New Study Analyzes Direct Primary Care’s Impact on Large School District’s Health Benefits

LONGMONT, Colo., Oct. 13, 2020 /PRNewswire/ — Nextera Healthcare, the first provider of direct primary care (DPC) in Colorado and one of the first in the United States, was the subject of an in-depth case study report on the positive impact in health and healthcare costs for a large local school district. The case study evaluated the benefits of DPC and how DPC is used to improve employee health outcomes while decreasing cost to the employee and employer. The analysis was performed by KPI Ninja, a leading healthcare analytics and performance improvement company. KPI Ninja conducted risk score analysis using the Johns Hopkins’ ACG® research system.

The analysis looked at 23,593 claims from September 2018 – August 2019 and compared two preferred provider organization (PPO) plans: a PPO Direct plan, which included Nextera Healthcare and a PPO Choice plan. The PPO Direct plan including the Nextera Healthcare membership cost, showed $76 per member per month (PMPM) less spend, resulting in a $913 per member per year (PMPY) difference when compared with the PPO Choice plan.

Nextera Healthcare members received unlimited access to in-office visits and telehealth with their physician/provider without having to incur any co-pays or cost per visit. Physicians used secure text messaging, phone calls and video chat to communicate with patients for conditions like high blood pressure, mental health concerns and diabetes. Physicians also provided follow-up care for patients who had undergone surgery or were admitted to the hospital. Patients were offered same day access to their physician’s office for urgent medical concerns during business hours as well as virtual care for urgent issues outside of normal operating hours. This prevented patients from having to visit the urgent care or emergency room. As the DPC model doesn’t rely on the volume of patients seen per day to generate revenue, physicians were able to spend 30 to 60 minutes with patients during their visit. This time allowed for significant focus on prevention and wellness.

Despite costing less per member in monthly premiums, the analysis found that healthcare costs for Nextera Healthcare members were significantly less than they were for non-DPC members of the PPO Choice plan. This is likely because PPO Direct plan members accessed significantly more primary, preventative care when compared to PPO Choice plan members. PPO Direct plan members visited urgent care at least 40.6% less, visited the ER at least 9.6% less, had 92.7% less inpatient admissions, and had 76.7% less outpatient hospital visits.

Considering premiums paid and overall PMPM spend, the return on investment (ROI) for the PPO Direct Care plan which included Nextera Healthcare is superior to the ROI for the Choice PPO plan. It’s clear that patients are benefiting from increased access to primary care, improved quality of care, and lower costs. Responses from this study and studies of other DPC models report that patients and physicians/providers are more satisfied with the DPC model compared with fee-for-service primary care.

These findings are consistent with a previously published Society of Actuaries DPC study that also referenced Nextera Healthcare. The study reported that DPC members had 25.54% lower hospital admissions, the cost of ER claims was reduced by 53.6%, and unadjusted and risk-adjusted claims costs for employers were reduced by 19.9% and 12.64%, respectively.

“Direct Primary Care provides tremendous value for both patients and employers. Patients have unparalleled access in a convenient and affordable manner to their physician/healthcare team. Nextera Healthcare members typically have more visits with their physician care team each year compared to traditional fee-for-service primary care. This helps build a deeper and more trusting relationship with their physician allowing for improvements in their overall health and well-being,” states Clint Flanagan, M.D. Founder and CEO Nextera Healthcare.

Visit www.NexteraHealthcare.com to learn more about direct primary care and Nextera Healthcare’s individual, family and employer membership plans.

About Nextera Healthcare

Nextera Healthcare is a direct primary care provider founded in 2009 with over 70 locations and is based out of Longmont, Colorado. Today, Nextera Healthcare is a leader at the forefront of the direct primary care movement, is a long-time steering committee member of the Direct Primary Care Coalition and works with the government, physicians and the private sector to improve healthcare. Nextera Healthcare delivers affordable personalized health and wellness services to businesses, families, and individuals and has the ability to do onsite and near-site clinics for employers.

About KPI Ninja

KPI Ninja, based in Lincoln, Nebraska, is a leader in healthcare analytics and performance improvement. KPI Ninja helps accelerate the achievement of strategic goals through a better means of managing key performance indicators, partnering with Health Information Exchange (HIE) companies, Health Systems, Critical Access Hospitals, Clinics, and Direct Primary Care (DPC) organizations. KPI Ninja has built a team of experienced professionals to study the model of Direct Primary Care and tell its story through data.

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Katie Harmon
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