This article by Lydia Ramsey was published in todays Business Insider- Employers Could Use Direct Primary Care – and features our friends and colleagues Dr. Vance Lassey from Holton Direct Care in Holton KS as well as Dr. Kim Corba from Green Hills Direct Family Care in Allentown PA. The article discusses how the big three of Jeff Bezos from Amazon, Warren Buffett from Berkshire Hathaway, and Jamie Dimon from JPMorgan have announced that they are trying to fix our healthcare system Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care and they seem to be looking at using Direct Primary Care to build a solid foundation of affordable primary care for their employees. All of those questions from skeptics that I have been repeatedly asked over the past three years such as “why don’t you take insurance?”, “why should I pay twice for healthcare?”  “why should I self-fund?” etc etc. are now being answered by people that have a lot more money and clout than I do. My hope is that maybe now people will not only start following, but also start teaming with a group of renegade primary care doctors across the country that have been doing this model for the last decade because they had enough of the “healthcare cartel.” If you use Amazon maybe you should also consider using a DPC doc.

I know it has been a while since I have written anything, but it has been a bit since I have seen something that has really driven me to write about. Yesterday I happened to see an article that was in the Boston Business Journal regarding health insurance options for our state employees that are on GIC plans- police, fire, DPW, teachers, etc. The following is a link to a free version by Martha Bebinger at WBUR Major Mass. Insurers Dropped From State Employee Health System. The three major players that are now out are Tufts, Harvard Pilgrim, and Fallon. What I find interesting about this change is that the GIC is quoted in the article are saying that “moving members to a more limited, less expensive number of insurance plans will save the state $20.8 million in the next fiscal year with little disruption.” I am very curious to see what these premiums will look like to our valued state employees. As a self-employed business owner I had to do my renewal by January 1st and by choosing Tufts Direct I was not only able to have great hospitals like Lahey and Tufts Medical Center in the network, but also saved $400 a month in premium compared to a similarly structured plan (i.e. same deductibles etc) with Neighborhood Health Plan that is owned by Partners. So again, I am curious to see where the costs savings will be? I highly doubt it will be to the employees.

See the issue here is that no one is actually addressing the cost of health”care” and only focusing on the cost of insuring it. The public has been led to believe that everything in “healthcare” is so expensive that we need a prepaid “insurance card”- one with a very large finance charge while we are at it-  so we don’t go broke. The irony is that it is the actual cost of insuring everything under the sun that is making people go broke. So employers- including the state government- have only two options to keep their spend under control: 1. transfer more cost to employees by raising out of pockets such as deductibles/copays/coinsurance and 2. limiting the network of hospitals/doctors employees can use with restrictive HMO-type plans. (As already mentioned, given that one of the options left here is NHP is quite strange given that Partners hospitals/practices are much more expensive but let us wait and see what the premiums are.) As a result of union leaders not wanting to see their employees carry huge out of pocket responsibilities such as deductibles and the like, what other options does the state have? When you expect a third party to cover 90-95% of your care this is what will happen. You lose money and the freedom to choose.

So my question to all GIC beneficiaries is do you really think your employer and the insurance carriers they are choosing are going to help address this cost equation for YOU? Are they providing the actual care you receive? No they are not , but they are determining where you can and can not get it from. So speak up! I lost a lot of you as valued patients when I stopped taking your “payment/insurance card” and instead wanted to be paid directly by you for all your primary care at a reasonable monthly fee that averages out to $75 a month. Sadly what you did not see is how on your side I was and continue to be.  Your choices of payment cards are now fewer and fewer and my educated guess is that it will cost you more to carry the card(s) offered to you and fewer places where you can actually use them. So why not grab your local DPC doctor as an ally so that we can fight this fight together and get more options for you-  like say a higher deductible plan that works like real insurance by covering major expensive medical care not the affordable part like primary care (lower premium) and combine it with a Direct Primary Care option. The only way we fix this system and the cost to you and the taxpayers of Massachusetts is to disrupt it from the ground up instead of letting policymakers do it for you from the top down. If you need more proof or evidence that it works look at what my colleague Dr. Rushika Fernandopulle has done at Iora Health in Boston for GIC members on Unicare: Iora Health and GIC Combine to Offer DPC to Unicare Enrollees. Why doesn’t NHP, Tufts, and HPHC offer the same? Hmmm. Also look at what Union County in North Carolina has saved offering DPC to their county employees! And this is with only 40% enrolled in the high decutible/DPC plan! Direct Care Helping North Carolina Public Sector Save Big On Health Care Claims. If you’re really bored but truly want to see how this worked in North Carolina watch this video. It includes my fellow DPC colleague and friend Dr Amy Walsh. It may be an hour but it is well worth it in my opinion.

