We got a couple of media mentions a couple of weeks ago for EverMed’s DPC efforts. They were brief, one more or less accurate and the other word-for-word the way we would have like the issues framed.
A Vancouver-area company is launching a new model of delivering primary care services in the Portland area, one designed to give patients direct access, regardless of their insurance plan.
EverMed Direct Primary Care of Camas isn’t itself insurance, but layers on top of a patient’s existing plan. A member pays a set monthly fee and receives comprehensive primary care services.
While most Director Primary Care companies employ doctors directly, EverMed is seeking established, independent primary care clinics. About 30 clinicians at eight clinics have signed up in Clark County and about half a dozen clinics are in various stages of the contracting process in Portland, said Seth Sjostrom, director of business development.
EverMed charges patients $45 to $85 a month for unlimited access to a primary care doctor for wellness exams, basic diagnostics and other non-emergency needs.
“The principle of DPC is that you don’t need insurance for day-to-day care. It’s for catastrophic illnesses,” said Dr. Dino Ramzi, EverMed’s chief medical officer and a physician with Lacamas Medical Group in Camas.
Members can enroll directly, though many have come through self-funded employer medical plans. Ultimately, EverMed would like to partner with an insurer who would devise a plan that doesn’t include primary care, Ramzi said.So far, EverMed has signed up 75 members and five corporate clients. Sjostrom said the company is now promoting itself with insurance brokers in hopes of attracting more business during the 2015-16 enrollment season this fall.
More and more patients have gravitated to “bronze” plans, with high deductibles. Faced with copays or an unmet deductible, these patients may defer care, which ends up costing more in the long run when a patient ends up at an urgent care clinic or the ER. Highly effective primary care could save the health system a third of its costs, Ramzi said.
This upset Seth, as noted above, our Director of Business Development. It turns out I misrepresented our pricing structure, essentially because it has undergone several changes. My momoery is not what it used to be. In fact, as we prepare to enter the employer market more profoundly, there are signals we may have to make further changes. Pricing is an important component. We want to make sure providers get good value, but it is telling that employers are falling over themselves, given the price of assured primary care is remarkably low from tehir perspective.
Direct Primary Care clinics have been popping up all over the country, it was only a matter of time before the Portland marketplace became a part of the revolution in healthcare.
Direct Primary Care is a healthcare benefit option where members pay a set, low monthly fee to receive comprehensive primary care services. DPC is not itself insurance, it is an affordable option to access primary care needs for the member and their family.
EverMed DPC is a new spin on the growing Direct Primary Care marketplace. While most DPC offerings are staff model enterprises (the physicians work for the DPC business), EverMed DPC seeks out independent primary care clinics that are already established in the communities they serve.
“One of our key objectives as EverMed DPC is preserving the viability of the independent primary care practice. We see Direct Primary Care as a way for clinics to not only survive, but thrive,” says founder and clinician Scott Jonason, PA-C.
EverMed DPC makes accepting direct primary care patients a turn-key proposition for clinics. “We handle nearly everything for clinics – marketing, contracting, payroll and bank withdrawals, enrollments – all the clinics we serve really have to do, is see their patients,” Director of Business Development, Seth Sjostrom states.
With their network in southwest Washington established, growing northward into Seattle and across the river into Oregon were natural next steps. “If anything, we were overwhelmed by the positive response we received. We quickly realized growing slowly was not an option,” Sjostrom says.
EverMed DPC’s plan? Having enough clinics spread throughout the Portland metro in time to have homes for primary care patients opting for DPC membership during the 2015-2016 healthcare enrollment season.
“Our second objective is to truly remove finances as a barrier to primary care,” Jonason explains, “Working with the healthcare broker community and employers, we provide an affordable way to provide quality care while at the same time, driving down costs.”
EverMed DPC aims to add value to employers and individuals by minimizing the number of urgent care and emergency room visits, thereby reducing the overall total healthcare spend. “When patients are concerned about paying copays or worried about unknown costs of seeking care, they tend to avoid seeking treatment until it is too late and then they end up in the ER. With DPC, if they have a concern or even unsure if they need to come in, they can call, visit or even use secure email or text depending on the clinic,” Jonason adds.
“We believe when physicians have genuine relationships with their patients, quality of care improves. Timely care that values the relationship and is focused on the whole patient means that doctors are in the position to respond quickly and guide the patient to the right diagnosis, coordination or medical management as efficiently as possible. The hallmark of quality primary care is taking care of the individual, not the visit,” Dr. Dino Ramzi, EverMed DPC’s Chief Medical Officer states.
With healthcare reform, many individuals and even businesses opted for plans with higher deductibles in order to secure lower premiums. Direct primary care serves those with high deductible plans to manage their day to day health, knowing their insurance is in place should they require more extensive care. The trend across the country is to increase individual out-of-pocket expenses. This trend is unlikely to reverse, but DPC makes those expenses more budget-friendly.
“We have had a number of members who purchased a Bronze plan through the exchange but signed up for DPC to take care of their more common needs, assuming they wouldn’t hit their deductible. We have had several taking part in Christian medical share programs that also saw DPC as a way to bridge the gap,” Sjostrom shares.
“Our most common membership, though, has been through employers with self-funded medical plans. They see DPC as a fixed variable in their annual medical cost plan while serving as a way to manage costly medical interactions by avoiding unnecessary Urgent Care an Emergency Department visits.”
How do businesses and individuals enroll in EverMed DPC? “Members can enroll directly through our website or 800 number, but we strongly encourage prospective members to learn more about DPC through their licensed insurance broker. Healthcare can be complex, we want to be part of a package that really meets our members’ needs,” Sjostrom says.
Direct primary care programs on their own do not meet the obligations required in the Affordable Care Act, though they can be a complement that makes sense for a lot of people and companies seeking for a solution that provides real healthcare value.
“No copays, no deductibles, the smallest administrative burden…with EverMed DPC, we return the focus of healthcare to the patient,” Sjostrom adds.