Study: Massachusetts Should Embrace Direct Healthcare Options

Share on Facebook
Share on Twitter
Share on
LinkedIn
+

RevCycle Intelligence: Direct Primary Care Increases Patient-Centered Care Access

Approach to investing in primary care yields lower costs, greater efficiency and increased patient satisfaction

BOSTON – Especially in the COVID era, many are looking to alleviate the increased burden on the healthcare system.  One solution is direct healthcare (DHC), which can provide more patient-centered care at affordable prices and is an effective model to increase access to care for the uninsured, underinsured and those on public programs like Medicaid, according to a new study published by Pioneer Institute.

“This approach to investing in primary care has been shown to reduce costs, emergency room visits, inpatient care and visits to specialists, all while increasing patients’ satisfaction with their care,” said Josh Archambault, co-author with Greg George of “Direct Health Care Agreements: A New Option for Patient-Centered Care That Costs Less and Reduces Provider Burnout.

Under DHC, patients pay practices a set monthly fee that covers a prearranged universe of services.  It is most common in primary care, but can be used for other types of care such as physical therapy, behavioral and mental health, and dentistry.  There are currently 1,200 direct primary care (DPC) practices in the U.S., at least 16 of which are in Massachusetts.

For primary care, patients begin by choosing their provider, then purchase a complementary insurance plan.  They can usually buy a much less expensive plan with a higher deductible because they have access to so many services through DPC.

DPC agreements commonly include:

  • Unlimited office visits
  • Home visits
  • Same- or next-day appointment availability
  • Longer visit durations
  • Annual physicals
  • Vaccinations
  • Routine lab tests
  • Stitches and splintering or casting of fractured or broken bones
  • Help navigating the rest of the healthcare system
  • 24/7 emergency triage support

Some agreements include access to generic prescription drugs at near wholesale prices.  Many DPC physicians give patients their personal cell phone numbers.

In 2018, nearly 80 percent of DPC subscription fees were between $51 and $99 per month, and costs have been stable over time.  About 60 percent of patients who belong to a DPC practice have an annual household income of $95,000 or less.

One DPC provider shared the story of an uninsured 30-year-old man who pays $648 a year for access to the direct primary care practice.  Since joining the practice the patient has suffered from a serious sinus infection, recurrence of cellulitis with abscesses that required draining, had multiple musculoskeletal injuries due to a car crash, and needed an x-ray for a possible femur fracture.  The only additional cost to the patient for treatment of all these ailments was a $60 x-ray and inexpensive antibiotics.  All other care was provided for under the $648.  If he had sought care at the emergency room for any of the ailments, his bill for one visit would have been two or three times that amount.

There are no deductibles, co-pays or third-party insurance claims.  The transparency and lack of surprise bills address the issue of those who don’t see their doctors because of uncertainty over the cost.

DPC patients have an average of four, 35-minute visits a year with their physician.  Under the typical fee-for-service model, patients have 1.66 visits annually and spend around 15 minutes per visit with their physician.

DHC also results in far less physician burnout. “Status quo” providers currently report spending around a third of their day on administrative tasks, by contrast direct care providers spend much more time with patients because there is no paperwork to fill out for insurers.

DHC could help a number of patient groups.  Access to same- or next-day appointments could be particularly helpful to MassHealth members.  Pre-pandemic, the average wait for a doctor’s appointment in Boston was 50 days, and many providers don’t accept Medicaid.

Older adults on Medicare who often have trouble finding transportation to medical appointments could benefit from the home visits usually included in DPC agreements and from the more personal management of chronic illnesses that comes with longer and more frequent appointments.

A study published in the American Journal of Primary Care found that a small subset of direct health care arrangements studied resulted in a $119.4 million decrease in preventable hospital use in these practices in New York, Florida, Virginia, Arizona and Nevada.  Over 90 percent of the savings – $2,551 per patient – came from Medicare patients.

DHC also offers an innovative option for small businesses.  Superior Packaging and Finishing in Braintree saved $370,000 in a year, or over $4,300 per enrolled employee, when the company switched to offering a DPC plan to its employees.

