How It Works for Employers – In Depth Analysis

The Supporting Data: Direct Pay Care

  1. Highgate Hotels, Ivie & Associates (a marketing & advertising agency), the Beryl Companies (operates a healthcare customer contact center for some of the nation’s leading hospitals) are three examples of self-insured employers working with DPC providers.The following items are some of the ways they measure the success of the DPC model:
  • Lower absenteeism
  • Reduced ER visits (they’ve seen a 10-40% reduction) and other medical costs (they’ve seen reductions of $25,000-$130,000 in the first year and more in subsequent years)
  • Decreased employee stress & improved morale
  • Saving time going to / from a doctor’s office and waiting room time, which can add 2-4 hours away from work

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  1. Iora Health’s new staff model of care has shown the ability to achieve an overall reduction in costs due to the prevention of costly ER admissions and hospitalizations.
  • Its original site in Atlantic City had a 12.6% net spending reduction and 20% in Seattle
  • In just one year, its original sites were also able to demonstrate improved patient results with an average 48% drop in emergency room visits, average 50 point drop in cholesterol levels among those with high cholesterol, and 63% of smokers with heart and lung disease had quit smoking
  • It is not surprising that these impressive clinical results were accompanied by high ratings in service and quality by patients

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  1. Personalized Preventative Care Leads to Significant Reductions in Hospital Care: American Journal of Managed Care, December 2012.
  • Overall (combining commercial and Medicare), MDVIP members were approximately 42%, 47%, 54%, 58%, and 62% less likely to be hospitalized relative to the nonmember population for the years 2006, 2007, 2008, 2009, and 2010, respectively.
  • By 2010, hospital discharges for the MDVIP commercial market population were 72% lower than the nonmember population in this study, and this difference was shown to be trending up since 2006 (where the discharge rate was 49%).
  • The estimated utilization savings for just 2010 inn these 5 states was calculated to be approximately $10.2 million for commercial members, $199 for combined commercial and Medicare. This savings in hospital admission costs equates to $485/member per year in the commercial market.
  • The 5-state study also showed positive health outcomes for these patients. In 2010 (the most recent year of the study), these patients experienced 56% fewer non-elective admissions, 49% fewer avoidable admissions, and 63% fewer non-avoidable admissions than patients of traditional practices.
  • Additionally, members of MDVIP “were readmitted 97%, 95%, and 91% less frequently for acute myopcardial infarction, congestive heart failure, and pneumonia, respectively.”

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  1. A British Medical Journal study of Qliance, another DPC group practice, also shows positive results. The study found that Qliance’s patients experience “35% fewer hospitalizations, 65% fewer emergency department visits, 66% fewer specialist visits, and 82% fewer surgeries than similar populations.

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