Director, Marketing and Product Development
Jennifer Austin joined The Alliance in mid-2019, leading the team in managing marketing efforts, including brand strategy, paid advertising, publication relations, social media, and website development.
Before joining The Alliance, Jennifer worked at a number of companies in Chicago and Madison focusing on marketing and strategy development for hospitals and health systems, including Advocate Healthcare (now Advocate Aurora Health), Augusta University Health, and HCA Healthcare.
Jennifer has a master’s degree in Global Marketing, Communications and Advertising from Emerson College and a bachelor’s degree in Art and English from The University of Iowa.
The Alliance hosted Dr. Kayur Patel of Proactive M.D. and Dr. David Usher, M.D., of ReforMedicine, for our first of a two-part series on Direct Primary Care June 8.
Missed the webinar? You can view it here.
What is Direct Primary Care?
Direct Primary Care is an innovative primary care model that emphasizes developing and maintaining a trusting patient-physician relationship while utilizing an alternative payment method that greatly improves access to high-quality care with a flat, affordable membership fee. It significantly differs from traditional primary care, which uses fee-for-service payments and third-party payers.
Employers are growing to identify the benefits of Direct Primary Care for their plan participants and their healthcare expenditure, and are adopting this model by utilizing an on-site, near-site, or shared-site clinic. In fact, in response to the ever-increasing demand for this model of care, The Alliance and Proactive MD are launching a pay-as-you-go Direct Primary Care clinic for employers called ProactiveMD Connected Health by The Alliance. Under this model, employers will only pay for the plan participants who access the health center.
Increased Time and Trust for Better Health
Direct Primary Care places an emphasis on length and frequency of contact between patient and primary doctor. “There is no substitute for time spent with patients – building trust takes time,” said Dr. Usher. By increasing the time patients spend with their primary physicians, a trusting relationship develops, which enables a more fluid and seamless flow of information between the patient and provider.
Practicing under this model, the physician inherently understands the patient and can make smarter recommendations and referrals. As Dr. Patel explained, “If the physician and patient spend more time together, they will intuitively make better choices for the patient and provide more complete care.”
Primary Care Directs Total Health
In today’s complicated health care world there’s a significant amount of specialty care and referrals, and there needs to be someone directing and managing each part of that care. Dr. Patel explained that direct primary care acts as that link and likened the primary care doctor to the quarterback of a football team.
“The quarterback has to be the family [doctor] who has the ability to navigate all the various specialty care, and soon as the patient is seen by the specialist, the primary care doctor needs to reprocess that information and figure out what the next move is going to be,” he said. In other words, the primary care doctor is the key to total health for a patient.
More Preventative Care = Less Emergency Care
More importantly, because the physician is more in-sync with their patient, they’re now better able to direct focus on preventative care, which can negate the need for expensive ER and urgent care visits, multiple and unnecessary tests and referrals to costly specialists.
“If we more appropriately direct care and manage preventative care,” Dr. Patel elaborated, “we will reduce the higher-complexity, higher-cost care – like surgeries and ER visits – to less-complex, less-expensive physicals and medications.”
Better Access for Patients
Additionally, patients have more convenient ways to access care in a Direct Primary Care model, like 24/7 telehealth services and same-day appointments. Some Direct Primary Care clinics feature expanded services, like on-site MRIs and prescription fulfillment, which increases convenience and reduces costs. As Dr. Patel explained it, “Access to care is critical in terms of offered value.” said Dr. Patel.
More Effective Payment Methods
Direct Primary Care providers pay for care on a per-member, per-month basis, as opposed to the traditional fee-for-service model. This reformed payment methodology rewards providers for quality of care, placing an emphasis on value over volume. There are no inflated costs due to third-party or fee-for-service billing because patients pay for their care directly to the physician. Most Direct Primary Care memberships/subscriptions cost less than the average cell phone bill, often for as little as $70/month.
“I want to have more time with my patients,” Dr. Usher said plainly, “In the traditional health care world, you make more money with two 15-minute appointments than a single 30-minute appointment. That’s why we moved into a Direct Primary Care model.”
Dr. Usher went on to explain that primary care is undervalued in traditional medicine due to the reimbursement structure in the fee-for-service model. “Primary care is often used as a referral engine to bigger, more expensive health systems,” he said. “For patients, this year’s charges become next year’s premiums – even with good insurance.”
