How Primary Care Affects Health Care Costs & Outcomes
Overview of HELP Committee Hearing
On Feb. 5, 2019, the U.S. Senate Committee on Health, Education, Labor & Pensions (HELP) met to discuss how expanded access to primary care can help reduce overall health care costs. This hearing was the latest discussion of reducing health care costs, with the committee holding five separate hearings during the last session of Congress on the issue.
In this most recent hearing, HELP Committee Chairman U.S. Sen. Lamar Alexander cited testimonies from Dr. Lee Gross, a Floridian direct primary care (DPC) provider, who has found cost savings and improved health care through primary care.
This article explains what DPC is and provides a summary of the four testimonies given during the hearing.
What is DPC?
With DPC, physicians, pediatricians and internists charge a monthly membership fee that covers most of what the average patient needs for primary care, including visits and drugs at lower prices, instead of accepting insurance for routine visits. As a result, DPC can provide substantial savings to patients. Here is an example of a typical DPC plan: • Cost of visit—Free with monthly membership • Copay cost—No copays • Length of visit—Typically 30-60 minutes (traditional doctor’s office visits are less than 20 minutes)
Because they don’t operate under the typical fee-for-service model, many DPC providers are able to spend more time with their patients. Research shows that patients who have a good relationship with their doctor receive better care and are happier with the care they receive.
In the hearing, Alexander explained that Dr. Gross charges monthly fees of $60 for each adult, $25 for one child and $10 for each additional child. In return, his patients receive primary health care services such as getting vaccinations or managing a chronic condition. Alexander stated that Dr. Gross’ DPC practice is a good example of how DPC can result in lower health care costs, as it focuses on continual wellness, helps keep patients out of the emergency room and provides easy access to more advanced care.
During the hearing, the committee heard testimonies from four different witnesses, all of whom gave anecdotes on how primary care can help lower health care costs, improve patient outcomes and improve access to affordable care.
The first testimony came from Dr. Joshua Umbehr, co-founder of AtlasMD Family Practice in Wichita, Kansas. Umbehr believes that including DPC could be beneficial to many, including patients, providers and employers. He goes on to say that the current insurance-based health care model has seen a disconnect between the value and cost of care.
Umbehr says that, because DPC offers an uncommon level of transparency and a flat fee, it’s possible to provide patients with the care they need when they need it and at a cost they can afford. Umbehr also points out that with DPC, the physician is the patient’s advocate, so they’re better positioned to help them make the most informed health care decision possible. As the market has seen lately, many Americans have low health literacy, which contributes to unnecessary health care spending.
Moreover, he affirms that he is not anti-insurance or anti-government in his approach, but he believes that DPC can decrease the cost of care so much that insurance is no longer needed unless in the event of a catastrophic or complex expenses. Umbehr believes that, with the support of employers and state and federal officials, DPC can be used to help revolutionize the way health care services are delivered in the United States.
The second testimony came from Dr. Sapna Kripalani, Associate Professor of Medicine at Vanderbilt University Medical Center. Kripalani believes that primary care is a time consuming but essential step in improving the quality and lowering the cost of health care. Her testimony focuses on how investments in primary care can increase innovation in health care, reduce health care spending and lead to investments in the work force.
Kripalani stated in her testimony that primary care investments would enable innovations in the way that health care is delivered. For example, telehealth could be made more available to patients, allowing them to receive care from the comfort of their own home. Providing this type of care of care is not only more efficient for patients and providers alike, it also reduces health care costs, as a telehealth visit is much less expensive than an in-person visit. In the same fashion, Kripalani believes that primary care will put patients in touch with the proper care they need at the time they need it. This can help reduce unnecessary health expenses because costly emergency room visits wouldn’t be used for conditions that could be addressed in a primary care setting. Finally, she sees a movement focused on primary care as a solution to the looming physician shortage.
The third testimony came from Dr. Katherine Bennett, Assistant Professor of Medicine and Program Director of the Geriatric Medicine Fellowship at the University of Washington. Her testimony was largely based upon the success Project Extension for Community Health Outcomes(ECHO) has had in various specialties, including hepatitis C,HIV, chronic pain, heart failure, mental illness and geriatrics.Project ECHO focuses on providing primary care services, like treatment, education and community support to address specific conditions. Bennett believes that projects like this will reduce the overall cost of health care if implemented across the country.
The fourth testimony came from Tracy Watts, Senior Partner, National Leader for U.S. Health Care Reform, Mercer. Through research of her own, Watts found that clinicians believe improvement of patient care and reduction in health care costs stems from primary care. Additionally, her testimony focused on what employers currently provide to employees.
Her testimony revealed that 31 percent of employers offer on-site medical services of some sort, bringing primary care to their employees. By creating this ease of access, employers surveyed found that overall employee health, presence and productivity increased. Watts also spoke on how telehealth and primary care services work hand-in-hand to reduce health care costs and improve patient care, similar to how Kripalani explained it works.
Finally, she called on Congress to pass legislation enabling the expansion of health savings accounts (HSAs) to cover health care costs such as DPC costs and pre-deductible use of telemedicine services or employer on-site medical clinics without risking HSA eligibility.
Reducing health care costs is a main concern for employees and employers. The Feb. 5 HELP hearing confirmed this. Chairman Alexander indicated that the committee will pursue legislation this Congress to reduce the costs of health care.
To view the hearing, click here.
This Benefits Insights is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.