Primary care is shaping the healthcare industry in many ways. According to Sherry Glied, PhD, Associate Professor of Public Health at Columbia University, changing health care costs is a leading concern as more than 44 million people in the U.S. have no health insurance and an additional 38 million have inadequate health insurance.
On February 5, 2019, the U.S. Senate Committee on Health, Education, Labor & Pensions (HELP) had a hearing to discuss ways to reduce health care costs by expanding access to primary care, the last of six Congressional hearings on the topic. This hearing began with testimony from Dr. Lee Gross, a direct primary care (DPC) provider from Florida. Dr. Gross discussed ways to improve health care and achieve cost savings through primary care.
In this article, learn more about what Direct Primary Care refers to and read a few summaries of the testimonies cited by HELP Committee Chairman U.S. Senator Lamar Alexander from the aforementioned hearing.
What Is Direct Primary Care (DPC)?
Direct primary care is an alternative to accepting insurance for routine visits. With DPC, physicians, internists, and pediatricians charge a monthly membership fee to patients which covers a broad range of primary care services, such as office visits and low-priced medications. In exchange, DPC is able to offer patients bigger savings.
For example, a standard DCP plan may offer a free office visit with a monthly membership with no copays. A visit is typically between 30 and 60 minutes long, compared to traditional office visits which are often less than 20 minutes. When doctors are not forced to provide services under a standard fee-for-service model, they have the ability to cater to patients longer to form better relationships. This often results in a better quality of care.
During the early February hearing, Senator Alexander shared Dr. Gross’ payment structure. Monthly fees of $25 for one child and $10 for each additional child were charged to parents. Each adult had a monthly fee of $60. This monthly fee covers everything from basic vaccinations to treatment for chronic conditions. Alexander discussed how this DPC practice helped to keep health costs down without sacrificing quality care. When families have access to low-cost care, it also reduces the number of emergency room visits.
Witness Testimonies at the Hearing
At the U.S. Senate Committee on Health, Education, Labor & Pensions (HELP) hearing, four testimonies were made by different witnesses who all had information on how to keep health care costs low while improving patient outcomes. These included the following four testimonies:
Dr. Joshua Umbehr, co-founder of the Wichita, Kansas AtlasMD Family Practice, delivered the first testimony. In his testimony, he stated that DPC could be beneficial to providers, patients, and employers if changes could be made to repair the disconnect between the cost and value of health care. DPC is offered at a flat fee, meaning greater transparency and health care at an affordable cost.
With DPC, physicians act as patient advocates which helps ensure that patients receive the best care possible. Due to a low health literacy among many Americans, unnecessary health care spending runs rampant. However, when patients become more informed through a solid doctor-patient relationship, spending can be drastically decreased.
Although Dr. Umbehr states that he is not anti-insurance, he does feel that DPC has the power to decrease health care costs to a level that makes health insurance obsolete. However, this requires assistance from employers, as well as federal and state officials. If successful, DPC could transform how health care is delivered in the U.S.
The next testimony came from Associate Professor, Dr. Sapna Kripalani, of Vanderbilt University Medical Center. While Dr. Kripalani referred to primary care as time-consuming, she also stated it was a necessary step in lowering health care costs and improving quality. Her testimony detailed how investing in primary care could potentially boost health care innovation, reduce spending, and result in investments within the workforce.
Dr. Kripalani explained that primary care investments would change the way that health care services are delivered. One example includes the use of telehealth. Through health care innovations, more patients would be able to receive care via telehealth without leaving their home. This not only benefits the patient, but could reduce overall health care costs as telehealth visits are generally much less costly than in-office visits.
Dr. Katherine Bennett, Program Director of the Geriatric Medicine Fellowship and Assistant Professor of Medicine at the University of Washington, gave the third testimony. Based on the success of the Project Extension for Community Health Outcomes (ECHO), her testimony looked at the link between specialties and their connection to health care costs.
Specific illnesses and diseases, such as heart failure, hepatitis C, mental illness, HIV, geriatrics, and chronic pain require a specific amount of higher care. Project ECHO was designed to put focus on primary care services, including education, treatment, and community support, to address specific health conditions.
The fourth and final testimony came from Tracy Watts, National Leader for U.S. Health Care Reform, Mercer, and Senior Partner. After conducting extensive research, she found that many clinicians believed that primary care could provide a reduction in health care costs and improved patient care. Watts’ testimony also looked at what is offered to employees by employers.
According to her testimony, 31 percent of employers provide on-site medical services. With easy access to health care services, employee presence, health, and productivity increased. She also discussed how primary care services in combination with services like telehealth helped keep patient health care costs to a minimum while improving patient care. Watts also recommended that Congress pass legislation to enable the growth of health savings accounts (HSAs) to help cover certain health care costs like DPC costs.
Both employees and employers remain concerned about rising health care expenses. This was confirmed in the HELP hearing on February 5th. Based on a statement by Chairman Alexander, the committee is planning to pursue legislation to lower the cost of health care.