Archambault urges the Commonwealth to take four steps to embrace DHC:

  1. Division of Insurance guidance should be updated to match 35 other states by clarifying that any form of direct care should not be regulated like insurance. If there was clear support, the Legislature could codify this standard.
  2. The Group Insurance Commission should embrace direct health care arrangements for public employees and offer it as a lower-cost option.
  3. MassHealth should explore DHC arrangements, especially for some of the sickest patients on the program.
  4. The Legislature could consider requiring that insurance companies offer at least one product to consumers that wraps around DHC arrangements, especially DPC. This reform would introduce a new, less-expensive option for consumers, as the product would have a higher deductible than most plans currently offered in Massachusetts.

About the Authors

Josh Archambault is a Senior Fellow at Pioneer Institute. Prior to joining Pioneer, Josh was selected as a Health Policy Fellow at the Heritage Foundation in Washington, D.C. In the past, Josh served as a Legislative Director in the Massachu­setts State Senate and as Senior Legislative Aide in the Governor’s Office of Legislative Affairs. His work has appeared or been cited in outlets such as USA Today, Wall Street Journal, The New York Times, Fox News, NPR, Boston Herald and The Boston Globe. He is the editor and coauthor of The Great Experiment: The States, The Feds, and Your Healthcare. Josh holds a Master’s in Public Policy from Harvard University’s Kennedy School and a BA in Political Studies and Economics from Gordon College.

Greg George is the health policy and state affairs advisor for the Mackinac Center for Public Policy.  Prior to joining Mackinac, Greg served as a senior research fellow at the Foundation for Government Accountability. He has also been a policy advisor for the Michigan House of Representatives and legislative director for the Michigan Speaker Pro Tempore. He holds a Bachelor of Science in Finance from Hillsdale College and a Master of Business Administration from Western Michigan University.

About Pioneer

Pioneer’s mission is to develop and communicate dynamic ideas that advance prosperity and a vibrant civic life in Massachusetts and beyond.

Pioneer’s vision of success is a state and nation where our people can prosper and our society thrive because we enjoy world-class options in education, healthcare, transportation and economic opportunity, and where our government is limited, accountable and transparent.

Pioneer values an America where our citizenry is well-educated and willing to test our beliefs based on facts and the free exchange of ideas, and committed to liberty, personal responsibility, and free enterprise.

Get Updates On Our Healthcare Research and Events!

Related Posts

Alzheimer Breakthrough Disillusionment: Confusion on FDA’s Approval of Expensive and Possibly Ineffective Drug

Hubwonk host Joe Selvaggi talks with precision medicine expert Hannah Mamuszka and Pioneer Institute's Bill Smith about the promises and pitfalls of the newly approved Alzheimer’s drug Aduhelm, and the challenges presented when new, expensive drugs of dubious benefit are introduced to the nation’s formulary.

Comparing Covid-19 Vaccination and New Infection Rates in Suffolk County: Is Vaccination Working?

/
Massachusetts ranks fourth nationally for the highest percent…

Dr. Babak Movassaghi on Winning in Football & Healthcare Innovation

/
This week on JobMakers, Host Denzil Mohammed talks with Dr. Babak Movassaghi, founder of InfiniteMD (acquired last summer by ConsumerMedical), which connects patients with top U.S. medical professionals through second-opinion video consultations, guiding patients to better care. When the world shut down due to COVID-19, Dr. Movassaghi's company was already prepared to serve patients via telehealth. In this episode, they discuss his fascinating pivot from physics and professional football in Germany, to healthcare and innovation here in the U.S., an extension of his ability to navigate multiple identities as an Iranian-German living the American Dream.

Valuing Life-Saving Drugs: What is the Price of Life and Who Decides?

Hubwonk host Joe Selvaggi talks with Pioneer Institute visiting fellow Dr. Bill Smith about Quality Adjusted Life Years (QALY) standards, and the ways in which so-called objective cost-containing strategies use expert opinion to determine the value of a life and thereby disadvantage the elderly, disabled, and those with less common vulnerabilities to disease.

Study: Massachusetts Should Retain Additional Healthcare System Flexibility Granted During Pandemic

Massachusetts’ emergency declaration for COVID-19 ends on June 15, and with it some enhanced flexibility that has been allowed in the healthcare system.  Some of the added flexibility highlighted barriers that make the system more expensive, harder to access and less patient-centered, and the Commonwealth should consider permanently removing these barriers, according to a new study published by Pioneer Institute.

