Reviving the Doctor-Patient Bond
Fixed-fee model taking root alongside mandatory insurance
Frustrated with America's broken health-care system, some doctors have turned to a new delivery model that harkens back to the days of house calls — but with a high-tech twist.
“We’re Marcus Welby with iPads,” says Dr. Clint Flanagan, founder and chief executive of Colorado’s first direct primary care (DPC) company, Nextera Healthcare.
DPC practices give their members unrestricted access to a single primary care physician and his or her medical team via phone, email and texts for a fixed monthly charge — typically $100 or less for an adult. Same-day or next-day appointments are the norm, compared with the 24-day wait at most traditional family practices.
“This model puts the doctor back in charge of health care,” says Mark Tomasulo, founder of PeakMed Primary Care.
The lag time to see a doctor has led to a proliferation of expensive stand-alone emergency rooms and urgent care clinics over the last 10 years. Visits tend to last about eight minutes, with another 15 minutes spent on administrative work required by insurance companies. DPC members, on the other hand, see their doctor for up to an hour, long enough to build relationships based on trust.
The membership fee, paid either by the individual or an employer, covers things like blood draws with low-cost test results; wound care, including stitches, staples and surgical glue; broken bones; dermatology procedures; and mental health. Some practices have pharmacies in their clinics that dispense medications for less than Walgreens or CVC. A primary care doctor can accommodate about 90 percent of a patient’s needs.
“We choose not to make any money on those things because we’d rather see patients get them done,” Tomasulo says. “Under the traditional model, if I order something you can’t afford, I won’t get the information I need as your doctor.”
Today, there are more than 500 direct primary care clinic physicians operating in 48 states, including about 60 in Colorado, according to the Direct Primary Care Coalition, an industry organization that is working to move the DPC agenda forward.
“We’re health care,” Flanagan says. “We want to provide care for you. We also encourage patients to get coverage — insurance for major medical procedures.”
DPC isn’t a substitute for health insurance. While the Affordable Care Act (ACA) contains a provision that allows for direct primary care, it clearly states that health insurance is still required.
“Health insurance is there to keep you out of bankruptcy — not to take care of your health,” Tomasulo says.
Many employers are including DPC alongside traditional health insurance as part of the benefit packages they offer employees. About 85 percent of Nextera’s membership are employers, including Left Hand Brewing Co., the Boulder Ballet, Comida Cantina and the town of Firestone among its clients. It’s even opened a clinic inside DigitalGlobe’s office near West 120th Avenue and Huron in Westminster.
When employees regularly visit their primary care doctors, it saves the company money, according to a case study conducted after DigitalGlobe signed on with Nextera. The study found that claims for Nextera Healthcare members were more than 25 percent less than for employees who had not enrolled in the plan.
“What happens when you have a relationship with your doctor is that you’re not going to Dr. Google anymore,” Flanagan says. “You see fewer ER visits, less urgent care and fewer claims on insurance plans. It results in savings for the patient and the company.”
Enrolling employees in PeakMed has resulted in significant savings for Mobile Transport Repair, a Colorado Springs truck repair shop owned by Holly and Eddie Lawrence.
“We’ve had an employee cut their leg and call PeakMed and go over there,” Holly Lawrence says. “They’ll sew him up and it’s not filed against workman’s comp. Those little ones, you get dinged pretty heavily for workman’s comp — urgent care would have cost $300 to $500. We’re happy we didn’t have to put a claim
PeakMed has worked well not only for the Lawrences’ business but also for their family. One night after dinner, their 4-year-old daughter fell and hit her head. Lawrence texted Tomasulo a photo of the wound over her daughter’s eye, and he instructed her to meet him at the clinic, where he glued the gash together. Lawrence’s daughter was home and in bed by 8:20 that evening.
“We would have waited in the ER or urgent care for hours,” she says.
Escalating health care costs prompted Ent Federal Credit Union to add PeakMed to health care coverage it already provides its 725 employees, says Sharie Flanagan, senior vice president of human resources and training. The benefit, she says, is particularly helpful for employees with small children.
“This is great for the sniffles or the flu or whatever for employees to take children multiple times because there’s no copay,” she says. “It’s back to the way medicine used to be when doctors made house calls.”