Patient-Centered Medicine—An Example of Pioneering in the New Era of Health Care
Operating on Colorado’s “front range urban corridor” is an appropriate setting for Dr. John Bender and his Miramont Family Medicine practice. The term sort of evokes images of the pioneer days out west, and that’s fitting for Miramont in its role as an early leader in opening up new territory in the world of family medicine.
Miramont Family Medicine is a network of four clinics serving roughly 20,000 patients in three communities, and has grown steadily since its formation in 2002. Traditionally, Miramont operated under a fee-for-service model, meeting the needs of Medicare and Medicaid patients as well as those covered by commercial insurance plans. In early 2016, though, the practice made a decision to break with tradition and embrace an emerging concept destined to change the face of medicine completely in the not-too-distant future.
As a board-certified family medicine physician, Dr. Bender is keenly aware of the forces at work in the re-shaping of America’s health care system. He’s also a steadfast advocate for changes that can better serve the ever-changing needs of his patient base, and it’s that advocacy that has led him to launch a Direct Primary Care option for his patients. Titled “MVP-Direct,” Miramont’s venture into this brand of patient service is indicative of a growing realization that traditional fee-for-service health care approaches are becoming problematic in today’s—and tomorrow’s—medical world.
Miramont’s MVP-Direct plan is offered at a flat monthly subscription fee of $49, with a roughly 20% discount for a yearly commitment. The beauty of the plan is that it offers families the ability to effectively build the cost of primary care—wellness visits, annual physicals, minor surgical procedures, lab services, X-Rays, and more—right into the household budget, with same-day appointment availability. Emergency services are another extremely attractive feature of MVP-Direct. “Our practice can handle 90% of all cases currently taken to an ER,” Dr. Bender reports, “at a cost covered by the monthly fee.”
So far, 700 patients have subscribed to MVP-Direct and, while that’s a small percentage of Miramont’s clientele, exponential growth is projected in the years ahead. Dr. Bender, former president of the Colorado Medical Society and currently serving on the Board of the American Academy of Family Physicians (AAFP), believes that the direct primary care model offers relief to folks dealing with the pain of high-deductible health plans, a common situation that has materialized as a consequence of the changes over the past several years in America’s health care system. “Regardless of whether the Affordable Care Act is repealed or remains the law of the land, high deductible plans are here to stay,” he observes, “but Americans are just now beginning to internalize the implications on their cost of health care.”
One of the hurdles Miramont’s MVP-Direct plan—and virtually all direct primary care plans—has had to face is one of conditioning the patient to understand that having a monthly plan enables them to avoid trips to the emergency room or an urgent care center in favor of a same-day visit to their primary care doctor. “With high-deductible plans, a single visit to an urgent care facility can leave the patient holding a bill for services that is at least equal to the annual subscription for a plan like MVP-Direct,“ Dr. Bender notes.
MVP-Direct: Not a Typical Plan
“The current joke going around is that if you’ve seen one direct primary care practice, you’ve seen one direct primary care practice,” quips Dr. Bender. That pun, of course, means that nearly every one of the estimated 300-400 direct primary care clinics in the United States is different in some fundamental way. For MVP-Direct, the differences include the operation of a drive-through pharmacy offering about 150 prescription drugs (mostly generics) and a narrow range of over-the-counter items. With an eye toward patient costs, Dr. Bender notes, the clinic routinely favors generic prescriptions, and the over-the-counter items are limited to products that support the patient care plan.
Another significant difference is Miramont’s practice of offering specialty services, like dental hygiene care, podiatry, and occupational therapy at a discount to MVP-Direct subscribers. Some of these specialty services, Dr. Bender notes, are also included under the subscriber plan, as in the case of Psychology services provided in-house. “Visits to our on-staff psychologist are included in the monthly direct primary care plan,” he notes.
MVP-Direct and Small Business
In its year and a half history, Miramont’s MVP-Direct program has been a success for the practice, with retention rates hovering in the 80% range. “Those who leave the plan,” Dr. Bender explains, “aren’t necessarily displeased, though. With the fluidity of today’s population, with job changes, relocations, upheaval in the Affordable Care Act, and the like, it’s inevitable that some folks will opt out at some point.” But for the most part, plan participants seem pleased with the service and the structure of the program.
Not one to rest on laurels, though, Dr. Bender has begun to explore extension of the direct primary care philosophy to small businesses in the area. “Just recently, we’ve contracted with a local nursing home to have their staff added to the MVP-Direct rolls,” he reports. “We’re optimistic about the small business connection, because it offers the benefit of rate-banding across a segment of the population that is typically healthier, a factor that minimizes our risk somewhat.”
One of the very real benefits accruing to small businesses via a direct primary care plan is the ability to handle minor injuries that previously ended up as a Workers’ Compensation claim and all that entails. “The Workers’ Compensation process is often a less than enjoyable experience for both employee and employer,” Dr. Bender explains, “so the ability to have those types of medical needs handled under the plan can be a win-win.” Likewise, he notes that their clinics offer more flexible office hours so that the employee can get treatment outside of a regular working schedule.
In addition to enrollment in the MVP-Direct plan, Miramont is also extending occupational health services to small businesses. For example, in working with the nursing home mentioned here, the practice can offer services at a discounted rate for employees with special needs, like chest X-Rays and TB screenings for immigrant workers. Miramont approaches this form of service with a Service Level Agreement-type that generates substantial cost savings for employers.
“Of course, small businesses will still need to maintain catastrophic plans in place for employees to avoid the employer tax under the Essential Health Benefits provision of the Affordable Care Act,” Dr. Bender points out, “but a direct care plan can make a considerable difference in everyday costs.”
A New View of the Role of Insurance
The emergence of direct primary care is, in the view of professionals like Dr. Bender across the country, is calling into question the true value of health insurance. What’s beginning to be understood is that health insurance is not really about access to health care—it’s more about protecting one’s finances in the face of a catastrophic illness or injury. In emergency situations, access to health care is a given, with the details of insurance coverage or lack thereof taking secondary importance.
In fact, Dr. Bender offers an interesting analogy between health insurance and another common form of insurance: fire insurance on your home. “I don’t use my fire insurance every year,” he suggests, “but it’s good to know that I have it if I need it.” The high-deductible plans that have become today’s norm provide the same type of comfort level, but people need to recognize that primary care is typically not covered until these elevated deductibles are met. “Patients can still get access to care… it’s just that it will be an out-of-pocket expenditure for a longer period than most are accustomed to.”
About Miramont Family Medicine
In 2008 Miramont received NCQA Level III recognition for its Patient-Centered Medical Home model and in 2010 won the national HiMSS Nicholas E. Davies Award of Excellence for outstanding achievement in the implementation of and value from health information technology. In 2011, The Colorado Academy of Family Physicians Foundation named Miramont the Patient-Centered Medical Home of the Year. And in 2013, the Robert Wood Johnson Foundation named Miramont an exemplar model for workforce innovation.
Dr. Bender is a board-certified family medicine physician, a Fellow of the American Academy of Family Physicians (AAFP), and the senior partner and chief executive officer of Miramont Family Medicine based in Fort Collins, Colo.
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