Reprinted from the spring 2018 issue of The Ohio Family Physician
By: Ryan Kauffman, MD
Too often as practicing family physicians, our eyes glaze over when the discussion turns to population health. While we appreciate the value it can bring to improving the health of our patients and communities, many of us approach it with caution. Physician views on population health are sometimes jaded because of disappointing experiences with electronic health records, pay for quality programs, and insurance reforms.
Some physicians view population health programs as thinly veiled attempts by hospital systems to expand their control, improve market share, and increase billable services, or by insurance companies to cut costs and shift administrative burdens to primary care offices.
As physicians who focus on patients and families, rather than organs or diseases, it is concerning that population health interventions frequently embrace a one-size-fits-all approach.
A population health model, done poorly, can not only dehumanize medical care, but can also push “cookbook medicine” over personalized patient care. That said, I want to share my experience of how I shifted my thinking and practice of family medicine toward population health.
There are many ways in which population health can be both rewarding to the physician and beneficial to the health of the individual and community. A population health care focus can foster better patient-physician relationships and increase patient engagement, while also decreasing overall healthcare costs.
After nine years in a traditional private practice, I started Hickory Medical Direct Primary Care (DPC) in Bellefontaine, OH, to meet the needs of my community. Wellness is a critical part of population health and structurally DPC is built to promote wellness. As a DPC practice, we do not take payment from medical insurance companies (private or public) for our services. Instead, our practice is entirely supported by patient membership fees and drop-in visits, which allows us to place our focus back on the patient and what the patient needs.
Our service includes basic lab work and in-office testing. We schedule two patient visits per hour, perform house calls (when necessary), and are available for patient questions via phone and digital communications. Because our practice is funded by membership fees rather than through fee-for-service payments, the patients’ health is the single most important consideration, not the volume of visits.
Routinely, we see patients who have not seen a physician in decades. DPC not only allows us to provide quality care at affordable prices, but even those earning a low-income hourly wage can afford our services.
In addition to the benefits of increased patient satisfaction and affordable care, the reduction in administrative tasks and increased job satisfaction allows us the time, resources, and energy to explore new opportunities to improve the health of our patients and community.
Many of our patients face systemic issues that adversely affect their health. When I was in a traditional practice, I often lacked the time and energy to manage more than a few issues within a single patient visit. In my DPC practice, I have more time to listen to the concerns and issues of my patients, and the more I understand, the more I am able to advocate for them.
At the community level, I have reached out to local government officials to address policies surrounding drug-assisted treatment for opioids during short-term incarcerations. The current policy of ceasing all treatment, regardless of the nature of the offense, or duration of incarceration has extremely high costs to the individual.
By taking the time to address this issue, we are able to reduce physical suffering and risk of relapse for those exiting the system, while helping our community move toward a better response to the opioid crisis.
We also promote population health by bringing new, needed resources to our community, such as working with a group in Columbus, OH, to bring diabetic education classes to our rural area, while also promoting literacy by getting all of our preschoolers signed up to receive free books through the United Way.
By transitioning from a traditional practice to a DPC model, we have made significant changes in how we meet and treat the needs of the patients we serve.
In traditional practices, most of the revenue is generated from face-to-face visits, but with DPC many medical concerns can be addressed over the phone, which offers additional value to our patients with general inquiries.
The ability to deal with issues promptly and efficiently improves the health of our community significantly and allows us to better allocate resources, and provide rapid diagnosis and treatment of infectious diseases. Our focus is on patient-physician relationships developing as health-focused experiences, rather than administrative or economic interactions.
Timely access to family physicians provides a host of benefits to our patients and community. Our DPC practice offers same day appointments, even for chronic conditions. From better coordination of medications to avoiding high-cost hospital-based care, availability contributes to a more sustainable and effective system.
Our two patient per-hour schedule means our average patient wait time is under two minutes. Patients who are students and full-time employees find our system most efficient when planning around busy schedules, allowing them to remain productive throughout the day.
As major financial contributors to health care, employers see our service as a way to improve the health of their workforce while also saving money and improving overall employee satisfaction. On staff, we have a dedicated practice manager that supports local employers in finding new insurance and healthcare solutions to manage costs for small businesses within our community.
This year, the City of Bellefontaine offered to cover membership through our practice for all their employees and families by switching from a fully-insured medical plan to a self-insured medical plan. This change in medical coverage allowed the city to offer the same benefits while saving hundreds of thousands of dollars.
Soon after the announcement, we had more than half of those who were eligible register for membership. By caring for this particular population, Hickory Medical DPC has started developing interventions and offering additional services, improving the health of the entire group while reducing their medical care expenses.
My practice has been open for two years now and we are fortunate to report that our patient panel is nearly full. While we have a unique ability to adapt our practice to meet the needs of our community, I hope our story can inspire you, the family physician, with a fresh perspective on how you can improve the health of your community through DPC.
Learn more about Hickory Medical DPC.