I am willing to speak with any town administrator, union leader, state official you would like. Just ask them to schedule a meeting. You, that provide our communities with so much service, deserve much much more when it comes to your coverage and your care. Remember, they are usually not the same. Thanks for listening.

When is the last time you went to a Blockbuster Video store on a Friday night to peruse the shelves for a rental? Yup, almost ten years ago. The key question is why is it extinct? There are many obvious reasons- inconvenience of having to go search the shelves, finding out the movie you want is out, and the most obvious is innovative disruption by companies like Netflix and Amazon (see article from Forbes below).

The key component of the decline of Blockbuster Video/On Demand and the rise of Netflix is what network scientists refer to as the “threshold model of collective behavior.” In other words, this is how innovation takes hold and finds success in society whereas other products/concepts fail and drift away because they do not keep up and change to meet the needs of the consumers of the service. Blockbuster tried to adapt but it was too late. It dropped its late fees- which was their key to profitability- and spent approximately 400 million dollars instead. All the while Netflix was charging an affordable monthly fee, could deliver DVD’s to your door, and figured out how to stream content. And even though their library was not as extensive, their affordability and no hassle service made them what they are today.

So what in gods name does this have to do with me? Well, I think it is pretty obvious. The Direct Primary Care model is the Netflix of Medicine. You pay less than a coffee a day, or less than an average cable/cell phone bill a month, so that you can receive primary medical care the way it was and should be delivered. It is easy, accessible, transparent, dependable, and personalized. We bring care to you not vice versa. There may be a month when you stream ten different TV shows or movies (not speaking for myself of course) or there may be a month when you watch none, but Netflix is always there. DPC is the same, and more importantly, there is a personal relationship and level of trust that is built to help you stay healthy, be accessible when you’re sick and need care, and more importantly help guide you through the tangled web of the US Healthcare/Insurance system.

The current system of insurance-based primary care requires in person visits for all care in order to bill your insurance – even for matters that could be handled remotely with a quick phone call, text message, or Skype session. This same in person care requires copays/deductibles for each visit, provides a maximum of 10-15 minutes with your doctor on a good day, and is inflexible to scheduling around your personal life. Also, with more and more people on high deductible health plans cost is being shifted onto patients. How do you shop for elective, outpatient care like labs and imaging studies in a system of zero transparency? How, in a country as developed and wealthy as ours, did it take this long to apply simple, affordable innovation to the most important, yet most costly, consumer-based product we have- our health and well-being. The current model of insurance-based primary care is Blockbuster video. Where do you want to be when it goes bankrupt?

Endnote: it is well worth an hour of your time to watch this incredible lecture by David Goldhill- CEO of the Game Show Network and author of “Catastrophic Care- How the American Healthcare System Killed My Father”- that I was fortunate enough to be present at this October in Dallas. His book is also worth the read. Besides a mortgage, healthcare is the largest expenditure we have so be informed and learn.

If you want to learn more in depth details about the decline of Blockbuster, please read this great article from Forbes A Look at Why Blockbuster Failed

Not surprisingly, recent studies have shown a broad value proposition that links workplace health and well-being to favorable business performance. So why don’t more employers invest in programs that promote healthy employees? Expense is one glaring reason! Employers, both large and small, are being crushed by the rising cost of providing insurance benefits to their employees. Most employers address this growing cost by shifting it to their employees in the way of increased premiums, higher deductibles or higher co-pays. There is a cost effective solution and this solution is Direct Primary Care.

With Direct Primary Care, employers pay a fixed amount for all primary care services. This removes the guessing game on how much money will be spent on claims filed by employees. Direct Primary Care can be inserted into the overall health insurance plan offered to employees and ultimately control downstream costs. DPC, combined with an appropriate supplemental catastrophic plan, can save employers up to 40% on healthcare costs! This is all in accordance with the Affordable Care Act, so employers won’t get fined for non-compliance.

If saving money wasn’t enough to convince you, other perks for the employer include: decreased absenteeism, decreased workman’s comp claims, utilization of telemedicine to evaluate employees so they don’t leave early for doctors’ appointments or miss work altogether. Employees benefit too, as they receive same day appointments, a personal relationship with their physician, telemedicine/virtual visits, decreased out-of-pocket expenses, no more visits to urgent care centers.

Direct Primary Care physicians can be an employer’s most valuable ally as they search for ways to control healthcare costs, while simultaneously offering their employees the highest quality of care. Check out this article http://www.directdoctors.org/blog/direct-primary-care-a-solution-for-small-businesses to learn more.

If you are a business owner or know a business owner call us at 781-842-3961 to start saving money!