Like many employers in Maine, Tom Adams is committed to providing his employees with meaningful health insurance as part of their benefits package. The founder in 2011 of Maine Coast, a lobster and seafood wholesale business, employs just under 50 workers at two sites, one in the town of York and another at a small satellite shipping office in Boston.
“We’ve provided health insurance since Day One. I’m a strong believer in people having health insurance,” Adams said.
But Adams, like other employers, felt the sting of rising monthly premiums and diminishing benefits of the plans he could afford to offer.
“What was being offered was being degraded every year, with higher deductibles, co-pays and premiums,” he said.
So Adams is trying something different. He’s giving employees an old-fashioned option — health care from a local doctor, paid out-of-pocket, that doesn’t tap into their insurance at all.
The company partnered with Dr. Peter Sacchetti, a local internal medicine doctor who in 2015 opened a “direct primary care” practice in York. Direct primary care providers do not bill insurance companies, Medicare, Medicaid, the VA or any other third party-payer. Instead, they typically charge a monthly membership fee for a set package of services, with additional services billed on a per-visit basis.
For a flat fee of about $60 per month — Maine Coast will pay about 70 percent and employees 30 percent, deducted from their paychecks — workers will have ready access to Sacchetti’s primary care services, including a comprehensive annual physical and three additional office visits during the year for acute illnesses, disease management, minor injuries and other routine needs. The practice offers an onsite lab and pharmacy as well.
The new option is designed to complement employees’ regular health insurance offered through Maine Coast. For 2018, the company opted for a partially self-insured commercial plan with a couple of different annual deductible options — $2,800 or $3,800 — and monthly premiums largely in line with the 2017 plan.
The visits to Sacchetti will not be billed to employees’ health insurance, will not count toward their plan deductible and will require no additional payment.
The new option is not a substitute for insurance, but Adams hopes his workers, who are mostly healthy, active men in their mid-30s, will seek medical care when they need it, instead of putting it off for fear of incurring uncovered expenses. For more serious needs, including hospitalization, the company’s health insurance plan will provide backup.
Health insurance companies are less likely to raise premiums for businesses whose employees don’t tap heavily into their plans. So keeping workers in good health can pay off in lower insurance rates.
“The reason for doing this is primarily a benefit to our employees,” Adams said. “But we do think they will be healthier, happier and more productive, so we hope there is a benefit to our bottom line as well.”
So far, 12 of his workers have signed up.
A new direction in medicine
Only a small percentage of doctors participate in the direct-care model. But they are growing in number, as physicians flee the confines and frustrations of more traditional and more regulated practice settings such as hospital clinics and federally funded health centers. In addition to serving individual patients, many in the field predict direct primary care will become a popular option in employer-sponsored benefit packages, providing routine care and basic services that increasingly pricey health insurances do not cover.
Some skeptics fear the trend could lead to a system of care that provides more options to patients who can afford private subscriptions to health services. Other say the attractions of the direct primary care model could lead to a shortage of providers in public clinics and other settings. But until and unless the nation’s health care system finds ways to attract and retain providers in more traditional settings, the trend seems likely to grow.
One website, DPC Frontier, shows nearly 800 direct primary care sites in 48 states and Washington, D.C. In Maine, according to the New England Direct Primary Care Alliance, there are at least four — the Osteopathic Center for Family Medicine in Hampden, Megunticook Family Medicine in Rockport, Ciampi Family Practice in South Portland and Peter Sacchetti’s practice, Independent Health Advantage, in York.
Sacchetti completed his medical residency in 2007 and worked at York Hospital for seven years, followed by a short stint at Southern Maine Health Care in Kennebunk. He said he felt overwhelmed and discouraged by the working conditions: the expectation that he would see 20 or more patients a day, spending only a few rapid-fire minutes with each; the voluminous record-keeping required to satisfy insurers and other payers; and the lack of control he felt over how best to care for his patients, when many treatment decisions were dictated by those payers.
“It was, ‘either I’m going to [start my own practice] or I’m going to leave the field of medicine altogether,’” he said.
He opened his direct care practice in December 2015 and boasts about 150 adult patients of all ages. He feels he can manage at least twice that many. A typical visit lasts between 30 minutes and an hour. He has time to talk with his patients, research their medical conditions and determine the treatments he thinks will work best, he said.
“I do everything, from soup to nuts,” he said. “I greet the patient when they walk through the door. I take their vital signs, draw their labs and conduct the exam. I think there’s something kind of nice about having that kind of contact with your doctor.”
His wife, Rebecca, assists with scheduling and some administrative tasks. The office pledges to see patients the same day they call or the next day, even if it means opening in the evening or on a weekend. Sacchetti is also available for email, text and other online consultations, often at no extra charge.
One of Sacchetti’s patients is Adams of Maine Coast, who signed himself up months before deciding to add direct primary care to his employee benefits package. Even though he enjoys a more benefit-rich health insurance plan than most of his workers, thanks to his wife’s employer, Adams said something was missing.
A few meetings with Sacchetti convinced him of the value of direct primary care.
“I tell my employees it’s absolutely essential to have health insurance,” he said. “But a relationship with your doctor is also important, and that’s been lost to all the insurance regulations and billing issues.”
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