Direct Primary Care: A New Concierge Model in St. Louis

[Music] you're listening to be Health connected a podcast by the St Louis area Business Health Coalition your host for today's episode is Lauren rspeer bhc senior director of member engagement and Communications hello this is Lauren REM specker and thank you for listening to another episode of the BC's be Health connected podcast today we will be focusing on the topic of primary care evidence shows that having a primary care doctor can produce high value results including better patient outcomes fewer inequities and lower overall costs but despite these benefits Primary Care investment remains lagging in the United States leading to lower numbers of Family Medicine Physicians andal internists compared to other Medical Specialties in light of this PCP shortage employers are seeking out Innovative strategies to improve Primary Care access for their workforces including preventive care disease management and treatment of acute injuries and illnesses here to discuss a new model of concierge direct Primary Care in St Louis are Dr Jeffrey Davis board certified emergency medicine physician and Dr Erica yelavarthy board certified Family Medicine physician thank you both for joining me today thank you for having us now I wanted to start today's conversation by looking at the current approach to Healthcare in the United States and as evidenced by my introductory remarks there are currently some problems uh can you go through what you see as maybe some of the gaps in how we're currently approaching healthare in the US sure uh so as you mentioned many Americans don't have the most important Health Care resource resource which is a fast and easy access to a primary care doctor who is a trusted position partner that knows them primary care is not valued in this country and as you just mentioned Primary Care is proven to improve health and populations increase life expectancy and decreas increas the total cost of Health Care Primary Care access is bad and it's getting worse the average patient panel size for a primary care physician is 2 to 3,000 patients this leads to an average delay to get an appointment with their doctor of about two months a recent study from the US Department of Health and Human Services showed that almost 7 million Americans lost their Primary Care access between 2002 and 2015 patients can't get access to a doctor so they T end up taking one of two actions they either ignore their medical problem and that often leads with terrible and expensive outcomes later on or they self-refer to an urgent care emergency room or to an expensive specialist another problem we see in Primary Care is that the current payment models do not support the critical role of primary care fee for service payment doesn't work for Primary Care care because it only rewards billable procedure volume so talking to patients and educating them about medical options is not reimbursed phone text email and video visits are not reimbursed like in-person visits and as a result doctors must expand their practice as I mentioned before to thousands of patients and then their visits become extremely short because primary care doctors need to see more patients each day to produce Revenue primary care doctors just don't have time to solve problems due to the constraints we just talked about so they end up seeing the patient for a short time and then ordering tests such as labs and imaging and sending patient for specialist referrals all leading to overall increased health care cost so if they just had more time with the patient appropriate testing could be accomplished oftentimes as well a patient will need to make a separate appointment to take care of their problems because the doctor just doesn't have time to handle them all in one short visit another thing is that primary care doctors are overwhelmed and getting burnt out working after hours to catch up on charting phone calls and paperwork because there's just not enough time to do this during patient care hours as a result we're seeing less doctors go into primary care which we're going to see a primary care shortage here soon Jeffrey do you have anything to add yeah thanks um so a few more things first is that health insurance is really expensive and it's getting more expensive every year but it doesn't improve health care access or customer value and we've seen that the cost of healthcare insurance is increasing year-over-year and is unsustainable and it's destroying businesses and it's ruining finances for families across the country um average premiums have increased over 19% since 2014 which is more than three times the rate of inflation and health care expense is often the number two or number three line item expense for a business which is remarkable um we've also seen that as companies are trying to stay afloat because of the cost of health care they're cost shifting to employees and so the employee share of cost is going up we've seen middle class family spending on healthc care has gone up by 25% since 2007 and at the same time spending on basic needs like clothing and food are going down uh because it's more and more expensive uh we've seen that 75% of medical bankruptcies in this country are from people that are covered by insurance which is amazing because the average deductible is $5,000 and 70% of households in the US have less than ,000 do in savings so these people are functionally uninsured even though they have coverage and so what you see is people rationing their care because of cost and so even insured employees are sicker over time we also know that less than half of small businesses even offer health benefits to employees because