What Types of ABQ Business Need Direct Primary Care?

ALBUQUERQUE, NM — Direct Primary Care (DPC) is the reinvention of primary care being embraced by more and more ABQ business and individuals. But what type of companies or employers can actually benefit from Direct Primary Care? And why do you and your employees need one?

We’re going to deep-dive into into the different kinds of employers common around Albuquerque and how they can benefit from DPC. 

ABQ Business | Direct Primary Care and Health Insurance

DPC is not health insurance. DPC doesn’t aim to replace it. Instead, DPC serves as added healthcare assistance for your employees. Compared to health insurance, though, DPC is cheaper. 

The Commonwealth Fund (CF) released a report about the state of New Mexicans in 2018. According to CW, out-of-pocket costs burdened New Mexicans with employer-sponsored health insurance. It affected them more than employees in any other state.

Fast forward to 2021; industry experts hint at an increased cost of health insurance premiums. They said the surge is due to the pandemic. In 2020, people avoided going to their healthcare providers. They feared they might catch COVID-19 while they got their check-ups or medical procedures. Insurance claims were low back then. But people may now be making up for what they missed. This increase includes New Mexicans.

One cost-effective option is to partner with healthcare providers. Direct Primary Care (DPC) providers offer various services at a fixed monthly rate. It’s a long-term solution to the rising cost of health insurance. Although health insurance may stay at a stable rate, you may still find it hard to afford them due to dropping revenues.

DPC reduces your healthcare costs. At the same time, it improves the quality of care for your employees. Here’s how.

1. Employers with No Health Insurance

Employers with fewer than 50 employees in Albuquerque are not required to provide insurance coverage. For one, you may not be able to afford a complete health insurance plan. Yet you may offer a different form of healthcare that’s within your budget.

DPC is a practical option for small employers without health insurance. It’s convenient since you don’t have to deal with third-party administrators or TPAs. It means you don’t have to pay for premiums, deductibles, co-pays, or claims. Instead, you get your money’s worth with a fixed monthly rate. In addition, as a DPC member, your employees gain access to various healthcare services. 

 DPC offers unlimited access to visits or consults, among their many services. At the same time, DPC’s services provide preventive care and chronic disease management. These services keep your employees healthy. Likewise, it helps them manage their chronic illnesses, if any. The results of these services are remarkable. 

Researchers published a recent study entitled “Direct Primary Care: Evaluating a New Model of Delivery and Financing.” It reveals 40% fewer emergency room visits by DPC members in two years. In the same period, DPC members admitted to hospitals were 20% lower. 

Further, you save about 5% on non-administrative plan costs based on the study. These savings may be small, but you will see a big difference. It allows you to keep your business afloat. You’re spared from laying off an employee, too. 

A Point to Ponder: DPC attracts and retains employees. 

It keeps your workforce healthy and productive. DPC may be a viable option, but it has its downside too. Unlike health insurance, it neither covers ER services nor hospitalization. In cases like these, employers can compensate DPC with a low-cost medical plan. 

2. Employers of Businesses (10-49 Employees) with Health Insurance

A small ABQ business has fewer than 50 employees. Some small business owners with current healthcare insurance are looking for options. DPC may be an alternate solution to the rising costs of health care and insurance. It meets the Quadruple Aim of healthcare.

1. Better quality of care
2. Improved client experience
3. Improved clinical-provider experience
4. Lower cost 

Other employers, like you, decided to retain their health insurance. The good news is, DPC doesn’t directly compete with your existing health insurance. Rather, DPC enhances it.

Small business employers can pay for the DPC of their employees. DPC provides acute and primary care. It’s advantageous for small businesses with limited access to healthcare due to remote locations. Virtual consultation and telemedicine are available in DPC. In contrast, health insurance covers services outside DPC like ER visits and hospitalization.

Moreover, DPC fills in gaps for what’s lacking in health insurance. For example, family members often aren’t included in health coverage under employer-sponsored insurance. DPC, as an alternative, considers your employees’ dependents. DPC providers accommodate members of the family regardless of age. 

The fee is usually minimal compared to health insurance coverage for additional dependents. You pay a fixed monthly rate for both your employees and their family members. It also applies to your employees who are contractors or part-timers.

Employers who have health insurance may still opt for DPC. First, they can cover the cost of membership fees. Second, they can give their employees an allowance as a DPC membership fee. And third, they can offer a mix of healthcare plans with high-deductible or catastrophic.

