“The more time you spend with your provider, the more accurate your diagnosis will be,” said Dr. Michael Tuggy.
Dr. Tuggy is the vice chair at Family Medicine for America’s Health and a clinical professor at the University of Washington. He spoke at two events hosted by The Alliance to start a discussion about high-value health care and employer-sponsored direct primary care clinics.
- A Patient Story on High-Value Primary Care
- Fee-for-Service Model in U.S. Health Care
- Benefits of High-Value Primary Care
- Different Payment Models for Longer Office Visits
- Employer Sponsored Direct Primary Care (DPC)
- Can you offer a Direct Primary Care Clinic for your Workforce?
Dr. Tuggy shared a story about a patient who was convinced he had a kidney stone. “The patient had a kidney stone years ago,” said Dr. Tuggy, “he thought his symptoms were the same as before and he was basically handing me the diagnosis.”
Dr. Tuggy’s clinic focuses on high-value primary care. One of the pillars of a high-value primary care office visit is longer appointment times than the current standard.
Because Dr. Tuggy had that additional time built into his schedule, he was able to ask his patient more questions. After a few questions, Dr. Tuggy determined that his patient was having symptoms that were similar, but slightly different.
Dr. Tuggy ordered an additional test which revealed that the pain was being caused by a small tumor on the kidney, not kidney stones.
Dr. Tuggy believes having additional time to ask more questions about the patient’s symptoms helped prevent a misdiagnosis of kidney stones. Because this patient’s tumor was found early, it was cured with surgery. High-value primary care may have saved this patient’s life.
Stories like this are one example of why The Alliance is focusing on high-value primary care. The February events hosted by The Alliance sparked conversations with employers and their brokers about changing the health care system where it starts. Primary care clinics are where patients receive the majority of their care.
“Most medical care in the U.S. is delivered under a fee-for-service model,” said Dr. Tuggy.
A fee-for-service model is essentially reactive care aimed at treating existing problems. Visits are kept short so providers can see more patients in a day, which means they receive more fees. When patients have problems that require more time, they must return to the clinic for additional visits or see a specialist, which means even more bills. Under the fee-for-service model, doing more things to patients — more tests, more procedures — increases the fees collected. That sometimes means that improving patient health outcomes matters less.
Diagnosis Accuracy = Chance of Referral
Chance of Referral = Total Cost of Care
Fee-for-service’s shorter office visits often mean reduced diagnosis accuracy, more referrals to specialists and a higher total cost of care.
High-value primary care promotes longer standard office visits. This leads to proactive care that treats the whole person, catches health concerns while they are still small and promotes better health outcomes.
Results of longer primary care office visits, include:
- Better communications and understanding between patient and primary care provider.
- Greater trust in the relationship between provider and patient.
- Increased accuracy of diagnoses.
- More time for basic in-office procedures without the need for scheduling an additional office visit or specialty referral.
- Lower the total cost of care by an average of 15 to 30 percent.
Longer office visits have been found to benefit patients, providers and the bottom line of the employer-sponsored health plan.
Paying for longer office visits requires a different payment model. Comprehensive Primary Care Payment (CPCP) is often structured as a per-employee-per-month (PEPM) payment.
This payment model focuses on the health of the total population served by the clinic care team. Protocols help care team members triage patient care to the appropriate team member and schedule the most efficient appointment available.
The Alliance’s Annual Seminar: Finding the Value in High-Value Primary Care
That is why The Alliance selected this topic for the May 21, 2019 Annual Seminar. Will you be attending?
Dr. Rishi Manchanda, Public Health Innovator and author of The Upstream Doctors and Former Chief Medical Officer of The Wonderful Company will be giving the keynote speech. Learn more about the event and register to attend, today.
Direct Primary Care (DPC) is more than just adding more time for standard office visits. In fact, employer-sponsored DPC could be a U.S. health care game-changer for employers with self-funded health plans.
DPC focuses on the well-being of the entire patient and offers multiple ways to access care. Same-day or next-day appointments are typical. Also, secure direct messaging or phone conversations are often available in place of a face-to-face office visit. This provides 24/7 access to care for all patients.
DPC also differs in other important ways.
- Proactive prevention is a coordinated effort by the direct primary care team. Electronic records, reminders and pre-visit preparation are used to increase the efficiency of the office visit.
- Chronic Disease Management can often be monitored by the direct primary care team, often without consultation from costly specialists.
- Basic procedures such as skin biopsies, joint injections or ultrasounds can often be performed during the primary care office visit without need for scheduling another appointment or referring the patient to a specialist.
- Population Health Management is a priority within this model. Risk-stratification protocols and regularly-scheduled time for the care team to conduct patient outreach are standard practice.
DPC is all about the patient’s needs. It is focused on providing the right care at the right time in a relationship based on trust
“No one changes their behavior unless they trust the person giving them the advice,” said Dr. Tuggy.
Whether it is a tetanus immunization reminder or a discussion about losing weight, patients are more inclined to change their behavior for a better health outcome if the information is personalized and coming from a trusted medical provider.
“Primary Care is an investment; the rest of health care is a payment,” said Dr. Jed Constantz, Dr. B.A., Health Care Strategist.
Large employers are more likely to offer a DPC clinic, but options are now available for smaller employer populations to start a clinic or join together and start a clinic. Guided by extensive research, The Alliance developed a DPC clinic model for employers in Wisconsin, Illinois and Iowa that can be shared.
- The role for employers: “Moving Upstream in Health Care.“
- Wisconsin Can Save $394 Million by Steering Patients to High-Value Health Care
- Searching for more ways to change the price of employee health care? Here’s eight ways.
- High-value primary care – read more about it.
- Moving Upstream in Health Care: The Role for Employers - June 17, 2019
- Employer Connections: Benefit Design Challenges and Solutions - May 13, 2019
- How to Give Your Employees Access to High-Value Primary Care - April 30, 2019