it's just too expensive the next problem is that patients don't choose Healthcare Services based on good data about quality and cost health care like everyone knows isn't measured or priced like other businesses and that's terrible for consumers um all of these health care companies are competing for patients and procedures and referrals but there's no transparent pricing so patients and employers have no idea what their supposed to be paying for services like surgeries or medications or lab tests and different people pay completely different prices for the same products and services which is crazy and consumers basically have no way to compare doctors or Hospitals number one prices are secret and we've seen a lot of uh discussion about that in the media and even when prices are published they're frequently meaningless like seeing a hospital charge Master there's no way to understand what that means in terms of what you might pay for for individual service and quality data are also either secret or they're published but uninterpretable um so it's a really difficult market for people to go out and try and purchase Healthcare Services I think this really sets a great foundation for today's discussion obviously there are many problems with the way that we're currently managing the system and it brings us to thinking about is there a better way to deliver care and in many cases pay for care so when we think about this concierge sort of direct Primary Care model can you talk a little bit about uh how this differs from traditional Primary Care um including the delivery and the cost yeah so first of all let me say that direct Primary Care is awesome and uh that's the reason that I chose to go this route and practice medicine in this way and it's so refreshing um first of all let me just tell you a little bit about what is direct primary care direct primary care means direct Contracting for medical services without third-party insurance billing so patients will pay a low monthly fee to be become a member of Link primary care which is our business they get concierge level service with fast and easy access to a full service primary care physician many people think that direct Primary Care is going to be more expensive but it is actually designed to save patients money and lower overall health care costs link Primary Care is much less expensive than other conier practices there's no insurance billing and our prices are all posted and transparent it's different link Primary Care is different than traditional primary care and that we have smaller physician practices so I have about an 80% reduction in my patient panel size so I can really get to know every patient patients have fast and easy access they can get seen the same day um or the next day or when they want to be seen we offer phone text email and video options for visits or for questions so patients can call me or they can text me directly and they actually get to talk to their physician they don't have to wait on hold or they don't have to wait all day for a call back after they've left a message at their doctor's office at link primary care we also offer long physician visits ranging from 30 to 90 minutes so patients can get all their concerns covered in one visit with appropriate treatment and like I said before it saves money the monthly membership covers all visits calls text and procedures such as biopsies cryotherapy laceration repair our whole goal is to keep Patients Out of the Urgent Care and out of the emergency room we also offer wholesale medications that we actually dispense in our office that are much cheaper than patients can get at the pharmacy and we can also save patients money on labs and imaging that we get much cheaper than they can even get with our insurance so at link primary care we have no Financial incentive to order inappropriate tests or do inappropriate referrals we only do what the patient actually needs and like I said we offer that price transparency so you know exactly what you're paying for I can tell a patient up front before we even draw all their blood um or Draw their labs in the office how much their labs are going to cost them obviously a lot that's included in the type of model that you've developed here um but what is perhaps not included in that can you talk a little bit about some of the services that might not be covered sure so I think the most important first point is that direct Primary Care is not Insurance uh that is a different kind of a product so link Primary Care membership doesn't meet an ACA mandate for coverage uh it doesn't cover the cost of hospitalization or for surgery or specialist doctors that our patients might need to see and there are separate costs uh like arog is just alluding to for medications for non-routine labs or for Imaging tests um so for patients that can afford it we recommend keeping a high deductible or a catastrophic insurance policy to cover those really high expenses for unexpected severe medical illness or trauma so if you have a heart attack or you have a bad car accident you have to be admitted the hospital the membership for our uh business isn't going to cover those costs and many DPC members have insurance either services like Medicare or other purchase policies thank you for clarifying I think that's really helpful to think in the scope of how people are receiving care um what considerations they might want to take when looking at this particular kind of model now you know Dr yavari mentioned many of the advantages of having this type of a primary care relationship uh could you maybe elaborate on some of the positive outcomes that can come from a direct Primary Care model sure so a lot of them