Direct Primary Care Committee Will Not Recommend Legislation, Kapenga/Sanfelippo To Reintroduce Bill

The Study Committee on Direct Primary Care (DPC) met for the final time on Sept. 18 to make their final recommendations from their work this summer. The committee concluded without recommending any legislation but agreed that DPC is a positive part of the health care system and that the Group Insurance Board (GIB) should explore DPC for state employees. After the conclusion of the study committee proceedings, Sen. Chris Kapenga (R-Delafield) and Rep. Joe Sanfelippo (R-New Berlin) announced this week they will reintroduce their bill (2017 AB 798) on the first day of the 2019-20 legislative session.

The Sept. 18 meeting began with a panel of DPC patients who spoke about their experiences with DPC, reiterating its benefits of cost savings and better patient-provider relationships. Next, the committee heard from Paladina Health, a company that provides DPC model health care to large employers.

Following the presenters, the committee spent the bulk of the meeting discussing four decision points laid out by committee chair Sen. Alberta Darling (R-River Hills):

  1. Whether DPC is insurance
  2. The definition of DPC
  3. Consumer protections
  4. A DPC pilot in the state’s Medical Assistance (MA) program.

Legislative Council also provided the committee with an overview of statutes in other states.

The committee’s discussion led to little consensus among committee members regarding legislation. The committee ultimately decided not to recommend legislation but to:

  1. State that DPC is a positive part of the health care system in Wisconsin.
  2. Recommend that GIB explore an “employer-sponsored direct primary care model in the state employee health plan under its current structure.” (Committee vice-chair Rep. John Nygren (R-Marinette) requested the language “under its current structure” to avoid bringing up the idea of a self-insured employee health plan, which was discussed but not passed in the 2017-19 budget proceedings last session.)
  3. NOT recommend legislation on whether DPC is insurance, the definition of DPC, consumer protections, or an MA pilot.

With no legislative direction from the committee, Kapenga and Sanfelippo said they plan to reintroduce the same language from the 2017-18 session. The bill 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 to create a work group to study the feasibility of creating a DPC pilot within the state’s MA program. The bill stalled in the Senate last session.

Committee members and documents

Summary of the first meeting

Summary of the second meeting