Frequently Asked Questions
Questions and answers for a buyer or employer
Questions for a buyer/employer
Who pays for the membership? The member or the employer for the member?
Normally, a self-insured employer would pay for this for their employees. Fully insured employers may pay the entire cost, or develop a shared cost contribution model, especially when offered alongside an HRA.
Are employees and dependents (members) ‘locked’ into a specific clinic?
No. Members can always access providers that are part of their health plans in -network or out-of-network provisions. However, the convenience of easy and timely access and a no-cost membership approach will get employees to consider Care Clinic+ as an alternative to their PCP.
Do you bill my claims payer?
No. All services provided within our Clinic, and in conjunction with our contract, are included in the monthly per employee per month (pepm) fee charged to the employer or plan sponsor.
This is not purely preventive care, so cannot be subsidized for those with tax-advantaged HSA HDHPs.
True. However, given that there is no copay, this will reduce any financial burden on someone’s HSA balance. We are extensively familiar with Section 223(c) of the IRS Code and how they relate to direct primary care membership models. With the emergence DMCA programs that are offered alongside an HSA, there are multiple program options available in HSA and HRA plan models, please call or email us for a discussion on this topic.
Most direct primary care is pretty local, so how is this a reasonable solution for multi-region or state employers?
In addition to our Clinics that are built around locations with at least 800 Employees. We have a national DPC network partner to address potential local/regional demand.
How do you evaluate and project ROI in your DPC Model?
Through our predictive modeling program, we analyze the previous 12 months of Medical and RX claims, ideally 24, and identify “impactable” claims that could, or should have been provided at the direct primary care setting. ROIs are based on a conservative first year estimate, with increased participation in years two through five. In seven years, we have not missed a single first or second year projection.
Are there scale issues? Small independent direct primary care practices can’t build capacity rapidly.
Primarily, we are contracting with IDNs or IPAs that have sufficient coverage and interest in building market share with employers in a given community. We have not experienced any limitations in our network’s ability to scale.
What if a direct primary care doctor is not in the carrier networks? They cannot do referrals and are not necessarily aware of plan rules?
It is highly likely that a PCP in the CareClinic+ network will already be in a given plan’s network. If a PCP is not in the carrier network, referrals to specialty and IP providers will still be permitted.
What are the clear standards for direct primary care?
Medical and contract standards are required with every CareClinic+ provider in the network. We only contract with MDs who are licensed, demonstrate proven quality, and abide by state and national laws.
