Why Choose Direct Primary Care?

Reflect on your most recent doctor appointment. Perhaps you thought you might have pneumonia. Were you able to have a same day or next day appointment? Did your insurance allow you to see the doctor you wanted to see or pay for the recommended treatment plan? Did you feel rushed in your appointment? Did it feel impersonal? The average doctor sees over two thousand patients a year in the traditional system and as a result only spends 7 minutes with each patient. Health insurance providers are often too involved in your healthcare plan, making treatment for conditions like the pneumonia a much longer and convoluted process than necessary. It’s time to take your healthcare back with direct primary care (DPC).

Solstice Health is the first independent and completely insurance-free direct primary care clinic in Wisconsin. Direct primary care is sweeping the nation as the answer to continually rising costs for mediocre primary care that is getting harder to access and more impersonal. With all of this said, you may now be wondering, what exactly is direct primary care?

What is direct primary care?

The Direct Primary Care Coalition defines direct primary care (DPC) as …

“… an innovative alternative payment model for primary care being embraced by patients, physicians, employers, payers and policymakers across the United States. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider… Direct primary care fosters this relationship by focusing on five key tenets: service, patient choice, elimination of fee-for-service, advocacy, and stewardship.“

Direct primary care includes unlimited access to your doctor, virtual visits, wholesale pricing on lab work, imaging, and medication help to provide the best, most affordable, and convenient care possible.

What are the benefits of direct primary care?

  • You are guaranteed to get the time and care you deserve with your direct primary care provider. With insurance and hospital group involvement eliminated, doctors are able to spend significantly more time with each patient, thus restoring the doctor-patient relationship.
  • Direct primary care doctors care for on average 600 patients per year. This is significantly lower than other traditional doctors. By accepting only 600 patients on average per year, same day and next day appointments are typically available at your request.
  • Unlimited visits, no copays, and no deductibles.
  • Direct primary care eliminates 40% of overhead by not accepting insurance, thus making it very affordable for everyone. Also, wholesale labs, imaging, and pharmaceuticals are another value add for members, allowing you to budget your care, your way. Steeply discounted (80-90%) rates are negotiated, and you get the benefits.
  • Direct primary care eliminates third party involvement in YOUR healthcare.
  • Direct primary care covers 90% or more of your overall healthcare needs. With better care, it decreases the down stream utilization of specialists, urgent care and emergency room visits. Direct primary care takes care of the acute urgent care issues, chronic disease management, preventive health and wellness, and even occupational health.
  • The direct primary care approach involves far fewer steps to treatment than a traditional insurance approach. Continuing with our earlier example of a possible pneumonia case, check here for an example comparison chart of a direct primary care treatment route and traditional insurance treatment route.

Direct primary care is a vital part of our mission here at Solstice Health. Our monthly membership plans are comprehensive and age based. For more information on plans, check here.

Contact us today to start your direct primary care journey. We have three convenient locations in Wisconsin: Oconomowoc, WI (262)-533-4528, New Berlin, WI (262)-505-6260, and Mequon, WI (262)-533-4528.

 

How Employers Can Take Control of the Healthcare System

The healthcare landscape continues to change rapidly. Recently the 21st Century Cures Act was signed into effect. The Cures Act is making significant provisions to health reimbursement arrangements (HRA’s) for employers with 50 or less employees. Changes to the Affordable Care Act will likely be announced in 2017. Regardless of whether the ACA is repealed or withheld, the US will continue to face the challenge of overpriced healthcare with inadequate quality. (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.)

Employers are faced with the burden of how to manage the never-ending price increase. The reluctant solution for many employers has been to shift the costs on to their employees. The high deductible, high premium health care plan has been the normal benefit offering. Cost shifting onto employees has proved to be inefficient, and often incurs additional costs for employers. Due to the high the high deductibles, many employees are reluctant to seek preventive care leading to increases in urgent care and emergency room utilization rates.

control healthcare costs

There is a solution and a growing trend in the US to improve health outcomes, quality and allow employers to take control of the healthcare system, the solution is Direct Primary Care. Direct Primary Care (DPC) is an affordable membership based healthcare model. Direct Primary Care does not bill through insurance, which reduces the practices overhead costs by 60% or more. The cost savings is passed on to the patients who are able to have 24/7 access through telemedicine, and same/next day appointments with their doctor for often less than a monthly cell phone bill.

Here are 3 significant ways Direct Primary Care helps employers reduce costs, improve quality and take control of the healthcare system.

  1. Improved Access since direct primary care reduces patient panel size to typically no more than 500-600 patients per physician versus traditional fee-for-service primary care practices in which the patient panel size is typically 2,500 to 4,000 patients per physician. DPC patients are able to have 24/7 access to their primary care physician, and same or next day appointments. Instead of the average 7 minutes spent with each patient in traditional fee-for-service primary care practices.

 

  1. Quality Improvement is often tied to improvement in access. DPC physicians have the ability to block hour-long intervals to ensure they have enough time for a more comprehensive patient history, the ability to perform a through exam and time for critical thinking. When paired with 24/7 telemedicine to provide immediate access to your own primary care provider who knows you and your health history on weekends and evenings results in more appropriate care, and a reduction in ancillary services such as the ER or additional specialty care. There are multiple studies that confirm Direct Primary Care does translate into improved quality of care.

