For those who need a quick explanation of direct primary care, it works like a health care gym membership. In exchange for a membership fee (the industry average monthly payment ranges from $25 to $85), patients have access to around-the-clock primary health care. They can even schedule same-day appointments and longer office visits with their doctors as needed.
Union County, a self-insured employer located outside of Charlotte, has contracted with Paladina Health, a large-scale direct primary care (DPC) organization, to offer its workers an additional health benefit option to seek care at Paladina’s near-site clinic. I’ve written about how the local government saved $1.28 million on health care claims in one year when board-certified physicians provided care for 44 percent of Union County’s 2,000 covered lives. This is what can happen when primary care physicians opt out of insurance-contracts. Less paperwork means more time to spend with patients as needed to effectively prevent at-risk health conditions or manage comorbidities. More time means better access which yields fewer specialist referrals, unnecessary hospital admissions, and emergency room visits.
The calculated savings is equivalent to the difference between the average per employee per month (PEPM) cost that consists of both medical and prescription claims incurred by employees who subscribe only to their consumer-driven health plan and those who choose to access care at Paladina’s clinic alongside their consumer-driven plan. That $1.28 million comes out to an average savings of over $260 per employee per month.
What do we know about that “44 percent” patient population? The end-of-year results indicate the following:
- Based on in-person office visits, 59 percent of Paladina members have at least one chronic illness, while 35 percent are diagnosed with multiple – the leading diseases being high blood pressure and hyperlipidemia.
- Of the 55 percent of Paladina members who have moderate to severe chronic conditions, over 90 percent of them are defined as being heavily engaged with their health care. Paladina defines “engagement” as having at least one in-person office visit per year at the near-site clinic. Patients with more than 3 chronic conditions averaged more than 5 visits in one year, while those with more than 1 chronic illness averaged over 3 visits.
- Paladina members with more than one chronic condition cost on average 28 percent less than the control group enrolled in Union County’s consumer-driven health plan.
Although control group data is not available at this juncture to compare the number of average annual in-office visits for chronically ill patients with Paladina’s statistics, it’s important to point out that Paladina’s patient population, including those who have complex medical needs, are voluntarily electing direct care. DPC attracts these patients because this method of health care encourages them to feel more empowered over their health care. The evidence also tells us that patients realize the value direct care has to offer and can make good medical decisions for themselves.
Read my latest in Forbes here.