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WNC Business

Increasingly popular healthcare model helpful for employers

Feb 06, 2024 08:30AM ● By Randee Brown

Direct Primary Care is a relatively new membership model for healthcare that avoids filing claims with health insurance companies. Dr. Chad Krisel at Integrative Family Medicine said all other insurances are put in place to protect against catastrophe. As people began using health insurance for routine care and minor injuries or illnesses, the additional processes and paperwork led to healthcare practitioners requiring higher volumes of patients to earn revenue.

Krisel said according to Health Affairs, a monthly peer-reviewed healthcare journal, taking on medical insurance can cost an average of $83,000 per year per medical provider. Taking on a higher number of patients to earn enough revenue to cover those costs means doctors have less time to spend with each patient.

“Taking insurance out of the equation allows physicians and staff to focus on face-to-face experiences with patients,” Krises said. “People should still have some kind of health insurance coverage, but a direct primary care membership model can help dramatically lower their monthly premium by allowing individuals to choose a plan with a higher deductible and less benefits. Plus, doctors don’t have to feel rushed, charting as fast as they can then sending a huge bill to their patients.”

According to Krisel, 85% of healthcare costs in the U.S. are focused on treating devastating outcomes of treatable, reversible, and preventable conditions. A five-minute office visit with a primary care physician cannot provide enough insight and recommendations to fully evaluate lifestyle-based conditions like high blood pressure or high cholesterol. With the third leading cause of death in the U.S. being medical errors, eliminating unnecessary procedures by implementing preventative plans to mitigate these conditions could save thousands of lives.

“By cutting out medical insurance, physician income needs are not as high,” Krisel said. “With this model, patients experience very short wait times and are able to spend 25-50 minutes with their doctor. This time allows an authentic connection, providing a deeper understanding of factors of preventable conditions.”

Several healthcare systems are beginning to implement direct primary care models into their existing services. President and CEO of Mercy Urgent Care Rachel Sossoman said offering this model in their eight clinics across five WNC counties not only provides improved access for individuals, it also provides employers the ability to offer medical benefits to employees at a reasonable cost.

Formerly working in human resources at Sisters of Mercy Services Corporation, Sossoman noticed a healthcare and benefits gap in what employers wanted to provide and what they could afford, especially the 700-plus nonprofit organizations in the Asheville area. 

“I saw that we were losing great people doing great work because organizations couldn’t offer certain benefits,” Sossoman said. “We felt like the logical next step is helping employers provide those benefits.”

Sossoman said employers’ ability to offer benefits helps with employee retention, and for nonprofits, this means more time can be spent on their services and the needs of the community. It also allows employers with a part-time workforce to decrease their high turnover rates by helping to retain those employees.

By cutting out administrative costs and paperwork as well as offering direct relationships with clinics, employers are also able to leverage offering benefits as a recruitment tool. Feedback from nonprofits and other employers has been positive, many never having the option to provide medical benefits to their staff in the past.

Since Mercy began offering its direct primary care model in October of 2022, Sossoman said employers and individuals have been signing up every day for different levels of membership. 

“We’re seeing a substantial number of signups,” Sossoman said. “The growth of this program is such that it is quickly becoming a primary segment of what we do. We won’t let go of walk-in urgent care, but we are moving forward in making sure that we are fully serving all different types of populations who live in our community.”