In fact, general deductibles have increased eight times faster than wage increases, and premiums have increased every year since 2008. These costs are causing patients to ignore symptoms and forego treatment on manageable symptoms until they become, what Dr. Usher referred to as, “medically homeless.” Ultimately, those patients will end up seeking costly emergency treatment when things get worse.
Patients and Employers Prefer DPC
However, the Direct Primary Care model combats those traditional health care inefficiencies by providing patients with:
Better access to providers
Deeper, trusting relationships with primary physicians
Address root causes to health problems (not just symptoms)
Produce fewer referrals and expensive tests
Better work and lifestyles providers
As for employers, in addition to paying a simple monthly, per-member fee, they also experience reduced absenteeism due to happier and healthier workforces.
Dr. Usher ended his presentation by explaining that by moving to the Direct Primary Care model, his patient satisfaction has skyrocketed: “This model is highly popular with patients who really enjoy the access to health care and more specifically, the lower costs.”
In Dr. Patel’s closing remarks, he expressed that a good health plan heavily incentivizes direct-contracted primary care, and that employers need to take action for widespread acceptance. “As employers, you can make an impact as the largest purchaser of health insurance,” he concluded.
For more information on our new Sun Prairie clinic or to learn what it takes to start your own on-site clinic, please contact your Account Executive or reach out to Business Development.
In late April, The Alliance hosted their first Employer Town Hall. The e-conference roundtable was intended to provide a place for employers to share solutions and discuss the impact that COVID-19 has had on business operations.
In addition to a panel of leaders from The Alliance on the call, we hosted two employer-presenters to lead the discussion and help facilitate conversation: Jim Sheeran, Sr. Director, Total Rewards at Molson Coors Beverage Company and Diana Clark, Benefits Manager at Promega Corporation.
Both of our presenter’s organizations have initiated a COVID-19 task force, and in order to remain flexible and respond to changes quickly, Jim said meetings occur daily. “Our task force meets every morning, and every day at 4:00pm we have a leadership meeting which provides quick input from HR. We have an immediate feedback loop with union leaders which frames how we work as a task force.”
Adapting to the “New Normal”
Our presenters shared what tactics their businesses use to screen and test employees for COVID-19 and how they changed workstations, and even shifts in some cases.
For example, Diana said Promega’s normal operations occur in two shifts during a 5-day work week, and now they’re operating as a 3-shift, 7-day work week employer. This has been helpful in keeping production up-and-running while reducing the number of employees working to create the necessary separation that the CDC requires. She also said that taking simple measures like using painter’s tape to display separation requirements is successful in keeping coworkers safely spaced apart.
Diana explained how they double-checked their benefit plan to ensure that telehealth was offered to their employees: “Physician visits were excluded in a telehealth setting due to the wording in our contract, so we reached out to the TPA to update the communication.”
Molson Coors Beverage Company is a multi-national corporation who is well-equipped to deal with challenging operational situations, yet due to unprecedented conditions, Jim explained they’re reacting and trying new things like everybody else.
“We put in temperature checks that were no-touch, but they didn’t work well because we didn’t take into account the heat from the employee’s environment,” he added, “People call in sick to our hotline for work. If someone called in Monday and Tuesday because they weren’t feeling well but came in on Wednesday and called in sick again on Thursday, we should’ve flagged them as high-risk patients and not had them come to work.”
Diana said her team has initiated random exposure drills to help educate managers how be prepared. “We can run them through what a situation would look like if a specific employee were to get sick and how severe it would be in terms of potentially infecting other people. The drills help point out to managers the importance of following company procedures. “
Whether you want healthy employees to come to work or don’t want high-risk individuals showing up for their shift, Jim said incentivizing employees works, and it’s important to carefully think through incentives in order to not pay employees too much or too little. His organization gave a substantial pay-bump to their front-line workers and offered a “high-risk leave of absence” to employees.
Diana offered several useful learnings through her experience over the past two months:
Figure out what symptoms require separation from other people
Screening for coughing, fever, and shortness of breath has been successful in catching a few cases.
Know newer symptoms
COVID-19 can manifest itself as the flu, a sinus infection, or with headaches and body aches.
Develop an assessment and update it frequently.