we we've kind of already touched on um but uh you know basically direct Primary Care lowers the cost of Health Care the total cost of Health Care is decreased by about 5 to 20% direct Primary Care also lowers the rates of emergency room and Urgent Care use by about 50 to 90% decreases specialist referrals by about 15% and decreases hospitalization rates by about 8% we also see better health outcomes so as Physicians we have um you know certain targets that we want to meet for patients with diabetes and high blood pressure and depression and and other illnesses and we're seeing better uh Health outcomes and Better Health Care delivery just because we're getting to spend more time with patients as is one of the reasons we're seeing happier patients uh there's a consistently High net promoter scores of 95 to 97% and employees are healthier they're happier they're engaged productive and they're more likely to stay with their company if direct Primary Care is something that their employer offers for them they have less time off work and fewer sick days um just an example of like a positive outcome from direct Primary Care is just this week I had a family call me because their child um fell and had a scalp laceration it was after hours um you know dinner time and the office our office was closed but wasn't a big deal because they just call me I met them at the office I was able to um provide care for him fix his laceration in 30 minutes they were on their way I was on my way they were happy they didn't have to go to the emergency room or urgent care which with a traditional Primary Care office they would have had to do and they would have ended up spending so much money for that and with direct Primary Care they had no cost it was all included in their monthly membership that's really impressive um to hear about that responsiveness and I think you're right you know beyond even just the uh direct Financial outcomes and and the physical outcomes that can come for disease management that patient experience is just so critical in making sure that people stay engaged in their primary care so I can see why this would be a really attractive model for an employer to consider um can you talk a little bit about you know if an organization is trying to decide if direct Primary Care is a good model for their population uh what types of things should they be asking themselves well I think there are a couple things the first is for them to look and see how they feel about their healthare spend uh probably most importantly like we said uh health care costs can be a really high line item on the p&l and it's generally for businesses getting worse year-over-year and I would want to tell businesses that there are great Solutions available in the market today we don't need new technology solutions to disrupt the current system uh these these kind of uh models exist in our Market um but they really need to think about the value of their current offerings in their company U which brings me to my second point which is really to think about how the health and wellness of their employees affects their company's performance not only in terms of the goods or services they produce but in their financials um and there's good outcomes data that employers that use direct Primary Care have a competitive advantage in the marketplace for a couple of reasons the first is because they have an advantage in hiring and retention because these are really valuable benefits and their employees number one are better taken care of from a health perspective but number two they feel better taken care of by their employer and we know that employees that have DPC are happier and more productive and they have lower rates of absenteeism and there's less turnover which is huge for businesses um the third point I would say is that companies really need to think about how they currently pay for healthare uh for their employees and there are really three buckets um the first are a lot of companies like we talked about that don't offer any coverage because it's too expensive but they're thinking about getting into that business and they're trying to understand how to have an offering with controlled costs and the second bucket are companies that are fully insured which means that they're generally experiencing increasing premiums but they don't really know what's going on they don't have line of sight to their claims so they know they're spending more money but they don't really know where and they can't tell how to fix it um and the third bucket is for self-insured businesses or businesses considering a transition to self-insured status and one of the big Health Care myths about self-insured is that you have to be a big company for that to make sense you have to have a 500 lives or a thousand employees and it's simply not true there are plenty of self-insured companies that have a handful of employees five or 10 or 50 um and and what's key about that model is that you have complete control over plan design you have transparent and aligned partner relationships but most importantly you have line of sight to claims so you understand your costs which gives you an opportunity to understand how to control them looking at your current employer clients I would be curious to understand how they're currently incorporating direct Primary Care into their benefit plan design or their insurance offerings for employees yeah so there are several ways that uh companies can incorporate our services so the first is to basically offer direct Primary Care as a standalone option without any other health care coverage and like we said these are generally costeffective ways for employers that haven't offered