Insurance-free approach to health care comes to the Lehigh Valley

Feb. 01--FOGELSVILLE -- Dr. Kimberly Legg Corba didn't go through four years of medical school and build a primary care practice from scratch only to rush her patients out the door with prescriptions for the cheapest medications even when more expensive alternatives would work better.

But that's what she felt insurance companies were pushing her to do -- until she cut them out of her medical practice altogether.

Last month Corba stopped accepting insurance, switching to a new business model called direct primary care. Now her practice, Green Hills Direct Primary Care of Fogelsville, works like a gym or health club: Her patients pay a monthly membership fee, which allows them to schedule an appointment whenever they want and as often as they need, without co-pays.

They can also call her on weekends and nights for advice and swing by the office to pick up commonly prescribed medications at deeply discounted prices. It's all so much easier without the insurance companies getting in the way, she said.

"Medicine and the care of a human being does not fit algorithms," she said. "In primary care, you really have to listen to everything the patients have to say ... You can't do that in seven to 10 minutes -- it's not good medical practice for the patients or the physician."

Direct primary care hearkens back to a bygone era when family doctors made house calls and got paid at the door. Proponents say it reduces health care costs by eliminating unnecessary paperwork and administrative expenses, and that it has the potential to revolutionize health care by allowing doctors to again focus on their patients, as opposed to billing issues.

An article published last year in the peer-reviewed Journal of the American Board of Family Medicine described direct primary care as a growing model, identifying 141 direct family care practices with 273 locations spanning 39 states. Corba believes hers is the first direct primary care practice in the Lehigh Valley.

Among the groups that have come out in support of direct primary care is the American Academy of Family Physicians, whose membership includes 120,000 doctors nationwide. The academy's president, Dr. Wanda Filer, a family physician in York, said frustration with insurance companies is widespread, and direct primary care is emerging as a viable alternative.

"The doctors who are doing it love it," she said. "Quality improves and the patients with multiple chronic diseases really benefit, because they get the face-to-face time."

Dennis Olmstead, chief strategy officer for the Pennsylvania Medical Society in Harrisburg, echoed the point: "It's an alternative payment model that is going to, in some cases, help restore the physician-patient relationship."

One of the most obvious benefits of direct primary care, according to Corba, is price transparency. Her patients now know exactly how much they'll have to pay. Monthly membership fees are displayed for all to see on her website: From $10 a month for the child of an adult member to $100 a month for people 65 years old or older.

For that, her patients get as much time with her as they need, including access via webcam, email and text, she said. Additionally, her office includes a small pharmacy stocked with commonly used generic medicine, which is available to patients at wholesale prices. Patients also have access to discounted lab and radiology work through special agreements with area providers.

So while patients must pay membership fees upfront, they can save even more money later, which makes the model affordable for middle-income and even some lower-income patients, she said. And since direct primary care does away with co-pays and other up-front expenses, the model can be especially cost effective for patients who couple it with high deductible insurance to cover the cost of major medical expenses such as hospitalization.

Olmstead stressed that direct primary care membership doesn't eliminate the need for at least some health insurance. "Buyers need to be aware of what's covered and what's not covered under the model," he said.

Corba, who graduated from Parkland High School in 1985 and Muhlenberg College in 1989 before attending Philadelphia College of Osteopathic Medicine, said she set out to create a small, intimate family practice.

"I like when I know the patients well enough that when they walk in I can tell if there's something going on," she said. "I like when they trust me, so they can tell me about anything."

Such relationships, however, require time, she said, which is something insurance reimbursement schemes discourage by placing such an emphasis on cost savings.

The insurers, along with government regulation, are diminishing care in other ways, she said. She described, for example, an instance when an insurance company reduced her reimbursement because she had prescribed one drug instead of a cheaper -- but less effective -- alternative.

A mother of two teens, Corba described Green Hills Family Health Care, which she founded 12 years ago, as her third child.

Over time it matured into a thriving practice. The shelves were filled with 2,000 patient charts, 1,200 of which were active. It was top-ranked four years in a row by the Achieving Clinical Excellence program of Lehigh Valley Health Network's Physician Health Organization.

"This is a bigger risk for me than starting my practice," she said of her switch to direct primary care. "I have more to lose."

Since rebooting as Green Hills Direct Primary Care, Corba has converted more than 150 of her patients into enrollees, which she said is enough to cover the practice's overhead. Corba, who is supported by a staff of two -- an office manager and a medical assistant -- said she could handle 400 to 800 patients, depending on their age and health. She'll stop accepting new members when she feels she has reach her limit, she said.

One of the enrollees, Pat Uhlich of Fogelsville, recalled her reaction when she learned of Corba's plans: "My first thought was: 'I don't blame you,'" the 60-year-old speech pathologist said. "Insurance is so onerous and time-consuming and convoluted."

Uhlich said she and her husband will pay $1,800 in Green Hills membership fees this year, though they expect to recoup at least some of that through their tax-exempt health savings account. They still have their insurance through his employment as an operations manager for a grocery warehouse.

She said she and her husband were willing to take the chance that they might end up spending a little more on health care this year. "We value [Corba] that much." Plus, she said, she's thrilled by the idea of reducing the amount of insurance paperwork in her life. "I don't have the time for it," she said.

Corba couldn't agree more.

"I had to do something to ensure the survival of what we do so well here," she said.

[email protected]

610-984-4713

___

(c)2016 The Morning Call (Allentown, Pa.)

Visit The Morning Call (Allentown, Pa.) at www.mcall.com

Distributed by Tribune Content Agency, LLC.