Patients staying at home often have complex medical conditions that are among the most costly in healthcare. Furthermore, they commonly experience health equity issues related to social determinants of health, including the ability to visit a clinic, hospital, or doctor’s office.
Many healthcare professionals believe that patients tend to be happier and healthier when they are at home. This increased awareness could fuel the trend toward shifting direct-to-home primary care.
Mackenzie estimates Up to $265 billion in care services (representing up to 25% of the total cost of care) Medicare fee-for-service and Medicare Advantage beneficiaries can transition from traditional facilities to home by 2025.
Delivering needed healthcare services and providing assistance with daily activities requires a team-based approach to guiding primary care that includes non-traditional providers, said Lynn Carroll, chief operating officer of HSBlox, a health information technology vendor for managing value-based care programmes.
Carroll talks about what direct primary care is; how direct primary care can achieve better outcomes, a better patient experience, and lower costs; and how coordinating care, services and compensation through a digital infrastructure can improve health equity for vulnerable populations.
Q: For those unfamiliar, what exactly is direct primary care and what does it entail?
a. Direct Primary Care is an alternative care and payment model that eliminates fee-for-service payments and third-party billing. Instead, patients pay primary care providers a flat annual or monthly fee for routine services, such as quarterly exams and routine lab tests, as well as for enhanced 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 eager to reduce administrative burdens, according to “Trends in direct primary care reportFrom Hint Health.
The success of DPCs relies heavily on a strong relationship between the patient and the PCP. Patients in the DPC model generally have greater access to their physicians/health care teams in a more convenient and affordable way compared to traditional billing systems.
The DPC model can help small practices stabilize their revenue streams while eliminating the administrative burdens of coding, billing and filing claims with insurance companies. This gives them more time to spend with patients and enables them to reduce costs.
Q: Why do you think direct primary care is essential to the future of healthcare?
a. The pandemic has exposed many of the inherent flaws in the US health care system, which has accelerated the adoption of new models of care delivery such as telehealth and home care. DPC is a viable alternative payment model for service providers with smaller practices who want to avoid administrative and reimbursement headaches.
Another reason why DPC is necessary to move forward is that it is a consumer-centric model of care, and health care consumers are more demanding than ever. They want personalized and appropriate service from personal caregivers, and they don’t want any billing surprises.
Finally, the inherent preventative nature of care under the DPC model is perfectly aligned with the goals of value-based care to improve patient experience and health outcomes, address physician fatigue and well-being, and integrate health equity, all while reducing health care costs.
Q: How can direct primary care produce better outcomes, a better patient experience, and lower costs?
a. DPC achieves better outcomes because primary care providers can spend more time with patients. This allows them to ask more questions, engage in discussions about possible conditions and treatments, and perform basic tests in the office and even at the patient’s home.
The more familiar the doctor is with the patient – including understanding the social determinants that may affect the patient’s life and health – the greater the chances of a better outcome.
DPC improves patient experience through better outcomes and greater comfort. Search It shows that DPC members can schedule appointments with their providers within a day, wait as little as five minutes at a DPC office, and spend an average of nearly 40 minutes with their providers, versus 15 or 16 minutes with a traditional primary care provider (PCP).
lately study Analyzing the impact of DPC on health outcomes and costs, DPC members had a 25.5% reduction in hospital admissions, while the cost of emergency claims was reduced by 53.6%. Improved outcomes, better patient experience, reduced paperwork, and lower costs resulting from DPC payment models can help smaller practices remain independent.
s. How can coordination of care, services, and compensation through a digital infrastructure improve health equity for vulnerable populations?
a. An essential component of DPC’s health practice is strong working relationships with community-based organizations that provide nutritional counseling, transportation, and other services that address the social determinants of health that can affect patients’ lives and outcomes. Creating this kind of community support network for vulnerable populations is essential if we are to improve health equity and achieve the goals of value-based care.
Digital infrastructure is needed to operate this network of service providers. Successful integration of CBOs into a network of care providers requires the deployment of technologies that provide complex hierarchical support for onboarding, data capture, digitization, and exchange. These technologies should support SDOH, quality reporting, and other use cases.
The right cloud-based digital infrastructure can support the many-person relationships needed for coordinated patient care. By sharing information and analytics and realigning final payment to include both medical and non-medical services, providers can activate a powerful community network to care for their patients.
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Contact the author: bsiwicki@himss.org
Healthcare IT News is a publication of HIMSS Media.