Patient. Doctor. How Direct Primary Care Improves Health Care 4/3/2018. Direct Care. Disclosures. Direct Primary Care. Learning Objectives

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1 Disclosures How Care Improves Health Care Nothing to disclose. LORI CARNSEW, MD FAAFP Learning Objectives Care 1. How is Care patient centered? 2. Can DPC reduce health care costs? 3. Can DPC help with physician burn-out? 4. How can DPC work with small businesses and self-insured employers? Practice Model: Direct agreement between a patient and a provider that specifies healthcare services to be provided in exchange for a set recurring fee (usually monthly). Average cost = $77 per month* for adults. Most models include well visits, sick care, or text with patients, same day appointments, discounted diagnostic tests, discounted medications. Most doctors have patient panels. (As opposed to primary care) Doctors do not bill any third parties (Therefore eliminating 40% of overhead) Third Party Payer Model Direct Care Patient Doctor 1

2 PCMH Benefits Care is Patient Centered IT ADDS VALUE FOR PATIENTS Improved communication with patients Better coordinated, more comprehensive and personalized care. Improved access Improved health outcomes Decreased cost by Majority of care at primary physicians office / less ER visits Appropriate diagnostic testing DPC: Communication DPC: Coordinated, comprehensive care Text, , phone, video chat with patients. Allows patients flexibility. More direct communication between patient and doctor. Time to send newsletters, bulk s, flu season updates, etc. Able to more quickly adapt new technology such as online scheduling, tracking devices (BP, steps, sleep hours). Longer appointment times (more face to face) Team is focused on the patient (not billing or coding) Better connected with referral and community resources: exercise, behavioral health, nutrition. DPC: Access DPC: Outcomes Same day visits, shorter wait times After hours direct access to physician More flexibility to treat over the phone when appropriate. Most DPC patients report improved satisfaction Initial data shows decreased hospitalizations, decreased surgeries with same or improved control of chronic diseases. Quality Impact studying quality measures/metrics in DPC practices as well as others. Practice Transformation Network and COSEHC. 2

3 Reduction of Overhead Care reduces healthcare costs No billing or coding. Reduced authorizations and referrals. Staff is only per provider, (4.5 per provider in FFS) *Overhead for primary care average is 59.5% Most DPC are around 30% (full patient panel). * MGMA 2017 report DPC: (Reduce) Cost Typical patient cost DPC vs Traditional Price Transparency Elimination of waste (office efficiency, outside service cost) Savings from ER, Urgent care visits, avoidable hospitalizations Discount Services Lab, pathology Radiology Diagnostic tests Specialty services In-office procedures Pharmaceuticals Care 4 office visits with A1C included 1 sick visit same day included Well Visit (with pap) included Flu shot $15 Lisinopril, metformin, abx $50 (year) Phone calls with doc FREE Skin tag removal included Annual Membership 708 Total $773 (5 office visits) Fee for Service with Insurance Average deductible $1500 (year) 4 DM visits Well visit, flu shot, pap Urgent Care for same day A1C s, CMP, Lipids, micral Procedure visit Lisinopril, metformin, abx $275 Total: $1775. (???) (6 office visits plus urgent care) We seek patient relationships Preventing or Relieving Physician Burnout IT S NOT OUR FAULT! Med School First Year cadaver is first relationship Residency Continuity relationships First Year Out Ideas and ideals for improving patient care and satisfaction. Third Year - clinicals 3

4 Care puts the relationship between the physician and the patient eliminating 3 rd party interference. And therefore eliminating many of the challenges that physicians are concerned about. 80% of healthcare happens in DPC complements SMALL BUSINESSES SELF-INSURED EMPLOYERS PATIENTS WITH HIGH DEDUCTIBLE INSURANCE OR HEALTH SHARE PLANS primary care. When patients do not delay care and start care with their primary physician, many redundancies and unnecessary tests (and costs) can be avoided. 4

5 Reduces need for higher cost care Avoidance of a single hospitalization can save thousands. Comprehensive primary care reduces hospitalization. Same day access, shorter wait times and virtual visits reduce time away from work. Care Improves Healthcare Care Improves Physicians LoriCarnsew@VerityMedicine.com Chronic disease management and prevention: Healthier employees are more productive. 5