Every year since 2015, the American Academy of Family Physicians (AAFP) hosts a DPC Summit in Chicago, where doctors, students, software companies, advocacy groups, and investors gather to discuss the latest in the DPC world. Topics vary from sharing DPC practice experiences and learning how to start a DPC clinic, to understanding advocacy groups and learning how to work with employers.
I only attended the Pre-Conference session on employer opportunities, but I’d like to share what I learned.
DPC doctors need to work with employers
It was clear from the four-hour session that opening up DPC to employers is a priority for the movement. Doctors need a more efficient way to grow their practices and employer-sponsored healthcare remains the best avenue for panel growth. The impression that I got from the strong attendance at this session (plus several previous interviews with DPC doctors) was that doctors want to explore opportunities to work with employers, but don’t know how.
If like me, the doctors in attendance were hoping for a playbook on working with employers, they probably walked away empty-handed. The majority of the session was spent emphasizing why working with employers is important but failed to give clear strategies on how to actually do that.
To be fair, many people in the audience may have needed an introduction to terminology and employer needs to understand the market. I thought it would be helpful to recap some of the introductory terms and offer some insights for those looking beyond the basics.
What types of employers are there?
First, it’s important to understand what kinds of employers are out there. They range in size, workforce demographics, healthcare needs, etc. Here’s a quick list of some employer characteristics you should be familiar with:
- Underinsured or uninsured employers don’t offer health benefits and tend to be under 50 employees. These businesses either have no legal obligation to provide health coverage and/or they simply can’t afford it. DPC doctors tend to target these employers because they can provide coverage for smaller groups and because the employer/employees don’t have an alternative to getting care.
- Fully-funded employers offer health plans through a regional or national insurance company, like Blue Cross Blue Shield, United, Aetna, Highmark, Kaiser, etc. They’re called fully-funded because they pay for full coverage and their employees’ claims are paid by the insurance companies. Small and medium-sized businesses (SMBs) that are not self-insured, but need to offer healthcare, will opt for this option. As a DPC doctor, there’s a small chance you can convince some of their employees to sign up for a DPC membership, but it’s very unlikely that the employer will sponsor it or even encourage it. They’ve already paid a lot of money to get their employees a health plan, which offers access to a large network of primary care doctors, and they’re not interested in spending more on DPC.
- Self-insured or self-funded employers are businesses that look and feel a lot like fully-funded employers in how they offer healthcare, with one big key difference. Like their fully-funded counterparts, employees receive a health insurance card and can access a network of doctors. But, with self-insured businesses, the employer is paying for healthcare claims themselves rather than the insurance company. This means self-insured businesses pay for all of their employees’ health care out-of-pocket, making them highly motivated to control health care expenses through creative approaches like DPC.
DPC doctors are targeting the wrong employers
The SMB market makes sense for finding small cohorts of patients to join your practice, but it’s a very small target to hit for DPC doctors. The smaller the business, the less likely they’ll have the budget (or time) to offer any kind of healthcare. Take restaurants, for example. Small restaurants have high turnover and seasonal workers, making it disadvantageous to offer employees health benefits. Many also employ younger workers that either don’t need health care or are covered under their parents’ health insurance, making it an even harder decision to invest in health benefits. As a DPC doctor, you really have to hunt for small businesses that have both the ability and the need to offer health benefits and convince them that DPC is the right strategy for them.
Once you get out of the really small business segment, you move onto medium-sized businesses with 50+ employees. These employers are likely fully-funded, which means they offer a health plan through an insurance company. It’s even tougher selling to them because they’ve already paid a king’s ransom to get their employees benefits, and aren’t interested in any additional costs. DPC doctors’ claims of better care and employee satisfaction will likely fall on deaf ears.
Follow the yoga classes
Contrary to what most DPC doctors believe, it’s the larger companies that are really the best target for getting employees onto a DPC membership. Because these employers are self-insured, every single dollar spent on health care is a dollar out of their bottom line. Their finance and HR folks are very acutely aware of how much they spend on employees’ health each year and are desperate for better options.
Have you noticed how many companies these days offer wellness programs, gym memberships, friendly competitions to eat better and lose weight, and a host of other employee initiatives? While employee morale and health may be a part of the plan, it’s not entirely altruistic. They’re offering those wellness programs to help drive down ER visits and hospitalizations. It’s all about getting your employees better prevention so they have fewer health care claims and your costs go down.
Self-insured employers want direct primary care. They are clamoring for it.
Working with larger employers is tough, but not impossible
Despite the aligned philosophies and growth potential, most DPC doctors have found that it’s very difficult to work with larger employers for a number of reasons:
- Capacity: If you’re an independent DPC doctor with a patient panel size of around 500–600, you simply don’t have the scale to take on hundreds or thousands of employees.
- Business risk: Even if you could take on a smaller self-insured business with around 200 employees, it’s too much risk for you as the doctor. You can’t tie up most of your revenue with one employer. If they were to leave, your practice could fold.
- Footprint: As an individual doctor, you’re limited to one location (maybe two) and employers may have employees living on different sides of town, making your location inconvenient.
- Employee/patient choice: People want (and deserve) a choice when selecting their doctor. For a larger self-insured employer, offering employees one or two doctors to choose from is simply impossible. People have different needs and are used to being able to pick from a network of doctors through their health plans.
All of these barriers have so far prevented DPC from being adopted by employers and becoming a mainstream way to get primary care. I think everyone at DPC Summit agrees that it’s a better alternative to traditional insurance-based primary care. But the DPC approach has failed to address these barriers and offer better solutions. Encouraging doctors to target the small business market, which is poorly equipped to offer DPC, is a weak strategy in my opinion.
Larger, self-insured employers are aligned with the DPC philosophy and are already investing heavily in primary care. But because of logistics, the DPC movement has allowed this market to go completely untapped. We’re working diligently at Equal to solve this problem and offer doctors a free solution to working with employers of any size. If you’re interested in learning how to collaborate with other doctors in your area and offer your services to self-insured employers, reach out to us! We’re happy to share knowledge and get you connected.