With the teeth of the Affordable Care Act’s individual mandate gone, patients in 2019 have more affordable choices for how they receive medical care. Locally, a growing health care model focused on accessibility and pricing transparency is gaining traction among patients.
Bucking insurance and copays, the direct primary care model has patients pay physicians and providers directly for primary care services. Patients typically pay through monthly memberships, usually under $100 per person. Providers say the approach provides patients quicker service that’s personalized to their needs at a fraction of the cost of traditional health insurance.
Industry analyst DPC Frontier estimates there are nearly 1,100 practices nationwide working the direct primary care model, up 280 percent in four years.
Dr. Luke Van Kirk owns one of the roughly seven DPC practices in the Springfield area.
His 3-year-old practice, Command Family Medicine PC, has grown most rapidly the past few months. He said it’s up more than 220 patients since December 2018.
“People were looking for alternatives,” Van Kirk said. “They were looking for other ways to have their health care.”
His practice today is nearing 1,000 members who pay $75 a month for adults and $15 a month for kids for unlimited primary medical care. Van Kirk said he’s priced his services at 30-60 percent less than traditional insurance plans.
Even before the penalty of the individual mandate was removed from former President Barack Obama’s health care law through the Tax Cuts and Jobs Act of 2017, he said a number of patients still chose his practice, often combined with a high-deductible or catastrophic health insurance plan in case of emergencies.
He was looking for an alternative, too.
“When I started residency, it was pretty apparent that the current system for family medicine was not something I wanted to be a part of,” he said. “It was really frustrating when I could only spend five minutes with a patient but they needed longer.”
South of Springfield, Dr. Matthew Green has operated Ascent Direct Primary Care LLC in Nixa since 2015. He’s also seen increased interest in the model, and with a surge in the past six months, Ascent is approaching 600 members.
“Insurance is so cost prohibitive, so they look for alternatives,” he said. “They also just want extra time with physicians. They want that family doctor feel.”
He said his most common patients are young families and adults nearing Medicare age, a common theme among DPC practitioners. Patients pay $59 a month, and an additional $20 a month per child in their household.
Green said his model allows insurance to do what it’s meant to do, which is to cover the cost of emergencies but not day-to-day care.
“Health care is provided by doctors,” he said. “Insurance is not health care.”
Green said he’s planning to add a second provider by the fall, which would help grow his partnerships with businesses, like nPrint Graphix, on their employees’ medical care.
In downtown Springfield, Equality Healthcare LLC just hired its third full-time nurse to help meet its goal of 400 to 600 patients for each of its three physicians. They used to work for Cox Family Medicine Associates.
“The care we were providing was expensive, it was difficult to access and visits kept on getting shorter. That was very frustrating to patients,” said Equality Healthcare co-owner Dr. Shelby Smith. “We felt that the direct primary care model actually seeks to make changes to improve things. We’re offering 24/7 comprehensive primary care for less than some membership barbershop companies.”
Plans range from $30 a month for children to $150 a month for families. For tests outside of the scope of primary care, like MRIs, he’s contracted with imaging centers for lower-cost tests available on a cash basis.
Providers, like Smith, said a tenet of the DPC model is pricing transparency. Health care costs are known upfront before tests are ordered.
Smith said lab costs are marked up 10 percent from wholesale, and most common lab and medication costs are available to the public through Equality’s website.
“We view everything from the lens of affordability,” he said. “We need affordable health care.”
While Drs. Eric and Tania Reavis don’t have a DPC model at their chiropractic, acupuncture and massage business, called a hip joint, they are looking to expand to include primary care.
“A lot of people are fed up with the medical side of things and just how they’re treated,” said Eric Reavis. “They go out there and they see they are a number. They come to us, and we try to do just the opposite.”
The business has grown from nearly 9,000 visits in 2017 to over 14,000 last year, producing $675,000 in annual revenue.
Like DPC, a hip joint is based off monthly membership, and the providers use their practice to treat a variety of ailments, such as injuries, chronic pain and women’s health issues. He said many of a hip joint’s nearly 500 members use their practice as a primary source of health care, while also having a high-deductible insurance plan for emergencies.
A hip joint last month opened its second location in south Springfield, and it recently added a physical therapist in its downtown office.
For 2019, enrollment in the Health Insurance Marketplace in Missouri decreased 9.4 percent, according to the Centers for Medicare and Medicaid Services.
Nancy Kelley, the expanding coverage program director for the Missouri Foundation for Health, said the removal of the individual mandate penalty was a factor that contributed to the decline, as well as decreased funding for outreach and confusion over whether the ACA was still in effect.
Expanding into businesses
Smith of Equality Healthcare said he works with 20 businesses that provide DPC to employees as a secondary or main health care option, along with a high-deductible insurance plan.
Jimm’s Steakhouse is one of them.
“I didn’t feel the ACA plan was enough. That was only a wellness plan once a year,” said Jimm Swafford, the restaurant’s managing partner. “This was something that I saw they were going to use.”
He said 14 of his roughly 50 employees opt into care through Equality Healthcare, and this year he expects to add another five employees to the plan.
The business splits the cost between employees, with each paying $25 a month for unlimited primary care. He said he pays around $15,000 annually to offer a high-deductible ACA plan that’s rarely used by employees.
“They use this plan,” he said of DPC.
Van Kirk works with 12 businesses that offer DPC to employees. He’s reached them through working with insurance broker Nevont LLC.
Nevont co-owner Royce Reding said the majority of the company’s new clients and renewals are opting to offer a DPC program to employees, and most are seeing savings of 20-30 percent compared with traditional insurance plans. Reding added a DPC model isn’t a fit for all employees, and suggests some clients offer a traditional health plan as another option.
“The employer that tends to be a good fit is an employer that is looking for where the overall industry is moving,” he said, adding one employer that uses the model is Jared Enterprises Inc.
He said savings continue for employers even after initially starting the plan, as renewal rates won’t see the typical price jumps from insurance plan utilization.
“That gets billed to the insurance company,” he said. “When you use direct primary care, they do that all in-house under the monthly fee.”
Local providers say DPC is getting back to health care basics by focusing on the physician and patient relationship. That means 24/7 access.
Smith likens the DPC model to how medical care once was provided.
“We’re sort of country doctors with an iPhone,” he said.
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