Foundation of a Plan
In order to create an effective, repeatable, and scalable plan, Craig Scurato advises practitioners to try to transform business owners’ perspectives. Most businesses think of direct primary care as an “add-on— something they're adding on top of their benefit program,” when really, DPC needs to be the focus and the foundation of the benefit plan. In effect, practitioners need to build a foundation of health care from doctor-patient relationships that are enhanced by direct primary care. “Then, based on the company's goals, their budget, and the demographics of their employees, practitioners need to figure out how to couple the right insurance plan with direct primary care,” Scurato explains.
Types of DPC Based Solutions
Any direct primary care solution needs to fit within the employer’s overall benefit structure. The first and most common solution is the “Stand Alone Employer” approach. Scurato notes that this is a pretty straight forward approach to healthcare where the employer is paying for their employees healthcare either fully or partially. Practitioners should make sure any group health program is “designed to maximize uptake of DPC.” It’s helpful to have the active involvement of the employer’s executives and human resources department.
The next approach is called the “Stand Alone Voluntary / 100% Employee Paid” solution. In this instance, the impetus is put on the employee. The objective here is to try to get as much employer involvement as possible to include onsite meetings, payroll deduction support, etc. As a DPC practitioner pitching to a business using a Stand Alone model, Scurato advises reviewing the benefit plan to tailor a pitch within the context of existing options.
The third solution is an Integrated with Benefit Program approach with companies that do not sponsor health insurance. Typically they offer small group health care solutions that can incorporate direct primary care memberships, though not all do.
Employers That Do Not Sponsor a Group Plan
For employers that don’t sponsor a group plan, Scurato recommends a “health allowance.” A health allowance is money provided for employees by employers to go purchase their own health insurance. In this instance, employees get reimbursed by their employer according to the schedule of their ACA-compliant insurer.
This approach creates more work for the employee, Scurato explains, but it allows for more flexibility and customizable solutions . “Employees can pick the plans that meet their health status and budget while still getting the value of the membership,” Scurato explains. A lot of times, these employees can choose a less expensive health insurance plan because already have the direct primary care membership that takes care of a majority of their healthcare needs.
Offering Two Benefit Levels
Employers who offer an Integrated with Benefit Program solution can also provide two different benefit levels. Scurato believes that many people worry about going on the market and/or the healthcare exchanges to buy their own insurance. To quell these concerns, employers can offer two healthcare plans with the same insurance company: one standard plan and then another cheaper one that’s paired with a DPC membership.
The Menard Experience
In Scurato’s experience, some clients are looking for a plan “that carves out every single reimbursement area that could be covered under your direct primary care membership--but that really doesn't exist.” In reality, everything is custom work. Take his experience with Menard’s, the midwestern hardware chain.
Menard’s is a huge employer with 300 locations, 55,000 employees. They’re a prime example of an employer that offers a Stand Alone/Voluntary healthcare solution. Dr. Brian Sachs of Platte Valley drove the opportunity and first put Scurato in touch with Menard’s. Initially, Scurato’s team attempted to work with one of the smaller locations, but Menard’s initially wouldn't to pay for any of it. He wanted to learn enough about their benefit approach so that they “could position the offer to their folks in a way that made sense, and hopefully try to find some money in reduced insurance expenditures within their particular plan design.”
They presented to Menard’s a business case that--from a financial standpoint--made a lot of sense for them. It would save them money by allowing their employees to spend their own money on a direct primary care membership. Menard’s asked them to talk to their health care consultant; according to Scurato, these consultants serve as gatekeepers for the business, often nixing a negotiation before it even gets off the ground.
“Surprisingly, their consultant was very supportive,” says Scurato. His team made a business plan and then a little brochure to facilitate the pitch to the employees. The intention was to match up twenty DPC practices with these locations and hold a meeting talk to employees about the opportunity to join these practices.
Scurato’s contact at Menard’s told him he’d take it to his superiors and they said no, so Scurato’s team went what he calls “guerrilla.” “Literally, I told the doctor, ‘Go get a sign! You're right across the street.’” The doctor took his advice and put up a sign that said something akin to, “Hey, Menard's employees open enrollment, learn how to save big money at Platte Valley Medical.”
The practitioner made some fliers, and, according to Scurato, he did enroll some patients among Menard employees. In this case though, they didn’t get employer support and that made it difficult. Scurato believes that if he got a chance to actually talk to the employees, he’d have a really high chance of success. “Ultimately what we were trying to get to the employees when they make their enrollment decision. We wanted to get them to think about this as a foundational element, versus an add-on.”
Although Menard’s negotiation didn’t bear fruit, the experience serves as an example of the kind of approach practitioners and consultants need to take with employers who have established healthcare plans. Talking to consultants, providing a business plan, and ultimately offering a custom business solution are all important elements of any successful business plan. As Scurato points out, the strength of the DPC approach lies in its focus on the doctor-patient relationship, so talking to employees and introducing them to these practitioners is an ideal way for DPC doctors to make their case.