Concierge Medicine for the Uninsured (Really).
It is estimated that nearly 1/3 of nonelderly US adults without insurance have at least one chronic condition. This runs counter to the prevailing notion that most of the uninsured are healthy without need for ongoing care. Uninsured patients with chronic conditions are more likely than insured patients to use the ER and are less likely to have visited a health professional in the past 12 months.
|
|
No Standard Site for Care When Sick |
Use Emergency Department Most Often |
No Visit to Health Professional Past 12 Months |
|
|
Insured |
Uninsured |
Insured |
Uninsured |
Insured |
Uninsured |
|
Cardiovascular disease |
3.5% |
17.4% |
3.1% |
15.3% |
3.0% |
23.4% |
|
Hypertension |
4.6% |
21.9% |
1.3% |
6.5% |
4.7% |
19.7% |
|
Diabetes |
1.8% |
9.3% |
1.3% |
3.7% |
2.0% |
11.6% |
|
Hypercholesterolemia |
5.5% |
24.4% |
0.5% |
6.5% |
5.9% |
24.2% |
|
Asthma / COPD |
5.8% |
26.1% |
1.2% |
10.8% |
4.8% |
19.2% |
|
|
|
|
|
|
|
|
|
From: A.P. Wilper, et al. National Study Chronic Disease Prevalence and Access to Care in Uninsured US Adults. Ann. Intern. Med. 2008; 149: 170-176. |
PC1 was developed to solve the twin problems of providing care for the uninsured in West Virginia and pre-emptively manage non-complex chronic medical conditions. That population traditionally received care in the most expensive way possible- going to the emergency room when end stage symptoms developed.
PC1 was developed by Dr. Vic Wood in 2003. Under that program, patients pay $85 per month; families pay $125/month. In return, they receive unlimited primary care visits; X-rays; a menu of lab studies; and free generic medication. PC1 patients are similar to national cohort of uninsured in that 1/3 have at least one chronic medical condition.
At launch, the risk to the primary care doctor was his office being inundated with the sickest patients rendering the model unprofitable.
The time-tested results:
- Patients do not abuse the system (the average patient is seen less than three times a year). The doctor is incentivized to manage the patient for optimal health- that is, get it right the first time; get it right every time. Increased frequency of unnecessary care is not rewarded. Patients and doctors incentives are aligned.
- Patients with chronic conditions behave similar to those who have insurance (see chart above). Virtually all PC1 patients with chronic conditions have a standard site for care when sick; do not use the ER most often for care; and have seen a physician within the past twelve months.
- Anecdotally, patients are happy with care delivered and pre-emptive management of non-complex conditions decreases ER visits and hospitalizations. These statistics are being collected prospectively.
Additional benefits driving physician acceptance:
- Low administrative costs as there are no "claims" to be filed.
- The physician experiences increased autonomy.
- Physician profits without feeling compelled to run a patient-mill limiting all patients to 8 minute visits. And, primary care for the "uninsured" is profitable.
- Doctors are doing what they always wanted to do- take care of patients. It's great to be a primary care doctor once again.
The model launched as a solution for the uninsured. Indeed, PC1, as an isolated service, does not address payment to specialists or hospitalization. The model is being investigated as complement to high-deductible insurance plans; the goal being to make sure patients don't forego necessary preventive care when they lock-into $5,000 deductible plans.
PC1 is promoted by Physicians Healthcare Solutions, Inc., a North Carolina company, in concert with Medical Justice, a Center for Health Transformation member company. PC1 was recognized as a Transformational Best Practice by Center for Health Transformation.
