Alternative healthcare model seeks to be more cost effective for patients

Physician Alica Wooldridge wants to spend more time with patients to better understand their individual medical needs, while offering them more affordable prices on tests, treatments and prescription drugs.

In February, Wooldridge opened LakelandMD, a direct primary care clinic at 202 Lake Miriam Drive in Lakeland to do just that. Direct primary care is for patients both insured or uninsured who pay a monthly fee to gain access to physician negotiated rates for everything from blood tests to x-rays and mammograms to medications.

Many tests for COVID-19, flu or pregnancy, among others listed on the doctor's website are included in the monthly fee at no additional cost. Others are negotiated by the direct care physician for their patients at rates significantly lower than insurance plans.

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This healthcare delivery model makes health insurance carrier plans optional or even unnecessary for seeing a doctor, as well as eliminating copays and deductibles. At LakelandMD, patients pay a monthly membership fee of $49 per child or $99 per adult. A family of four pays $279.

Wooldridge is among a growing number of doctors who have found a work-around for their patients and employees who are fed up with the lack of pricing transparency, surprise medical bills, formularies dictating covered prescriptions and hurried doctor visits.

"The model behind the DPC is that you have fewer patients, and you have a lower overhead because you don't have to pay for all the billing people and all of the support staff for checking all the boxes the insurance companies require," said Wooldridge.

"You don't bill insurance and you keep your overhead lower and pass the savings on to your patients," she said.

Patents with existing health insurance often with no hope of reaching their deductible still visit Wooldridge because of the overall lower cost of medical care at a DPC clinic.

Those wanting catastrophic coverage can keep their existing health insurance or secure a medical cost sharing membership plan, including those offered by Sedera or Christian Healthcare Ministries.

Patients Benefiting

One of Wooldridge's patients, Anna Bracato, likes more than just the pricing.

The former Wesley Chapel resident found a DPC physician there for her daughter who suffers from an childhood illness and then sought one in Lakeland for herself and her younger daughter after relocating.

"My oldest daughter has had significant health issues and we have gone from doctor to doctor to doctor around the globe and this is the first time we found a physician that we thought was not only qualified as a medical doctor but was also willing to explore things that maybe new or natural," she said.

"He was willing to explore it. He went to great lengths to get other physicians that could help us, I mean, we were blown away," Bracato said.

Bracato found that most traditional physicians were prescribing expensive medications during brief appointments that did not seem to improve her daughter's health.

"They were only willing to prescribe the top medicine, not necessarily listen to our specific case," she said. "And so my experience with DPC and doctor Wooldridge is she's absolutely qualified and, you know, willing to go deeper than just the 15 minutes."

Bracato thought it was going to be more expensive but after comparing costs with her health insurance provider she found, "we saved significantly more money. Significantly."

Employers Benefiting

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Rising heath insurance premiums come with higher deductibles, which are usually never reached by most employees in health insurance plans, Wooldridge said. So unless the patient has "a very major illness or accident, the employees don't actually derive any benefit from it," she said.

Employees often avoid ongoing appointments "for routine things, for urgent care visits, for ear infections, for strep throat, for whatever; because it (the insurer-based plan) doesn't really kick in until the deductible has been met." Wooldridge said.

With lower overhead, doctors are happier because they don't have to have thousands of patients, they get to have hundreds, Wooldridge said. They can control their lives and their schedule to spend as much time as they need with individual patients "because they are not being told by administration that you have to see 20 people a day and we're giving you 15-minute appointments."

DPC and employers

In addition to the doctor patient relationship, direct care is catching on with at least one Lakeland employer.

At Lakeland Automall, the employer recently offered DPC to its employees through Persona Healthcare Direct in Lutz.

"I think this is going to be an excellent thing for our local employer groups," said Liz Antaya, employee benefits advisor for the Lakeland office of Stahl & Associates Insurance.

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She had worked with a few well-known insurance carriers for the Lakeland Automall for several years when "every year they were getting pretty large increases, not every year, but most years," Antaya said. "And so, It gets frustrating as a benefit advisor, going to your client and delivering the bad news – don't shoot the messenger – you're getting increases, and often times you're taking away benefits and then charging more for it."

A master's degree program helped her to learn "about the other ways to provide real value" while meeting people who could show her better ways to serve her clients.

With the Automall facing 25% increases year after year, she helped the owner offer employees membership to a DPC plan, similar to a gym membership, that was employer-built, which offers on-site doctor appoints every other week with both included tests and lower pricing for medical treatments and prescriptions.

"The direct care primary care physician provides up to 75 to 85% of the care," Antaya said.

Some employees opted to retain their existing health insurance plan so they could continue seeing their current primary care doctor who they may have seen for decades, she said.

Plans that are built by employers offer Center of Excellence for special treatments and procedures needed by some members in the direct care plan, including out-of-state medical facilities.

Typically there are 50 employees on the DPC health plan, smaller groups can offer payment toward membership for a direct care physician and couple with medical cost sharing for much less than legacy health insurance.

Carl Schuessler is the founder and managing principal at Mitigate Partners, an employee benefits consulting firm. He and Antaya are part of the Health Rosetta, which seeks to help advisors learn more about employer-built healthcare plans.

"It's about getting the money off Wall Street, and putting it back on Main Street," Schuessler said.

Health Rosetta seeks local, non-partisan fixes to the health care system for public and private employers and unions to reduce their health benefits spending by 20% to 40% while improving the quality of care, its website said.

According to the website, https://mapper.dpcfrontier.com/ Florida has more than 50 DPC clinics similar to Wooldridge's from South Florida to the Panhandle.

Paul Nutcher covers business and industry for The Ledger. He can be reached at [email protected].