Comprehensive primary care for employees means better employee health, greater productivity, less absenteeism and lower costs for both employee and employer. That is why some companies are making health care a company-wide strategic imperative rather than just a tactic as part of human resource cost management. There are many variants or options. Some are developing full service enhanced primary care clinics on site with excellent success. Some companies with fewer employees have partnered together to create a joint primary care program.
Another variant, rather than establish their own primary care clinic, some companies have decided to purchase the retainer/membership for their employees in a direct primary care (DPC) practice. They choose one or more practices that offer the type of comprehensive primary care that has proven to be effective in both enhancing health and lowering total costs. Alternatively, they place a sum of money in the employee’s HSA or HRA which can be used pay the membership fee for the DPC physician of the employee’s choice.
Another example is a Catholic Health Initiatives (CHI) option for their employees. CHI’s Nebraska and southwest Iowa division with about 20,000 staff members established a DPC clinic and about 1100 employees opted for it in the first year, 2018. Total costs have and patient satisfaction improved.
Image from article explaining CHI program
Note, I use DPC here to refer to any of the variants of direct primary care, membership care or concierge care. In all cases, I refer to a physician who has a panel of about 400–800 patients rather than the usual 2500–3000, offers same or next day appointments for as long as necessary, responds to text and emails and makes their cell phone number available 24/7. They offer episodic care, full attention to complex chronic illnesses but when a specialist is needed, they coordinate the care and assist in making an expedited appointment. They are razor focused on wellness maintenance and disease prevention and may work with a health coach, nutritionist or others in a team manner. Some, but not all, offer reduced rates with local laboratories and radiology services and a few make available generic medications at cost. There is an annual or monthly fee for the physician’s services.
Image from Premier Health
Insurers have been slow to enter this field, preferring to let the employer purchase DPC rather than offering it as part of their policies. But it can work for the insurer. For example, the individual either directly or via the exchanges selects an insurer that partners with DPC physicians. Part of the payments to the insurer go to pay the DPC doctor, perhaps $100 -120 per month, and the remainder purchases a catastrophic policy with a reasonable but not excessively high deductible. To make the program even better, some insurers contract with a DPC group that also includes a health coach for each patient along with classes on health and wellness at no additional charge. The downside, of course, is the individual does not have full free choice of their preferred DPC physician.
A similar approach begins with a DPC physician group that offers self-insured employers a package of direct primary care along with insurance for specialty care and hospitalization. The employer pays the primary care physicians’ group which uses part of the premium to pay for the DPC physician care, including extensive preventive care and chronic disease management and, often, including common labs, radiology, generic meds, and vaccines. There are no co-pays nor deductibles. Specialty care and hospitalization is covered by the insurance component and may or may not include co-pays and deductibles as determined by the employer
Iora Health (a Boston-based company acquired a year ago by One Medical that in turn is being acquired by Amazon) also largely deals directly with employers or unions to purchase complete expanded primary care for their employees or members. An example is the Dartmouth clinic for its employees.
These are but a few of the new approaches being taken by employers and enterprising organizations to improve primary care and in the process improving the total health of company employees and their families. Do these represent the future? Only time will tell. But employers and insurers will recognize that high quality comprehensive primary care, although it costs more than typical primary care, will actually reduce their total costs while improving quality and satisfaction. Then I predict employers who appreciate the value of these arrangements will increasingly gravitate to DPC models.
Note: The companies listed are for illustrative purposes only; inclusion is not an endorsement. I have no financial arrangements with any of them.
