If you’re a broker, benefits consultant, or independent TPA, it’s important to understand your clients’ options for increasing healthcare access for employees. Accessing healthcare appropriately and cost-effectively is wildly difficult for people. They’re sick or hurt and scared. Changing behavior so people use healthcare intelligently isn’t easy, especially when people think they need a doctor fast and default to the ER or urgent care center or go directly to a specialist for care. And the second they step foot in the healthcare system, the system attempts to bill them as much as they can.
Over the last 15 years, a few concepts have evolved as options to streamline access to care and attempt to save money for companies and individuals. Here’s a quick overview of the top 3 primary care innovations.
Examples are TelaDoc, MDLive, and Doctor on Demand. They are 10 minute phone or video conversations with a random doctor. There is no ongoing care from the doctors throughout the illness, they can’t order tests to confirm suspicions, and, therefore, they are restricted to simple diagnoses like pink eye. However, they are typically bundled into a health insurance plan. So they’re free or very close to free ($1 per employee per month). They’re free because usage is low and their ability to solve most health issues, especially the expensive ones, is severely limited.
Cost: Free or $1 per month per employee + employee pays $49-$79 per 10 minute visit
Usage: 2–3% of employees leverage these services
Biggest Deficiency: Compared to an in-person PCP, they can only safely diagnose ~30 simple issues
Advantages: Simple conditions can be treated inexpensively
Direct Primary Care
Independent primary care doctors in brick and mortar practices are opting out of working with insurance companies and contracting directly with employers or individuals to offer their services at a fixed price. There are an estimated 600 direct primary care physicians in America. Some of them have recently banded together and formed a direct primary care network to counteract their biggest deficiency— when a company has employees scattered geographically, a neighborhood-based brick and mortar practice is irrelevant to most employees. They typically cost ~$70 per month per individual. These fees buy same day access to these PCPs and the ability to email and text with the doctors.
Cost: ~$70 per employee per month for unlimited, free care for employees
Usage: High for employees who live or work close to the practice
Biggest Deficiency: Expensive + Neighborhood-based practices do not scale for larger geographically widespread companies.
Advantages: Personalized, high quality care for employees with access to the practice
Virtual Primary Care
Sherpaa is an online medical practice staffed by full-time primary care doctorsavailable anywhere in 49 states (not Arkansas) and accessible 24/7/365. Employees always work with the same doctors throughout the illness and these online doctors can order tests and diagnose and treat ~70% of health issues presented to them without an in-person evaluation. For the other 30%, Sherpaa’s doctors coordinate care with vetted local, in-network specialists or facilities known to offer care at non-exorbitant prices. Because Sherpaa doctors understand exactly what’s needed, referrals and care coordination is extremely targeted and always appropriate. For the 30% that needs to be evaluated in-person, here’s how Sherpaa refers:
- 55% go to specialists
- 30% go to an urgent care center
- 5% need a retail clinic
- 5% need a PCP
- 5% need an ER
Over the last 6 years, we’ve found that if an online PCP cannot solve a problem virtually, it’s highly unlikely an office-based PCP would be the most appropriate professional to solve the problem. In other words, adding an office to a PCP makes them only marginally more effective than an online PCP. This makes sense as you consider how many times PCPs send patients to specialists after they realize the patient needs expertise beyond their capacity. This means that Sherpaa scales primary care and cost-effective care coordination to all employees, anywhere at any time.
Cost: Employers either pay-per-online visit, cost-share with employees, or cover the entire cost of care at $20 per employee-user per month
Usage: When employers cover the entire cost of care, 50–70% of employees use Sherpaa over the course of 12 months
Biggest Deficiency: Getting care online first is a new behavior and employees need education.
Advantages: Sherpaa scales accessible, effective primary care treatment and bespoke cost-effective care coordination for any employee anywhere. And it’s not nearly as expensive as DPC.