Employer Plan Sponsor Innovation Case Study: Pennsylvania
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Dr. Patrick Rohal of CovenantMD and Tina Wilt of BCF Group deliver a case study from Pennsylvania. They walk us through their work building the business case for a DPC-centric employer plan, the process of getting sign-off, and the work needed to deliver high-quality care to employees. See the full session at: http://video.hint.com/pennsylvania-case-study-integrating
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Employer Plan Sponsor Innovation Case Study: Pennsylvania
- 1. Case Study 3/3: Pennsylvania Dr. Patrick Rohal CovenantMD Tina Wilt BCF Group
- 2. CovenantMD & Paul B. Zimmerman, Inc. Patrick Rohal, MD, FAAFP & Tina Wilt, PHR, GBA 2
- 3. Dr. Rohal, circa 2000 3
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- 5. Dr. Rohal, circa 2015 5
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- 9. Our First Three Years added 2nd doc added NP Added 3rd doc, 2nd location 9
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- 14. Why work with employers? ● Cons • Returning to a “third party system” • Patients have little “skin in the game” • Substantial revenue wrapped in one cohort ● Pros • 49% of Americans have employer health coverage • Reaching a “functionally uninsured” population • Helps the bottom line 14
- 15. CovenantMD and Employers ● 13 employers ● 3 to 475 employees ● Employees comprise 19% of patients at Lancaster office, 100% in York, 40% total 15
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- 17. Rohrer’s One Hour • 69 patients enrolled (21 employees, 48 family members) • 111 total visits (not counting nurse visits) • Some home visits • Some urgent and emergent visits 17
- 18. Rohrer’s One Hour CovenantMD Other Medications $528 $10,135 Labwork $626 $8214 Procedures $500 $3729 Imaging $585 $3877 Visits $50 $11,342 18
- 19. Rohrer’s One Hour ● Total savings of $37,297/year compared to usual care ● $507 per patient per year 19
- 20. Paul B. Zimmerman, Inc 20
- 21. Stakeholders: The Employer • Progressive, strong community presence • Family-oriented • 200 employees, 600 plan participants • Plan design: a single $1500/$3000 PPO plan with OVC (Primary $30, Specialist $50, Urgent $50, ED $200) 21
- 22. Stakeholders: The Practices • CovenantMD (choice of 3 providers), n = 134 • Heritage Family Health (choice of 2 physicians), n = 107 • Alere Family Health (1 provider), n = 12 • Each presented to employees during open enrollment 22
- 23. Stakeholders: The TPA (CoreSource) ● Familiar with DPC ● Plan Structure ● Enrollment/Eligibility ● Claim reporting ● Member Support ● ID Cards? ● Ongoing comparison of DPC vs. non-DPC cohorts 23
- 24. Stakeholders: The Advisor (BCF Group) ● Coordination between stakeholders ● Documentation of all collective decisions ● Work flow for plan enrollment & eligibility, DPC payment, member education ● Facilitating direct contract arrangement to downstream providers (e.g. imaging provider) ● Compliance concerns and tax implications ● Ongoing support 24
- 25. Final Offering • Effective 1/1/2019, PBZ offers 3 DPC options • PBZ pays for any member (employee or dependent) • CovenantMD and Alere have monthly membership model • PBZ pays these practices monthly based on the enrollment reports generated by CoreSource ■ Heritage Family Health maintains a cash-pay FFS model, PBZ credit card pays for payment at time of service 25
- 26. Thank you! 26