Study Committee on Direct Primary Care Meets

The Study Committee on Direct Primary Care met for the first time on July 24, 2018. The committee, chaired by Joint Finance Committee co-chairs Sen. Alberta Darling (R-River Hills) and Rep. John Nygren (R-Marinette), is tasked with examining how direct primary care (DPC) affects Wisconsin’s private and Medical Assistance (MA) health care systems and potentially recommending legislation regulating DPC in these markets.

The study committee comes after Rep. Joe Sanfelippo (R-New Berlin) and Sen. Chris Kapenga (R-Delafield) introduced legislation in the 2017-18 session (SB 670/AB 798) that would have created new statutes regulating DPC agreements in Wisconsin by, for example, requiring 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 to create a work group to study the feasibility of creating a DPC pilot within MA. The bill stalled in the Senate this session.

Darling began the meeting by emphasizing the options that could come out of the study committee. Options include presenting legislation to the Joint Legislative Council to approve for introduction to the full legislature, putting forward legislative options for individual legislators to consider introducing next session, or recommending no legislative action on the issue.

After the chair’s remarks, the committee heard from three DPC providers. The providers’ practices treat patients with individual DPC agreements, employer groups, and MA patients, among other arrangements. Dr. Steve Bondow operates a DPC practice in Delafield. Dr. Josh Umbehr operates a DPC practice in Kansas. Dr. Philip Eskew provides DPC onsite at prisons and employers.

The providers said DPC would reduce physician burnout and increase primary care access because it improves doctor-patient relationships by allowing providers to spend more time with patients and less time on administrative work. According to the providers, DPC drastically reduces costs for tests and procedures, decreases costly emergency room and urgent care visits, and thus helps reduce employer premiums and patient costs.

Network Health CEO Coreen Dicus-Johnson asked questions clarifying the relationship between DPC and insurance. The providers responded that DPC does not replace insurance altogether but only replaces insurance for cheaper primary care treatment. Patients should still have “wrap-around” coverage for procedures outside DPC agreements.

Next, Legislative Council briefed the committee on their assignment and provided background on DPC. Legislative Council laid out four perspectives committee members might consider throughout the process: DPC agreements, effects on private insurance, MA options, and large employer and state health plans. Legislative Council said other state legislatures have clarified DPC is not insurance, defined DPC, and created regulations governing participants, antidiscrimination, and disclosures.

Following Legislative Council, University of Wisconsin Population Health Institute researchers overviewed how DPC compares to the current insurance market. The researchers emphasized that current DPC users are generally healthier than a standard insurance pool, so data may be skewed. The researchers outlined comparable cost factors for both DPC and insurance, but overall there is little measurable data to prove DPC’s cost-effectiveness beyond anecdotal evidence. UW also pointed out that medical data often uses insurance claims as health care measurements, so the committee may need to require similar data collection in DPC.

After the UW researchers, Wisconsin Council on Medical Education and Workforce (WCMEW) briefed the committee on DPC workforce impacts. WCMEW urged the committee to consider how DPC might reduce doctors’ patient panels, increase time with patients, and reduce administrative work. In response to a question from Rep. Mary Felzkowski (R-Irma) about how DPC would affect midlevel providers, WCMEW said DPC encourages more team-based care.

The Office of the Commissioner Insurance (OCI) was the last presenter of the day. OCI clarified that DPC is not insurance, but DPC providers must be careful to avoid setting up practices that border on the definition of insurance (i.e. risk distribution, premiums, underwriting, marketing as insurance). OCI reminded the committee that last session’s bill would have explicitly exempted DPC from standard insurance regulations but would have required other consumer protections outside of current insurance code and statute.

Other concerns from committee members throughout the day included patient safety and how DPC fits into MA. Darling emphasized that Wisconsin will not be able to fit DPC into the existing health care model.

In closing, Darling listed future meeting ideas including: Sanfelippo and Kapenga discussing their bill from last session, local governments discussing how they use DPC, QuadGraphics/QuadMed discussing how they use DPC as an employer, and discussion about DPC pilots in other states. The tentative date for the committee’s next meeting is August 29.

Committee members and documents