any benefits to date to basically cover 90% of the healthcare needs of their employees and their employees families with minimal expense so that the first option the second is to create an Integrated Health Plan with direct Primary Care at the center and a lot of companies this transition looks like offering two similar Health Plans they'll have options for employees so for example it might be a high deductible Health a high deductible health plan with a PO and maybe the same high deductible Health Plan Plus link Primary Care what's interesting is that direct primary care plans are less expensive and they offer better benefits than typical plans because third party administrators already know about the savings that we were talking about from direct Primary Care they understand that claims costs are lower and so they can embed those savings and pass them along to their clients and so see we see a lot of employers who then gain share with employees so the costs of care from employees are less and then the benefits that they see Downstream they can share with their employees and also actually with the communities that they serve I mean a great example of this is Rosen hotels uh which is uh operates hotels they have eight hotels in the Orlando area and for the last 20 years they've been using direct Primary Care to re-engineer their health care benefits for their employees and they spend 50% less per capita than the average employer in Orlando and they have much lower rates of turnover even in the populations of their employees where you generally see really high turnover rates um and so they're charging much less to their employees to get this great coverage and one of the things they've done with all the money they've saved from their health care spend is to reinvest in the community so the Tangelo Park program from Rosen started in 1993 and basically the goal of that was to use education initiatives as a way to turn around an underserved Community where they have their hotels uh they guarantee free preschool education for every child in tangel Park they offer full college and vocational school scholarships including room and board for every graduating high school senior and what they've seen in outcomes for that Community are astounding so crime has gone down by 63% and high school graduation rates went from 45% to basically 100% and college graduation rates are 70 70% above the national average so what we see is that companies that start using um new and Innovative Delivery Systems to save money on their healthare can give that back to either their employees or also to their communities in ways that are really beneficial not just for the firm but for the entire Community I love that message and I think you know it really hits upon a theme that we talk a lot about at the business Health Coalition uh the sense that with the limited resources that we have uh as communities if we find a way to deliver care more effectively efficiently uh at a lower cost it really does enable us to put those investments into other areas that can help us to advance uh whether that be economically or from a population level so thank you so much for offering that example now we also know that in looking at Health Care uh we're constantly changing uh there always seems to be new things on the horizon so I just wonder uh what you see as the future for direct primary care how is that going to evolve moving forward I think direct Primary Care is going to really take off in the future uh patients want and need more time with their physician who knows them uh leading to better care and I think that once people know that direct Primary Care exists they will really love the model it's actually the fastest growing Primary Care segment in the United States because patients and businesses understand the fundamental value proposition which is an ounce of Health prevention is worth a pound of cure which saves money for employers right now most direct primary cares are small and individual practices I think in the future we will see Evolution to larger systems that offer direct Primary Care rather than local or Regional practices uh I also think that more Physicians are going to want to go into direct Primary Care um we you know talked a lot about how patients are happier but direct Primary Care really makes Physicians happier too because you have a better lifestyle and it's just a better way to practice medicine kind of getting back to uh the roots of actually taking care of patients instead of spending all your time um you know having to check off boxes for insurance companies so I think we're going to see a lot more Physicians trying to go the direct Primary Care Route well you've really given us just so much food for thought today and I really appreciate Dr Davis and Dr yalavarthy you both sharing your insights uh do you have any final comments for our audience well first I just like to say thanks for having us on it's a great opportunity to talk about what we're doing um and if anyone has any you know questions we're always happy to talk about what we do have people over and uh see the shop um and you can get our information obviously uh off the podcast and from our website definitely thank you for having us on and if people just want to come by and you know meet us or meet me before deciding that this is the route they want to go I'm always happy to uh meet patients and talk with them first uh before they make that important [Music] decision thank you for listening to the be health conect Ed podcast for additional episodes or to learn more about employer resources available through the St Louis area Business Health Coalition please visit www.st lbhc do org [Music]