
did Union County's pilot with DPC prove savings, it proved savings with
access for the portion of patients who were chronically ill.
Direct Primary Care is an emerging model in the chaotic healthcare
landscape of the U.S. As patients become better health care consumers
and more acutely aware of cost, they are asking themselves, what are their
health care dollars buying them? More Americans are finding value for
an affordable monthly membership fee that costs less than a cable or cell
phone bill. Imagine the possibilities.

REFERENCES: › Health Costs › 2016 Employer Health
Benefits Survey

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FALL 2017 | Lehigh County Health & Medicine 15


Table of Contents for the Digital Edition of LCHM Fall 2017

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