Promega uses their Human Resource Business Partner team to help triage patients; they have a chief medical officer, an RN, and six other officials who clearly communicate to symptomatic patients to not go to work and call their manager instead.
Overall, Diana said their biggest goal is to keep people off campus if they are symptomatic. With the aid of their Medical Director, they’ve developed a protocol to call affected employees and ask them a series of questions to further determine their risk level. “We really stay in contact with our employee population. We’ve compiled a symptom checker that can be accessed through the patient’s computer or phone, and depending on how they answer, they’re either cleared for work or HR reaches out to them with next steps.”
Navigating furloughs was also part of the discussion, and Promega has been creative in shifting job responsibilities to eliminate the need to furlough. For example, they have a large staff of cafeteria workers who are now contributing to the manufacturing/operations side of the business. “It’s been amazing to see people step up. They want to help and be utilized,” Diana said.
Keeping Employees Safe (And Sane)
As far as supporting remote workforces, she offered a few tips: “Our physical therapists are now doing tele-consults, helping people with lower back pain, setting up their home workstations, etc.”
Knowing its importance, both organizations offer mental health resources through telehealth. “We have an emotional-social mental health team that helps boost our Employee Assistance Program (counseling,) which helps spot people with addiction and depression. Creating check-ins and virtual lunches have been critical for our remote employees,” said Diana.
Communication is Key
Both Jim and Diana also agreed that it’s not enough to ensure your employees are safe – they need to feel safe, too. By communicating protocols, posting flyers, and making constant announcements and reminders, employees will be more at ease about coming into work. Here are some ideas:
Use painter’s tape to direct employees to stay six feet apart
Use visual cues like signs to help facilitate proper safety, like washing your hands often and properly, coughing into a tissue, and wiping down frequently touched areas
Implement special visitation rules that include a screening and questionnaire
Jim and Diana agreed that things are changing quickly, and employers need to be willing to adapt to those changes; both of their companies follow all CDC guidelines and are continually watching for new state-specific mandates.
Stay tuned for our next Employer Town Hall, subscribe to our newsletter to stay up-to-date on upcoming learning opportunities, and watch for details on our upcoming webinar series about Direct Primary Care and how it can help your business.
The Alliance is a purchaser of health care services on behalf of our employers. That means that The Alliance is not a typical payer or insurance plan but understanding what health insurance plans are doing is essential to continuing to learn and grow to help our employer-members. Attending the AHIP (America's Health Insurance Plans) Consumer Experience and Digital Health Forum involved a lot of discussion around transparency, benefit plan design, and payment reform – what we consider to be the core drivers that employers can use influence in high-value health care. And most exciting of all, one of AHIP’s panelists, Martin Makary, MD, MPH, said the very thing we know to be true. Employers may be the biggest driver in creating change within health care.
Data was a major theme at the conference. Not just for consumers, who want access to their own health data, but also for doctors and employers to have greater access to claims data. Farzad Mostashari, MD, ScM talked about how claims data could help predict patient outcomes by analyzing medical errors and oversights. He suggested that there isn’t greater availability to this data because people are okay with the status quo, quoting Upton Sinclair. “It is difficult to get a man to understand something when his salary depends upon his not understanding it.” Salaries depend on keeping data hidden, so it remains unavailable to those that might benefit from it most.
Dr. Mostashari believes, in the end, that all the worries about price transparency will have the same outcome as the transparency around clinical data. “It will be fine.” Every other industry that has gotten more transparency has seen more innovation, so he thinks it will improve health care.
In addition to the transparency around cost related to health systems, there was also a session about the role physicians play in health care transparency. Martin Makary, MD, MPH, presumes that there needs to be greater availability of quality data with measures beyond just complications. He has been focusing on the appropriateness of care and billing quality. Both Dr. Makary and Reed V. Tuckson, MS, FACP agreed that there should be a standardization of quality measures, so doctors are measured similarly and know the expectations.
They also talked about how doctors can help change patient behavior. “Access to data is not enough. Data alone doesn’t change behavior,” Dr. Tuckson said. He feels that physicians need to understand people’s decision-making and beliefs about health better. He wants to work with health plans to get data on how to be more consumer-centric. This topic isn’t covered in medical school, and Dr. Tuckson said there needs to be medical education around how to change people’s behaviors.
