Employers should be commended for implementing an onsite clinic or direct primary care program. They are taking bold action in recognizing primary care’s critical importance in reducing healthcare costs and improving health outcomes.
Anyone contemplating such a move should know that onsite clinics and direct primary care are different.
A key characteristic of direct primary care is its focus on relationship-based care as opposed to transaction-based service. With direct primary care, the typical flat, per-patient-per-month fee paid to a physician allows for a more proactive, equitable, productive and accountable relationship than one finds in the usual fee-for-service healthcare system. In that model, payment is tied to high-volume transactions like office visits, procedures and tests, which are then paid for through a maze-like billing and coding scheme.
Until recently, most onsite clinic vendors offered only transaction-based care models that simply took the regular fee-for-service system and put it right at the workplace. In fact, today, most onsite clinics still favor a transaction-based “cost-plus” payment design.
Comparing the two
Both onsite clinics and direct primary care provide individuals easy “first-contact” access to a physician. However, significant differences between onsite clinics and direct primary care result when it comes to having an ongoing relationship with the same primary care physician over time.
Onsite clinics advertise their brand. They do not highlight specific physicians. In fact, it is common for onsite clinics to pay their doctors by the hour, setting them up as interchangeable commodities. With direct primary care, the individual relationship and, importantly, the financial relationship, are both tied directly to a specific doctor.
Furthermore, family-centered care is compromised if the onsite clinic does not adequately reach-out and welcome employee family members. Often, these individuals will view the onsite clinic as a “work thing” that is mostly for the employee, not the spouse and/or dependents. That dynamic is exacerbated if the workplace and onsite clinic is far from employees’ homes or if spouses work at different employers.
Contrast that with direct primary care physicians who are based in the community, treat patients of all ages and aren’t solely seeing individuals from one employer. They are more likely to understand the distinguishing community characteristics that influence the health needs of those individuals and provide culturally competent care. In Flint, Mich., it was the community-based pediatricians who first recognized lead in the drinking water.
Both onsite clinics and direct primary care provide the convenient access, comprehensive care, and care coordination necessary to strong relationship-based care. However, the biggest difference between the two models is the strong, community-based, personalized, and financial connection that direct primary care provides.
Primary care assessment tool
The crux of the PCAT is based on what’s known as the 4Cs, or four core domains:
- An individual can easily make first-contact with a primary care physician;
- An individual has a continual relationship with a primary care physician over time;
- Primary care physicians provide comprehensive care, which includes prevention, coaching, counseling when appropriate, care for acute and chronic illnesses and injuries, minor surgery, injections, aspiration of joints, simple dislocations, common skin problems, behavioral health and common mental health problems and community health resources information
- Primary care physicians provide coordinated care when treatment is required outside of primary care.
The 4Cs are followed up by three aspects of care that can also be included in the PCAT:
- Primary care physicians understand the need for family-centered care, where family members, family structure, and family history are an important part of the diagnosis, decision-making and ongoing treatment of an individual;
- Primary care should be delivered in a community-oriented way that understands the needs of certain populations and recognizes how distinguishing community characteristics influence the health needs of everyone in that community;
- Primary care is culturally-competent care that not only respects the beliefs, attitudes, and behaviors of patients, but also understands how they contribute to the overall health and ongoing treatment of an individual.
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