Direct Primary Care Webinar

THIS EVENT IS AVAILABLE TO WATCH ON-DEMAND.

Please join us for the first of a three-part webinar series on Direct Primary Care featuring Dr. Kayur Patel, Chief Medical Officer at Proactive MD, and Dr. David Usher, M.D. at ReforMedicine. HRCI Credits have been approved and other CE Credits have been applied for.

Dr. Patel will discuss how and why health care doesn’t have the systems in place for integrated health, and what we can do to provide real, quality care to patients by utilizing incentives. He’ll also provide an overview on Direct Primary Care – what it is and how it works.

In addition to talking about how he’s approached health care during the pandemic, Dr. Usher will discuss his background as a Family Practice Physician and chair of the Family Medicine Department in a large system and how that experience influenced him in 2011 to found a Direct Primary Care Practice focused on affordable high-value health primary care.

In part two of this series (June 25th, 11:00am) you’ll hear from employers on why and how they got involved in Direct Primary Care – including their internal processes and success stories related to opening an on-site or shared-site clinic.

Watch the recording:

If you attended this webinar you know that Direct Primary Care is a very hot topic. There were a lot more questions asked than our experts could answer in a single virtual session, so we took the time to compile those questions and ask our speakers to answer them so we could share them with our stakeholders. Here they are:

We’re building a clinic in conjunction with a few other area employers, and we are in a rural area. Can DPC staffing work with a Nurse Practitioner (NP) or a Physician’s Assistant (PA) as the lead at the clinic?

• Patel: Yes, I think the key thing to consider is the level of service you’re trying to provide. For the most part, NPs and PAs do a phenomenal job, it’s really about navigating the care through your community or through the specialty in your town. Of course, with resources, sometimes it’s hard to recruit. Our number one problem right now is just getting the recruitment in an area where you need help. We have many practices that do run on NPs and PAs today.
• Usher: I would agree. Among our providers, we have fantastic NPs and PAs staff who I really trust implicitly. I agree with Dr. Patel, it’s really a strategy issue from the employer and what it is they are trying to achieve as to how much they want to put into a Physician vs. NP vs. PA. There’s just some cost differential there and recruiting is tough. Not everyone sees us as the quarterbacks.

Do you handle more than primary care?

• Usher: Sure, we have contracted with licensed professional counselors to see patients within our office space, pre-COVID of course. Since then we have learned that patients really like that counseling administered via telehealth. That same counseling group has been providing telehealth services for our folks in the counseling realm, so the patient doesn’t even need to come into our office. That has gone pretty well. We have not contracted directly with any physical therapy or chiropractor ourselves. Some of our employers have contracted directly with them, they have PT onsite for example, and I do think that’s a really valuable service.
• Patel: Yes, number one, all our clinicians are trained in the direction of muscular skeletal and physical therapy. Number two, we have one of our health centers that has a full-time, 40-hour PT onsite in conjunction with the clinician. So essentially, that population of the employees have access to a clinician and a physical therapist anytime. We deployed that about 8 or 9 months ago, and we are looking at replicating this similar model in other areas of our health owners based on size, volume, and need. In looking at options of smaller population, telehealth would be another option. As far as behavioral health, like David said it is very medicine-driven and we are actually looking to recruit a full-time MD to help navigate the first site and then multiply it across our centers.

Is The Alliance Clinic staffed by Physicians?

• Melina Kambitsi: Yes, The Alliance has made the commitment to bring in a Physician to staff the first clinic we will be offering. Going back to what Dr. Usher & Dr. Patel said, it’s a strategic decision. We absolutely believe in the middle-level provider offering services, and the Nurse Practitioner and the Physician Assistant as leads at clinics. Because this is the first for The Alliance, our clinic will be staffed by a Physician.

Do most of your Employers in DPC models cover only those in their plan, or do they cover their entire employee population? Is making it free critical for maximizing utilization?

• Patel: It depends on the employer. Most of our employers allow their employees that are on their health plan and their dependents to join the DPC model. There are very few employers that only have the employees and not the dependents, so it’s based on what their needs are.
• Usher: Because DPC is not insurance, employers can put anyone on the plan or allow anyone on the plan they want to involve. You can have part-time employees on your plan if you wish.

Do you offer MRIs? How do you recommend where patients go to receive MRIs?

• Usher: What we do is we look at what the employers network is and usually they will have a high-value set of centers that they have designated as the lowest price and the best deal for getting things like MRIs, CAT Scans, specialty care and so forth. We always direct our patients to that resource person for their plan, and they then can inquire of them what their options are and then the patient lets us know. The last thing we want to do is send a patient somewhere out-of-network and have them wind up in medical bankruptcy. That’s just not a very good wellness strategy for our patients. So, we make sure the patient is interacting with their health plan.
• Patel: So specifically, you mentioned MRI and specialty services, we have 44 clinics total right now and each community is different. We need to customize to each community, such as what are the resources, how far do they have to travel to get the MRI and/or the specialty services. Each community we obtain a database that says if you get an MRI here, here, or here, how quickly can you get in, what the cost is, etc. Essentially, you have a care navigator – a patient advocate who will tell this to the patient, so they are not lost in the system.

How do you approach to handling Rx? Both potentially treat package medications and specialty drugs?

• Usher: With regard to prescriptions, it is just inherently in our nature to use generics. We do dispense some prescriptions out of the office, we are actually looking at changing that in the future. Just dispensing them out of the office can even save more money than what occurs under the Pharmacy Benefits Manager. This is really convenient for the patient if they are not feeling well and you can get them their antibiotics, so they don’t have go stand in line for the pharmacy. Things such as high blood pressure drugs, or diabetes drugs, if they can just send them with people it’s a very nice option. As far as specialty drugs, the same thing occurs with basically the approach to getting the MRI done. We put the people back in touch with their health plan and work with them as much as we can to understand whether or not they actually need the medication. We aren’t the specialists, but we do want to talk with the patient and see what the specialist is saying about their medication just to make sure this is the best thing for them at the time. We will review that with them, but we do refer people to patients’ systems sometimes or a variety of things that will help take some of the cost out. As far as specialty care drugs, we don’t have a lot of control over that.

How do you capture avoidance of needing a surgery by improving primary care?

• Patel: When we said surgery, let’s take orthopedic surgery. If the patient comes to us (Primary Care), and we navigate their care and we manage the imaging and bring the imaging back to us, we aren’t saying that they don’t need to go to orthopedic surgery. We’re saying there could be other options that are more viable, like physical therapy. This is why we have a Physical Therapist onsite. The idea behind it is to say if we capture the patient early, keep the joint moving, and we may not need to put a needle. What usually happens is patients will come in with knee pain, and say “I want an MRI and surgery,” but there is this window of opportunity that we are missing. If we can capture that, you would be surprised how many surgeries we can avoid altogether. Statistics are very astonishing on how many surgeries can be avoided if you follow a pattern. What we are saying is we want to navigate their care in the community, once they go down the path of X-ray, MRI, and needle they are just down that path.