NJ Spotlight – Four primary-care practices have opened for business in a pilot program that can treat tens of thousands of government and school system employees for free, the realization of a plan developed by Senate President Steve Sweeney and labor unions to improve patient care and reduce costs to taxpayers.
The R-Health Direct Primary Care Program is now operating in Burlington, Camden, and Mercer counties, and just across the river from Trenton in Pennsylvania, with a model designed to allow doctors to spend far more time with their patients and better understand their concerns, leaders at R-Health explained.
By shifting the way their physicians are paid, the program reduces the pressure on doctors to squeeze in more patient visits and gives them the time needed to better diagnose and treat those who are under their care. A lack of any co-pays or other fees makes it even more attractive to patients, according to the company.
“Typical practices are still based on volume,” Reiner said. “When you’re feeling the volume pressure, the doctor is always trying to figure out, ‘What’s my exit strategy?’” he added, noting that is often a prescription or a referral — as opposed to spending the time to identify the root cause of a patient’s concerns.
The focus on primary care also seeks to keep patients healthier and reduce the need for more costly treatment in the future, R-Health CEO Mason Reiner explained. The program is set up to treat public workers — state, county, municipal, and school system employees — so trimming the cost of their medical care also benefits the taxpayers who cover these expenses.
“The sum total of these features is really transformational,” Reiner said, noting they could open another half dozen facilities in the coming year if there is demand.
The program is part of a wider focus on health outcomes and reducing costs. The healthcare industry is experimenting with a variety of models designed to improve the quality of care and the patient experience, while saving money for those paying the bills.
The pilot project — which was first announced this week two years ago and is expected to cover 60,000 patients, at least — is one outcome of Sweeney’s ongoing work with labor leaders to reduce the cost of medical care for New Jersey’s roughly 700,000 public workers. This year New Jersey budgeted $3.7 billion to cover the cost of caring for these employees, retirees, and their families.
Sweeney joined union leaders in mid-January to open the most recent office, in Ewing, which offers traditional primary-care services like preventative care, chronic disease management, wellness coaching, sick, and other urgent care. Staff also helps patients navigate their network of specialists or other caregivers to better coordinate their treatments.
The model allowed for physician interactions the way he recalled them from childhood, Sweeney said. “It was a very comfortable feeling. There was a great deal of trust between the doctor and the families and you felt you were getting good care,” he said. “Instead of what we have today, when it’s in and out in six minutes.”
Hetty Rosenstein, with the Communications Workers of America, New Jersey, agreed that the model allowed doctors to get to know their patients and “make them and their families healthier.” Plus, she added: ““We’ve got an opportunity here to show what primary care can do and how critical it is” to controlling costs.
Reiner said that patients haven’t yet flooded into the R-Health’s offices since the first sites opened in November, but healthcare experts across the country are watching the Direct Primary Care Program carefully to see how it works. There are some smaller-scale pilots under way and some self-insured companies have tried similar models, but no one has launched such a large-scale program with the potential to cover so many patients.
“People are really looking at this as the first large-scale demonstration of what primary care can accomplish,” he said. “This is kind of a watershed moment in the shift to value-based care.”
At the opening of the Ewing facility, Kevin Kelleher, with the New Jersey Education Association, also underscored the importance. “There’s not a lot of great healthcare news, either in New Jersey or in America, and today we can really celebrate here in New Jersey,” he said. “It’s a win for all of us.”
While Patient Centered Medical Homes also seek to provide coordinated, comprehensive primary care and share similar goals of improving care and reducing the larger cost of care, Reiner said many use a mix of value-based care payments — in which physicians get financial incentives to keep patients healthier — and fee-for-service billing, the traditional model that rewards doctors for providing more treatments or seeing more patients.
But the Direct Primary Care model run by R-Health does not use fee-for-service billing. Instead, the company pays doctors a salary or set amount, regardless of how many patients they see. While most primary-care physicians will be responsible for as many as 3,000 patients, the pilot program limits each of its physicians to 1,000.
The program is open to all current and retired employees and family members covered by the State Health Benefits Plan or the State Education Health Benefits Plan — as long as they are not in an HMO plan or eligible for Medicare. Reiner said this includes approximately 550,000 of the 700,000 employees covered by the two public plans.
While patients must sign up to become R-Health members to participate, there is no fee or change to their insurance plans, and membership doesn’t restrict them from visiting other doctors in their plan network, he said. The offices are not walk-in clinics, but Reiner said patients can usually get an appointment the same day.
In February 2015, Sweeney outlined the Direct Primary Care concept with Mark Blum, Executive Director of America’s Agenda, a national advocacy organization that seeks to improve access to care. The group also worked with Sweeney to craft plans for a high-tech oversight system it believes will save the state at least $200 million a year in prescription drug costs for government workers.