Dr. Makary also believes employers have the biggest ability to drive high-value care through steerage and by owning independent primary care clinics. He mentioned large employers, like Walmart, and I chimed in that we have small employers doing that great work as well. And that those are just two strategies The Alliance is working with employers to implement to drive high-value health care.
For more information on the strategies that our employers have implemented around high-value health care, and tips for self-funding, read The Alliance case studies. To learn more about how The Alliance works with employers to make health care more affordable, contact our Business Development team. Members and their advisors who want to learn more about our four core drivers are encouraged to contact the Member Service Team.
More About How Employers Can Change Health Care
Learn how you can influence health policy with The Alliance
Wisconsin Can Save $394 Million by Steering Patients to High-Value Health Care
Read case studies about employer-members who made a difference with self-funding
One of the best things about being part of an employer cooperative is watching employers learn from and with each other. Attending the National Alliance 2019 Annual Forum took that to the next level by gathering health care purchasing coalitions together to discuss new ideas and share best practices. The National Alliance 2019 Annual Forum, held November 11 – 13 in Washington, D.C., hosted about 40 health care purchasing coalitions from across the country, along with a number of vendors and partners.
The Fight For Transparency
The biggest takeaway from the forum is that most coalitions have the same focus that The Alliance does. The four core drivers – transparency, payment reform, benefit plan design, and provider network design – were discussed throughout the three-day event. The RAND Study, in particular, was presented as a helpful tool in the fight for transparency. The coalitions that have price information around how much hospitals are paid relative to Medicare are taking it to the negotiation table to get more affordable health care. The negotiations are not just for the employers, but for their employees too since households in the bottom 20 percent of income spent 26.8 percent of their income on health care in 2016, according to Health Affairs.
Payment Reform That Fits The Bill
Payment reform was also a hot topic discussed, in particular, surprise billing. The Economic Alliance of Michigan discussed surprise billing legislation that would limit out-of-network care providers from collecting only 125 percent of what Medicare pays for care in Michigan. Hospital associations are in support of a fix for surprise billing but do not want to agree to 125 percent of Medicare, according to one article. While this is being discussed at the federal level, individual states are trying to pass legislation until a federal law can be passed to resolve the issue.
One session, which included speaker A. Mark Fendrick, MD and Director of the University of Michigan Center for Value-Based Insurance Design, explored benefit plan design to eliminate low-value care and incentivize high-value care. Frendrick said that the employer sector is the right one to figure out health care because they’ve figured to spend money more efficiently in every other area. He believes that patients should have little to no out-of-pocket cost for high-value health care. Fendrick and a multi-stakeholder task force identified overused services that could be reduced with little to no harm to patients. Those services included vitamin D screenings, PSA screenings in men 70+, diagnostic testing and imaging before low-risk surgery, and exchanging branded drugs for generic drugs when they are available. When looking at those services, The Washington Health Alliance used the Health Waste Calculator to identify over $92 million in unnecessary pre-op testing alone that could be eliminated based on the recommendations. The conclusion being that increased cost-sharing on low-value services reduces health care spend and allows for increased spend on high-value services.
Network Design Based On Value
Provider network design was also a highlight of the event as General Motors’ Sheila Savageau, U.S. health care leader for global compensation and benefits, spoke about their unique partnership with Henry Ford Health Systems. They created a narrow network with concierge services. In doing this, they have reduced employee health care costs and improved service. The integrated health care delivery system shares cost savings and pays based on value. Henry Ford needs to hit a financial budget and will be held accountable for hitting essential quality, cost, and utilization of services metrics agreed upon with General Motors. Savageau ended her session by saying, “Employers need each other to really make a difference [in health care].” And The Alliance couldn’t agree more.
To learn more about how The Alliance works with employers to make health care more affordable, contact our Business Development team. Members and their advisors who want to learn more about our four core drivers are encouraged to contact the Member Service Team. And to learn more about why our member, Brakebush Brothers, Inc., won the 2019 Employer/Purchaser Excellence Award by the National Alliance of Healthcare Purchaser Coalitions alongside The Walt Disney Company this year read the case study on how they had lower per member health benefit costs in 2018 than in 2014.
Learn about The Alliance Roadmap to High Value Care: Provider Network Design, Payment Reform and Transparency
Read the case study on our member, Brakebush Brothers
Visit the National Alliance of Healthcare Purchaser Coalitions website