Study Committee Update: Direct Primary Care Committee Discusses Employer Models, Physician Burnout, Legislation

The Study Committee on Direct Primary Care (DPC) met for the second time on Aug. 29. The committee heard from several presenters and engaged in discussion on what the future work from the committee might look like.

First, Rep. Joe Sanfelippo (R-New Berlin) and Sen. Chris Kapenga (R-Delafield) gave the committee an overview of the DPC legislation they introduced in the 2017-18 session. SB 670/AB 798 would have codified DPC agreements in Wisconsin and required particular consumer disclosures. Under the bill as passed by the Assembly, a DPC agreement would have to state prominently that such an agreement is not health insurance and that DPC fees might not be credited towards deductibles or out-of-pocket maximum amounts under the patient’s health insurance. As amended, the bill also would have directed the Department of Health Services (DHS) to create a work group to study the feasibility of creating a DPC pilot within the state’s Medical Assistance (MA) program. The bill stalled in the Senate this session. The authors stated that data shows the importance of primary care in reducing long term health problems and costs and that the federal Centers for Medicare and Medicaid Services is encouraging states to incorporate DPC into their programs. Committee members questioned the authors about how care coordination fits into DPC and about the feasibility of an MA pilot program.

After the authors’ presentation, Mark Grapentine of the Wisconsin Medical Society gave a presentation on increasing physician burnout in Wisconsin. Grapentine cited burdensome insurance and governmental administrative requirements as some of the main causes of burnout.

Next, the committee heard from several employers using DPC contracting models. QuadMed and Quad/Graphics discussed their program that gives employees access to an on-site clinic. Quad/Graphics stated that the program has benefitted them as an employer because it provides high quality care, competitive health benefits to attract and retain employees, lowers costs, and increases employee productivity.

In addition to QuadMed and Quad/Graphics, representatives from Waukesha County, La Crosse, and Milwaukee discussed how they have developed similar on-site clinic programs for their government employees.

Next, Justin Sydnor, a professor in risk and insurance at the Wisconsin School of Business, gave an overview of how DPC fits into the health insurance market. Sydnor offered several legislative suggestions to the committee including:

  • Consumer protections.
  • Prohibiting DPC from profiting from services outside the subscription cost (e.g. labs, surgeries, specialist care).
  • Prohibiting non-compete clauses for physicians in health care systems.
  • Transparency requirements.
  • Data-sharing requirements.
  • Piloting DPC with state employees instead of in MA.

After Sydnor, Tim Lundquist of the Wisconsin Association of Health Plans shared community-based health plans’ perspectives on DPC. Lundquist said increased DPC utilization could accelerate adverse selection and thus raise premiums. In respect to state legislation, Lundquist recommended no statutory exemptions from insurance law, establishing consumer protections, designating an oversight agency, and requiring DPC practices to establish proof of financial responsibility.

Next, employer Larry Chapman of Summerset Marine Construction provided a patient perspective on DPC. Chapman testified that he has reduced health care costs for his business and his employees by changing their health plan to coverage of the cost of a DPC subscription plus a higher deductible.

With the presentations finished, the committee moved into discussion. Legislative Council laid out seven issue areas for the committee to discuss and decide upon:

  1. Is DPC insurance?
  2. Definition of DPC.
  3. Essential elements of the agreement.
  4. Required disclosures.
  5. Acceptance or discontinuation of patients.
  6. Network participation.
  7. Administrative oversight.

Initially, the committee voted on a motion to agree to put into statute that DPC is not insurance. The motion passed 7-4 but was later rescinded by unanimous consent after it was noted that Nygren was not present and after a few committee members voiced opposition.

Throughout the discussion, some committee members pushed for not legislating DPC and instead leaving it up to the free market, subject to regulation by the Office of the Commissioner of Insurance. Legislators including Felzkowski, Sanfelippo, and Sen. Tom Tiffany (R-Hazelhurst) suggested that legislation might be necessary to protect DPC from the inconsistency of potential future state agency actions. Overall, the committee agreed that traditional DPC models are not insurance but disagreed on the need to put that definition in statute.

Other areas of contention among committee members included whether mid-level providers should be able to operate DPC practices and whether and how DPC practices and providers could accept or discontinue patients.

The committee plans to meet again on Sept. 18 – this time with fewer presenters and more time for discussion and decision-making.

Committee members and documents

Summary of previous meeting