NEW OPTIONS – Direct Primary Care

One of the first questions our clients and prospects have is “Can you help me with affordable health care options for my employees?”

Yes, we can!

For companies (like yours!) that have been besieged with annual healthcare cost increases, who have exhausted traditional cost containment strategies, incorporating direct primary care as a benefit offering allows for increased control over the heath care supply chain without decreasing benefits for employees.

You may sense that health benefit costs are out of your control, but you shouldn’t underestimate your influence in the healthcare cost arena.

Most well managed organizations have deployed traditional containment strategies over the last decades. Some have produced incrementally successful outcomes, while others were either unsuccessful or too nebulous to measure.

And now there is a new option for you to consider. Direct Primary Care (DPC).

Direct Primary Care (DPC) is an innovative alternative payment model for primary care being embraced by patients, physicians, employers, payers and policymakers across the United States. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.

Direct primary care started out in Washington state about 12 years ago.  It has now swept across the country to the point where there are only 4 states that do not have some form of direct primary care being offered.  In Minnesota, PrimaCare Direct is one of the most advanced models of direct primary care and has many attractive features for employers to seriously consider.

The most revolutionary change that Direct Primary Care brings to the table is cost conscious providers who are motivated to lower employer’s expenses.

For the first time in decades, employers, employees, insurance and provider’s interests are in alignment, as the DPC practice is motivated to minimize cost and maximize employee health.

The Providers are incentivized to include financial concerns in their decision making and time management.

From the employee standpoint, the key advantages are lowered out of pocket healthcare costs, improved access and higher quality, more comprehensive and better coordinated healthcare. Employees have a direct one-on-one advocate offering highly personalized care.

As direct primary care becomes more widespread, options for self-funded health plans re increasing. In fact, direct primary care lowers the entry-level threshold for self-funding. Self-funded companies dramatically lower healthcare costs by minimizing downstream costs:

  • Reducing unnecessary utilization of hospitals, ERs ad specialists
  • Objective referrals to specialists and hospitals that deliver improved value
  • Decreasing excessive lab, radiology and ancillary testing through active care coordination
  • Improving chronic care treatment adherence
  • Expanding the savings of primary care

Did you know that, according to the Institute of Medicine (IOM), one third of the healthcare dollars are spent on unnecessary care – or upwards of $690 Billion per year?

Since direct primary care eliminates the perverse financial incentive to refer patients out to specialists, clinics that are part of direct primary care networks often contain more in-house testing options. In other instances, DPC networks may seek out specialists who will steeply discount their charges in exchange for immediate payment.

PrimaCare Direct is a cooperative of clinics in Minnesota that want to lower the cost of healthcare to the patient, while focusing on providing exceptional care, centered around wellness. Traditional health insurance programs discourage doctor visits by adding extra costs to each visit (copays) or even accessing insurance altogether (deductibles.) PrimaCare Direct encourages patients to visit their physician regularly to achieve good health outcomes.

PrimaCare Direct covers 90{bcdee29d8ece072d76c660bfa283f395bc73ff9272f7bb81f739f49cdd20ae0b} of medical needs, but it will not cover 100{bcdee29d8ece072d76c660bfa283f395bc73ff9272f7bb81f739f49cdd20ae0b} of medical needs. A major medical plan is needed for the other 10{bcdee29d8ece072d76c660bfa283f395bc73ff9272f7bb81f739f49cdd20ae0b} of healthcare, hospital and specialty care. When you pair PrimaCare Direct with a major medical plan, it meets the Federal requirements of the ACA.

If you think this might be a viable option for your organization, let’s get together and discuss your situation. We have money-saving solutions for smaller groups as well as for larger groups.  For groups considering going self-funded, using direct primary care will be a great way to contain claim costs, and using a captive reinsurance approach will deliver the most efficient cost arrangement possible.

Remember, the physicians at participating PrimaCare Direct clinics are financially motivated to keep their patients healthy, and will manage their patients care to this end.  Where else does this situation exist?

 “Our organization has worked with The Cleveland Company for 25 years. Throughout the entire time, they have been an invaluable business partner. They have kept our organization aware of regulatory, legal and business practice changes in the industry ad provided appropriate resources and solutions. The staff at The Cleveland Company has always responded to our needs and requests in a very timely manner. They truly put their customers first. They are not only our broker, but our advocate.”

Leah Bredehorst, Training Manager, Lifecore Biomedical

For companies dealing with an endless sea of annual health care cost increases, aggressive solutions are critical to sustain business health and remain competitive. Let The Cleveland Company help you evaluate the past, current and future trajectory of your company’s health care costs.

DPC is a revolutionary concept, and I’ll touch more on the employee benefits and what’s covered under the plan in my next blog. In the meantime, if you would like to know more about the direct primary care product that PrimaCare Direct offers, please contact me.

Be well,



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