Transforming Free-Market Health Care Through Direct Primary Care

Imagine if you and your family could have unlimited access to your doctor and receive individualized wellness care at your home or office? Now imagine you could do all of that and actually save money on health care costs like prescriptions and laboratory tests.

Imagine no more. CovenantMD, a direct primary care (DPC) practice in the Lancaster-Lebanon area allows patients to contract directly with their doctor and “save insurance for the big stuff.” CovenantMD, and self-funded DPC providers like them, are revolutionizing the current health care market with the direct primary care model.

DPC differs greatly from the traditional primary care model that most individuals experience. DPC practices do not bill for their services through insurance companies, instead charging a monthly membership fee. Once a member, the patient has 24/7 access to their doctor through texts, emails, and phone calls. Most DPC practices offer same-day and next-day house calls and workplace appointments, and patients can see their doctor an unlimited number of times. With a lower doctor-patient ratio, doctors can spend whatever amount of time they need with their patients to both treat current ailments and practice preventative health care. Appointment times can range from 30 to 90 minutes, depending on the needs of the patient. DPC practices take pride in restoring human dignity to the patient-doctor relationship.

Dr. Patrick Rohal opened CovenantMD in January 2016 and added his first physician partner in September 2017. The practice is already nearing capacity. Patients’ testimonials reflect their satisfaction with the innovative yet personal care they receive. One patient exclaimed, “My experience was above and beyond anything I have ever experienced at a doctor’s office.”

In addition to exceptional care, CovenantMD has found ways to slash health care costs for patients. Prescription costs and lab work fees have been cut to a fraction of what patients usually pay through their regular insurance.

DPC practices like Dr. Rohal’s are an exciting part of the future of health care. Practices like CovenantMD are cropping up all over the country, which means that more business owners can incorporate DPCs into their employee health care plans—a solution that can better serve employees and reduce health care costs. With such an arrangement, employers can provide high-value primary care at a low predictable cost. The savings on office visit costs, as well as medication and laboratory test costs, represent a substantial savings on claims. DPC practices can also streamline access to other high-value resources in a local health care network, including imaging, and specialty and hospital care. 

In a self-funded health care plan, otherwise known as an Administrative Only Plan, the employer assumes the risk for payment of health insurance claims. While this may involve more risk than an employer has traditionally assumed with other health care plans, self-funded plans lead to increased transparency and decreased overall health care costs.

Langdale Industries, a Georgia-based company with 1,000 employees, exemplifies how self-funded plans can revolutionize a business’s health care benefits. Because of its rural location, Langdale’s access to hospitals is limited, resulting in less competitive pricing. It responded to this lack of competition by setting up a HIPPA-compliant claims management system. This system provided quality and cost information on facilities used by the plan and created incentives to encourage employees to seek high-value care. The results were astounding. With a decrease in overpayments, waste, and abuse, the company experienced savings of $29 million between 2000 and 2009.

Langdale is not the only company to experience such tremendous savings using an innovative benefits system. Dr. Nick Pandelidis, a York-based physician and advocate for direct primary care, points to the success of the Allegheny Public School System, which saved $7.36 million in hospital spending, and Enovation, an equipment management solutions company with 600 employees that now saves $2 million annually compared to previous health care costs.

Employers are no longer constrained to expensive all-or-nothing health care plans for their employees. Innovative health care plans that provide high-value primary care offerings like Direct Primary Care demonstrate that free-market principles benefit both companies and their employees. Entrepreneurs now have the opportunity to revolutionize the health care industry and see both their companies and their employees thrive.