Here & Now

Alternative Health Model Being Considered

Frederica Freyberg:

In tonight’s inside look, an alternative model to primary healthcare that costs patients less than $80 a month. As healthcare costs rise, many patients are looking for other ways to pay for their routine medical needs. Marisa Wojcik reports.

David Usher:

Big breath, in and out.

Marisa Wojcik:

What if your primary medical care was delivered with like a gym membership? You pay a monthly fee for an expected set of unlimited services and leave insurance out of the equation. It’s called Direct Primary Care. Steve Heintz of Eau Claire can go see his primary care physician, Dr. David Usher, however many times he wants at no extra cost beyond the monthly fee.

Steve Heintz:

He said come in and just sit next to meet and we can just sit and talk. I spend quite a bit of time right here because of the health problems.

Marisa Wojcik:

Heintz does have health insurance through his employer but it covers specialty and catastrophic medical services. Proponents say that cutting out the insurance middle man for primary care means cutting overhead and administrative costs.

David Usher:

So in the standard world where you have to bill insurance on a fee-for-service basis, there’s always an incentive to see one more person. Why? Because that’s the only way you get paid.

Marisa Wojcik:

Dr. Usher and others say that patient numbers can be cut in half. They can spend more time with each patient and see them sooner so they can avoid visits to urgent care and emergency rooms.

Louwanda Heath:

It’s great. I mean really because it’s better than urgent care. I mean the cost and everything, you come in and you know you’re going to get treated. And you know you are not going to be in debt when you leave.

Marisa Wojcik:

There is another benefit that’s often over looked. Primary care is less attractive as a career path as physicians deal with large loads of patients for less money than specialty care.

David Usher:

Because primary care providers have been basically bought up by big systems, it’s hard sometimes for primary care providers to control that, the pace. That leads to a lot of burnout.

Marisa Wojcik:

Detailed recordkeeping required by health insurance companies also contributes to primary care physician’s exhausting workloads. But Donna Friedsam of the UW Population Health Institute says there’s a reason why these requirements exist.

Donna Friedsam:

Direct primary care providers, if they’re operating independent of any kind of integrated delivery systems, not billing insurance and not billing payors for their services, would not be submitting that kind of data and there’s some question about whether there would be monitoring of the quality and process for their services.

Marisa Wojcik:

The direct primary care model or DPC as it’s commonly referred to, is not insurance. Wisconsin legislation introduced last session would have specified that DPC providers are not regulated by the state insurance commissioner.

Donna Friedsam:

Insurance commissioner actually regulates health plans and managed care plans and insurance to make sure that whatever the product being provided, the insurance provider of managed care plan has the ability to provide those services.

Marisa Wojcik:

Regulation would also ensure patients could not be cherry-picked because they’re healthy or denied based on pre-existing conditions. The Eau Claire clinic does not discriminate what patients it accepts. Representative Melissa Sergeant wants to make sure consumer protections are built into the legislation. And the Wisconsin Association of Health Plans said the proposal could have unintended consequences on health insurance markets. The bill got put on the back burner. Starting next week, the legislative council will begin a study committee to research direct primary care.

David Usher:

Ok.