Patients at home often struggle with complex medical conditions among the most costly health care conditions. Furthermore, they often face health equity issues related to social determinants of health, including the ability to visit a clinic, hospital or doctor’s office.
Many in the healthcare industry believe that patients tend to be happiest and healthiest when they are indoors. This growing awareness is likely to fuel the trend of moving primary care directly into the home.
McKinsey an estimated $265 billion worth of care services (up to 25% of the total cost of care) for Medicare fee-for-service beneficiaries and Medicare Advantage beneficiaries who can switch from traditional facilities to home by 2025.
Lynn Carroll, chief executive officer of HSBlox, a health IT provider for managing value-based care plans, says providing essential healthcare services and helping with operations Every day requires a team-based approach to directing primary care that includes non-traditional providers.
Carroll talks about what direct primary care is; how direct primary care is likely to produce better outcomes, improved patient experiences, and lower costs; and how to coordinate care, services and reimbursement through digital infrastructure has the potential to improve health equity for vulnerable populations.
Q. For those unfamiliar, what exactly is direct primary care and what does it entail?
ONE. Direct primary care is a payment and respite model that eliminates service fee payments and third party billing. Instead, patients pay their primary care provider a flat annual or monthly fee for routine services, such as quarterly visits and routine lab tests. , as well as advanced services such as telehealth and home visits.
DPC is becoming increasingly popular among patients and self-insured employers concerned about rising healthcare costs, and among providers wishing to ease the administrative burden, according to “DPC.”Trends in Direct Primary Care Reporting” from Hint Health.
The success of DPC is highly dependent on the close patient/PCP relationship. Patients in the DPC model often have greater access to their doctors/healthcare team in a more convenient and affordable way than with traditional payment systems.
The DPC model can help smaller operations stabilize their revenue streams while removing the administrative burdens associated with coding, invoicing, and filing claims with insurers. This gives them more time to spend with patients and allows them to reduce costs.
Q. Why do you feel direct primary care is imperative for the future of healthcare?
ONE. The pandemic has exposed many of the vulnerabilities inherent in the US healthcare system, which has prompted the adoption of new models of care delivery such as telehealth and caregiving. at home. DPC is a viable alternative payment model for smaller providers who want to avoid administrative hassles and chargebacks.
Another reason why DPC must become a must-have product in the future is that it is a consumer-centric model of care, and healthcare consumers are more demanding than ever. They want convenient and personalized service from their PCP, and they don’t want any bill surprises.
Finally, the inherent preventive nature of DPC care is fully aligned with the goals of value-based care to improve patient experiences and health outcomes, to address physician fatigue and health, while incorporating health equity, while reducing healthcare costs.
Q. How can direct primary care produce better outcomes, improved patient experiences, and lower costs?
ONE. DPC produces better outcomes because primary care providers can spend more time with patients. This allows them to ask more questions, engage in discussions about the condition and possible treatments, and conduct basic testing in the patient’s office and even at home.
The more familiar the physician is with the patient – including understanding the social determinants that can affect the patient’s life and health – the better the chances of achieving a better outcome.
DPC improves the patient experience through better outcomes and greater convenience. Research shows that DPC members can schedule an appointment with their provider within a day, wait less than five minutes at a DPC office, and spend an average of nearly 40 minutes with their provider, compared to 15 or 16 minutes with traditional PCP.
In a recent time In a study that analyzed the impact of DPC on health outcomes and costs, DPC members had a 25.5% lower hospitalization rate, while emergency claims were reduced by 53.6%. The improved outcomes, better patient experience, reduced paperwork and lower costs created through DPC payment models can help smaller practices maintain their independence.
Q. How does coordinating care, services and reimbursement through digital infrastructure improve health equity for vulnerable populations?
ONE. An important element of healthy DPC practice is strong working relationships with community-based organizations that provide nutritional counseling, transportation, and other services that address social determinants. Health can affect a patient’s life and outcome. Establishing this kind of community support network for vulnerable populations is essential if we are to improve health equity and achieve values-based care goals.
A digital infrastructure is needed to power this network of service providers. Successful integration of community-based organizations into care networks requires providers to deploy technologies that support complex hierarchies for presentation, data collection, digitization, and communication. change. These technologies must support SDOH, quality reporting, and other use cases.
The right cloud-based digital infrastructure can support the many-to-many relationships needed to coordinate patient care. By sharing information and analytics, and reordering follow-up reimbursement to include both medical and non-medical services, providers can enable a robust care network that relies on community for their patients.
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Healthcare IT News is a publication of HIMSS Media.
