A new model of primary care is making family practice a more viable and attractive choice for doctors and medical students alike, and is making it easier for patients to get medical care, according to testimony Monday at a legislative committee meeting in Lovell.
Drs. Mike Tracy and Bob Chandler, both of 307Health, and medical student Galen Mills, all of Powell, told the Wyoming Legislature’s Joint Labor, Health and Social Services Interim Committee about the direct primary care model for family practice physicians.
Under the new model, patients pay a monthly fee, which varies from $20-$75, according to their ages. For that fee, patients have round-the-clock access to their doctors via telephone, text or email, as well as more immediate medical appointments.
Tracy and Chandler adopted that model when they opened their own practice, 307Health, in Powell last month.
“It is a new enough concept that probably many of you don’t know what that is, but that’s OK,” Chandler said. “Basically, it’s a paradigm shift in how we look at our health care.”
The new model is a shift that makes primary health care a fixed, predictable cost and moves away from relying on insurance to pay for routine medical care, Chandler said.
“The idea is, they’ll no longer need insurance for primary care,” he said.
That was not what insurance was designed for, he said.
“We have it to protect us from catastrophic loss,” Chandler said, “but, currently, 80 percent of insurance claims are for primary care that we do every day in the office. Yet, only about 20-30 percent of the money that’s paid out ... is payment to primary care.”
On the flip side, some statistics show that 25-30 percent of the costs for a primary care practice are costs for managing paperwork and additional administrative requirements for insurance companies, while other estimates put that cost as high as 41 percent, Chandler said.
Tracy said 307Health patients pay a monthly membership fee, and they are not charged additional fees for office visits. Those visits can include services such as freezing of warts, EKGs, urinalysis, office spirometry and instant strep tests — “typical things you do at a doctor’s office, but there’s not a co-pay or an additional charge for the services provided,” he said.
“We also have the opportunity to interact with patients in other ways that aren’t recognized so much by the current system. We can have extended phone calls, we can have text messaging with patients, we can have video conferencing, we can have email exchanges, we can do house calls, and we can do these things without worrying about how that might fit into the current structure of third-party payment.”
The new model changes the patient and the provider relationship, Tracy said.
Under the current system, “patients are viewed as a revenue stream and providers are viewed as a revenue producer,” he said. “What we’re trying to do is add value instead of viewing them as a revenue stream.”
Chandler said at least one state has opted to pay membership fees for direct primary care for Medicaid recipients.
“Even after they paid the monthly fee, Medicaid was still saving 20 percent per patient,” he said. “If it’s easier to get in to see a provider, there are fewer emergency care visits.”
For example, if a patient with asthma is able to get treatment early on in an asthma attack, that likely will prevent an emergency room visit or hospitalization, he said.
Sen. Charles Scott, R-Casper, said the current system tends to incentivize doctors and hospitals to do tests and procedures that are not necessary, because that’s what they get paid most for. Scott said he sees direct primary care as a possible solution to that.
Scott asked what the complications are for the direct primary care model vs. the Medicare model.
Tracy responded, “The easiest thing would be to opt out of Medicare, but we decide not to do that so we can care for patients in the hospital. We had a lot of patients ask, ‘Will you be my doctor in the hospital?’”
Rep. Sue Wilson, R-Cheyenne, suggested the primary care model could be a good fit for people working to overcome substance abuse health issues.
Tracy said he is working with some patients with those issues and believes they are benefitting from the new model of care.
“If they can get a hold of us, see us early on, they can prevent things from spiraling,” he said.
Rep. Lloyd Charles Larsen, R-Lander, asked about the feasibility of the direct primary care model for a family, citing the example of a family of six people that would have a combined monthly membership cost of $195.
“This cost won’t apply to an insurance deductible if I understand correctly,” he said.
That is correct, Chandler said. In fact, as federal rules stand now, health savings accounts won’t apply either, though an effort is underway to change that.
Chandler said some families will view the new model as a good solution for their medical care needs, while others will say, “This does not work for me.”
Chandler and Tracy said they believe employers will see the benefits as well.
Greg Wilson, general manager for Heart Mountain Farm Supply, said that business has opted to pay membership fees with 307Health for its employees.
“We, as a small business, truly can’t offer health insurance, but we can offer this to employees who would like it,” he said. “It’s attractive to our employees and attractive to us personally. One employee who is 47 years old said, ‘I’ve never had a doctor before.’”
Greg Wilson cited the example of his wife, who couldn’t get an appointment with her doctor for four to six weeks, unless she called early enough on any given day to get an appointment on the same day. So she saw a provider at the ExpressCare Clinic and got a prescription for an infection; that one didn’t work, so another appointment and a new prescription were necessary.
“That cost our family $460,” he said. “We can’t call the doctor at the clinic — have you ever tried to call a doctor in a clinic?”
Galen Mills of Powell, currently a medical student at the University of Washington, recently completed a four-week health care immersion experience in Powell with the university’s Rural Underserved Opportunities Program, both at Powell Valley Healthcare and at 307Health.
Mills testified about his experience before the committee on Monday.
Mills described his impression of the primary medical care field in Powell and in other Wyoming cities as “bleak” — until he spent time with Chandler and Tracy at 307Health.
Mills said most primary care doctors are frustrated and discouraged about the amount of time they spend doing paperwork instead of caring for patients.
But 307Health was different. Tracy and Chandler were communicating with and caring for patients.
“They are able to do what they were trained to do,” Mills said.
“I think what they’re doing changed the conversation for medical care,” he said. “It can help break the barrier to access for primary care in Wyoming.”
Mills said he doesn’t see a lot of interest in primary care among his second-year medical school classmates, but direct primary care could change that.