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0029, 15 Jan 18

Wisconsin Considers Direct Primary Care Reform

Better care? Lower cost? Sign me up.

The Senate Committee on Public Benefits, Licensing and State-Federal Relations on Thursday heard testimony on a bill authorizing the Department of Health Services (DHS) to launch a direct primary care pilot program in BadgerCare, the state’s Medicaid program.

Direct primary care is a method of delivering health care in which patients pay their primary care doctors directly via a monthly fee, bypassing traditional health insurance that can obscure the actual costs of procedures. Since patients are paying cash, there’s significant downward pressure on prices.

“Price transparency means patients see a significant savings with the DPC model. Some DPC providers are successfully delivering care resulting in savings of 15-30 percent,” the bill’s author, Sen. Chris Kapenga (R-Delafield), told the committee.

That kind of cost reduction means that implementing direct primary care into the state’s behemoth Medicaid program would be a taxpayer windfall.

“Medicaid spending has continued to balloon, accounting for almost 20 percent of our entire state budget, so it’s obviously an issue that we have,” Kapenga said. Total Medical Assistance payments in Wisconsin have soared from $4.7 billion in 2004 to nearly $9.2 billion in the 2016-17 fiscal year, according to the nonpartisan Legislative Fiscal Bureau.


“The first several months I was practicing in this model of healthcare, I was surprised by the number of people who came to see me who had not seen a physician in ten to 20 years,” Dr. Suzanne Gehl, a direct primary care physician in Delafield, told the committee. “We were diagnosing high blood pressure, diabetes, hypothyroidism, and cancer at unbelievable rates,” she said.

Once patients familiarize themselves with the direct primary care system, with its more personalized approach eschewing large hospitals and cumbersome health insurance paperwork, they quickly realize the benefits.

“The thing that amazed me is once you removed the barrier of cost and access, how quickly we were able to get these conditions under good control and help them navigate the healthcare system in a very efficient and cost saving manner,” Gehl said.


0029, 15 January 2018


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