A Point to Ponder: DPC is a convenient and affordable healthcare system. You can customize its benefits based on your existing health insurance. The better news is, the IRS proposed a new regulation. Based on IRS Code Section 213, the IRS suggested allowing reimbursement of the DPC membership fee. 

The regulation applies to employees who have a Health Reimbursement Account (HRA. HRA is usually unfunded with no cash value. Employees use it to reimburse for their medical expenses. DPC can step up, but the regulation has yet to materialize.

3. Self-funded Employers of Large Businesses

Unlike small businesses, an ABQ business with more than 50 employees must provide health insurance. Large employers can either be self-funded or fully insured.

• Self-funded: A company takes the risk for their employees’ healthcare costs. These costs are paid directly without an insurance agency. Instead, a TPA manages its services. It’s an independent organization connected to a health insurance provider.The company saves money when the costs are low and vice versa. Self-funded plans cost less than fully insured plans.

• Fully insured: A company transacts with a health insurance provider. The health insurance provider delivers service for employees on a fixed plan. The services are funded and administered by the health insurance provider.The risk is with the health insurance provider and not the company. The company doesn’t suffer from possible ups and downs of the cost of claims. But business owners rarely see savings from it.

Whether self-funded or fully insured, these companies already have a budget for DPC. As a partially- or self-funded large business, why would you still need DPC?

• Reduced claims: Self-funded businesses pay fewer claims for healthcare services. Your employees can contact a DPC provider anytime through various channels. It’s inclusive of the monthly membership fee.For example, your employees can call the 24/7 telemedicine instead of going to the ER or urgent care. They won’t have to pay for fee-for-service on primary and preventive care or procedures.

• Huge savings: Discounted medications and lab saves you thousands. It’s possible because DPC providers bypass the insurance claims process. Instead, it pays for medications and supplies directly from a manufacturer.Moreover, you get huge savings if you offload primary care from monthly insurance premiums. Health insurance covers the heavy stuff. At the same time, DPC covers the small stuff that makes a significant financial difference.

A Point to Ponder: DPC is a value-added service to self-insured large companies. It decreases claims and adds significant savings for you. A company with a high-deductible health insurance plan (HDHP) is eligible for a Health Savings Account (HSA). Unlike HRA, an HSA is funded and stays with the employee even after resignation.

HSA offsets some expenses in HDHP.  You cover the cost of copayments and deductibles with an HSA.  It costs about $3000 or more annually for an HSA. On the other hand, $900 per employee is a fraction of the price for a DPC. However, DPC doesn’t compete with an HSA. It complements it by making primary services more affordable.

What Type of ABQ Business Are You?

1. An employer with no health insurance for its employees?
2. An employer of a business (10-49 employees) with health insurance?
3. A self-funded employer of a large business?

You can be any of these three employers. But one thing is sure, you and your employees benefit from DPC. It offers advantages, with or without health insurance. 

There are DPC providers in Albuquerque with various packages and rates. Choosing the right DPC provider depends on your aim. A study suggests it’s a reward strategy for employers based on the Quadruple Aim of healthcare.

• Do you want a better quality of care and improved client experience for your employees? Then, you can choose a DPC with various touchpoints. It means multiple channels of communication to access healthcare services, even if the rate is higher.
  
  
• Do you want a lower cost of care? It’s a no-brainer to select a DPC provider with the lowest rate. The kind of service won’t matter much as long as it’s competitive. What’s important is, it fits your budget.

Where is the Nearest ABQ Business Direct Primary Care Provider?

Virtual consults and telemedicine are great. But part of DPC’s convenience is its location. You may consider a DPC provider near your business or where your employees live. 

Based on a study, people travel only a certain distance to access primary care. Therefore, regardless of the DPC service or incentives, more than 25 miles is too far. 

Well Life Family Practice is conveniently located in downtown Albuquerque. It offers the following healthcare for as low as $75 a month per employee:

• Healthcare for the whole family
• Discounted medications
• Vitamin infusions and IV therapy
• Chronic disease management and acute care
• Discounted labs
• 24/7 Telemedicine

Talk to us at Well Life Family Practice today for your employees’ healthcare package at 505-585-2345. Or send us the list of your healthcare requirements at hello@welllifeabq.com, and we’ll gladly get back to you soon!