 

  1. Cost Reduction occurs through a variety of channels when utilizing Direct Primary Care. First, DPC reduces overall healthcare costs by reducing unnecessary healthcare utilization. Data from Qliance, One of the US largest direct primary care practice, shows the DPC savings vs. fee for service primary care had:
  • 14% decrease in ER visits
  • 60% decrease in the number of days admitted to the hospital
  • 14% decrease in specialty referrals
  • 29% decrease in radiology exams
  • 58% increase in primary care visits

Yielding a $679.00 savings per patient per year compared to traditional fee-for-service practices.

Local Governments are utilizing Direct Primary Care for significant cost savings. In 2015, Union County North Carolina expanded its health benefits to include a Direct Primary Care (DPC) option for employees. It is the first county in the state to offer such a plan, and its experience offers valuable lessons to other counties. Direct Primary Care in comparison to their CDHP (Consumer Driven Health Plan) and in the first year has saved over 1.28 million in healthcare claims for Union County.

control healthcare costs

control healthcare costs

As health care costs continue to rise faster than the rate of general inflation, employers must necessarily consider new and innovative ideas. Direct Primary Care has the potential to effectively transform our healthcare system in the United States.

If you are an individual or employer group, Solstice Health has Direct Primary Care solutions to fit your budget and company needs. Solstice Health provides Direct Primary Care services in 3 clinic locations throughout Southeastern Wisconsin and through on-site and near-site clinics for employers. Contact the Solstice Health team today to learn more about our Employer Direct Primary Care Solutions.

Solstice Health provides direct primary care at 3 convenient locations throughout southeastern Wisconsin.

Employers: Direct Primary Care Can Improve Your Company’s Bottom Line

Employers are faced with a plethora of challenges regarding ACA compliance such as increasing health care costs and employee retention. Next to payroll, health care expenses are most employers’ largest expense. In 2017, insurance premiums are expected to increase. Sadly, most employers think a less expensive ACA compliant alternative does not exist.

An ACA compliant alternative does exist in the Direct Primary Care (DPC) model that is gaining national attention. This model is effectively helping employers navigate the costly traditional methods of health care delivery.

Understanding Direct Primary Care Capabilities

In order for employers to fully maximize the benefits of direct primary, a solid understanding of the DPC model is key. Currently, many companies and benefit advisers think of direct primary care as an “add-on” to their existing benefit program. Direct Primary Care should be the foundation of a truly effective benefit plan. Fully understanding the capabilities and offerings of direct primary care is critical. First, the scope/capabilities DPC is able to provide: routine physicals, urgent care needs, chronic disease management, wholesale medication, labs, imaging, reduction in workman comp claims, 24/7 telemedicine services, and population health management. Second, removing the barriers of co-pays and visit limits enhances the access to providers. Additionally, same/next day visits along with telemedicine solutions are improving health outcomes and accessibly to health care . Third, direct primary care is able to lessen the out-of-pocket health care costs for employees, including co-pays, prescription, lab costs, urgent care needs and many more.

Direct Primary Care and the Traditional Health Insurance Model

When looking to create a cost effective health care strategy, employers need to have a solid understanding of the true purpose of health insurance. Health insurance was designed for catastrophic events such as cancer, strokes and heart attacks. Not for all health care needs, as it is currently structured in the US. Insurance in all other industries, such as automobile, is used for catastrophic events. Does your auto insurance pay for oil changes? No, but this is an important routine service which is needed for the life of your vehicle. Health care is the only industry where insurance is used for the rare catastrophic events and also common health care needs. This excessive health insurance cycle is leaving us financially crippled and incredibly ill as a nation.

Direct Primary Care WisconsinThe traditional health insurance model increases premiums when claims are routinely filed. To decrease the cost of premiums, the frequency of claims needs to be reduced. Since all health care costs are so expensive it appears there is not an alternative to this health insurance cycle. However, not all health care is expensive. In fact, around 80 percent or more of health care needs are very inexpensive, and can be effectively treated through direct primary care.

To cap costs, Direct Primary Care is packaged in an affordable flat monthly fee, typically less than $60 a month. Cheaper than most monthly cell phone bills! Direct Primary Care keeps insurance use and costs low. The health insurance is available for the rare 20 percent of health care needs. This model is a proven and effective way for employers to reduce health care costs, while providing access to quality health care.

How Employers Can Utilize Direct Primary Care

To make Direct Primary Care work, employers are required to have a wraparound insurance plan. Direct Primary Care paired with a wraparound insurance policy is compliant with all ACA mandates, and results in significant savings on health care costs for employers and employees. There are a variety of insurance wraparound policies to accommodate DPC. If your organization is self-funded, Direct Primary Care can control catastrophic costs by providing accessible quality care as a strategic tool in your health benefits plan.

As our health care costs continue to skyrocket, many companies need to have a pulse on the latest models to keep costs down, while continuing to improve quality and health outcomes.

For Companies facing year-over-year health care cost increases, aggressive solutions are critical to sustain business health and remain competitive. The traditional cost containment strategies such as: increasing deductibles, increasing out-of-pocket costs for employees, decreasing benefits, and most wellness programs are proving to be ineffective with controlling or stabilizing health care costs. Most of these strategies fail to address the root cause drivers of escalating healthcare costs and to provide real solutions on how to mitigate these costs in the short and long term.

Takeaway

When evaluating various healthcare cost containment strategies, employers need to have a solid understanding of how these models will help them achieve their short and long-term goals in their corporate health and wellness strategy. During the evaluation phase, employers should seek advice from their benefits consultants, research current and future health care cost containment strategies, and have a firm understanding of the health care needs in their employee population.