Study Calls for Better Reporting on Impact of COVID-19 in Eldercare Facilities

Over time, the Massachusetts Executive Office of Health and Human Services and Department of Public Health (DPH) have improved reporting about cases and deaths from COVID-19 in state-regulated eldercare facilities, but flaws and omissions remain and should be corrected, according to a new study published by Pioneer Institute.

Massachusetts Should Disclose More Information about Its Recent Reduction in the Official Count of Long-term Care Deaths

The public -- particularly in Massachusetts, where COVID-19’s toll on elders has been so great -- has a right to know how many deaths occurred in state-regulated eldercare facilities, and how that compares to the total number of deaths. But the state's new counting standard clouds this information, and should be corrected or at least disclosed.

Preparing For Disaster: Health Readiness Expert’s Performance Review

Hubwonk Host Joe Selvaggi talks with Emergency Preparedness expert Dr. Paul Biddinger about how experts plan for disasters, and what went right and wrong in this pandemic.

COVID-19 Vaccine Tracker

Pioneer is proud to present a new vaccine tracker, the newest tool in our COVID-19 tracking project. Pioneer distilled the vaccination data down to those who are either fully vaccinated or partially vaccinated, by all the demographic categories published by the DPH. Use the new tool below to compare rates among groups, by municipality and by county. We will update the data every week.

Doctor Heal Thyself: Insider’s Prescription For Healthcare Reform

Host Joe Selvaggi talks with surgeon and New York Times bestselling author Dr. Marty Makary about the healthcare reform themes in The Price We Pay, the 2020 Business Book of the Year.  The discussion covers the value of price transparency, provider accountability, and performance information to drive better medical outcomes and improve doctor and patient satisfaction.

New Analysis: ICER Framework Ignores Patient Preferences, Innovation & Societal Benefits in Evaluating Cost-Effectiveness of New Cancer Treatments

Pioneer Institute today released a new analysis, The QALY and Cancer Treatments: An Ill-Advised Match, that examines the alarming methodological and contextual shortcomings of the Quality Adjusted Life Years (QALY)-based methodology in evaluating new cancer therapies. The Pioneer Institute analysis reveals five specific problems with ICER’s evaluation of cancer treatments and demonstrates the urgent need to prohibit the use of the QALY amid trends in rapid cancer innovations and personalized medicine.

Digesting Digital Medicine: Healthcare Benefits When Smart Pills Track When Taken

/
Host Joe Selvaggi and Pioneer Institute’s Bill Smith talk with Valerie Sullivan, President and CEO of EtectRX about the health care costs of improperly taking prescriptions and the promise of smart pills to signal and track medicines when ingested.

Patient-centered Model Outshines Insurance-centered Healthcare during Pandemic

/
Joe Selvaggi talks with Pioneer Institute Senior Fellow Josh Archambault about his newest research paper entitled, "Direct Health Care Agreements: A New Option For Patient-Centered Care That Costs Less and Reduces Provider Burn-out" and how this emerging service model provided its patients with comprehensive health service throughout the COVID-19 pandemic.

Study: Massachusetts Should Embrace Direct Healthcare Options

Especially in the COVID era, many are looking to alleviate the increased burden on the healthcare system.  One solution is direct healthcare (DHC), which can provide more patient-centered care at affordable prices and is an effective model to increase access to care for the uninsured, underinsured and those on public programs like Medicaid, according to a new study published by Pioneer Institute.

COVID-19 Vaccine: The End of the Epidemic is Within Reach

/
Join Host Joe Selvaggi and Virologist and Investor Dr. Peter Kolchinsky as they discuss the rapid development, efficacy, and rollout of the newly approved COVID-19 vaccines.

Voting for Health: Party Opinions, Election Results & the Healthcare Policy Implications of Election 2020

/
Join Host Joe Selvaggi as he discusses with Harvard Professor Bob Blendon his New England Journal of Medicine Special Report, "Implications of the 2020 Election for U.S. Health Policy," which covers broad differences in both party’s view of the role of government in health care and what the election results will mean for Americans.