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Innovative health clinic celebrates 3rd anniversary

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When the Legislature wrapped up its biennial session last week, two bills signed into law by Gov. Greg Gianforte won praise from Polson physician Cara Harrop, whose pureHealth direct primary care clinic is one of just eight in Montana. 

Senate Bill 374, which allows physicians to dispense medications directly from their office (with the exception of controlled substances), can provide a substantial cost savings for patients. And Senate Bill 101 clarifies that DPC clinics are not the same as insurance providers and don’t require the same level of regulation. That’s an important distinction, says Harrop. 

Clinics like hers are designed to offer a direct delivery model for healthcare outside of the health insurance industry. Members or subscribers pay a set monthly fee ($75 at pureHealth) for direct access to their  physician via in-clinic visits (appointments are typically available the same day or next day at pureHealth), phone, text messages and video calls. 

“We’re here simply to partner with you to help you achieve the best health possible,” says Harrop. It’s an outcome she believes is more feasible when providers are directly available and more affordable. 

The model isn’t limited to primary care. It also allows other specialties like dentists, physical therapists or even surgeons to create direct care relationships with patients.

Of course, direct primary care is not a substitute for hospital and emergency care. That’s why Harrop counsels her patients to also carry an insurance policy that covers emergency medical costs.  

“I’m very transparent that patients do need to have some kind of catastrophic safety net to cover things that none of us expect, like accidents, heart attacks and cancer treatment,” she says.

“To be fair, if I’m doing my job we’re catching those things before they’re in that catastrophic state. But we’re never going to have zero heart attacks or cancer diagnoses and the cost of that care is what insurance was designed for.”

Harrop believes price transparency is an essential component of the DPC model. Patients know what’s covered with their membership fee and what costs extra, including imaging, lab tests, specialist visits and procedures that are beyond the scope of an office visit. She’s often able to help patients find less expensive options for the services she doesn’t offer. 

And now, thanks to Senate Bill 374, she can also pass on savings for many common prescription drugs, such as antibiotics and blood pressure medications. Patients will have the option of paying wholesale plus 10 percent, instead of retail costs for most common medications, which can translate into startling savings. 

For example, Omeprazole, a common medication for ulcers and other digestive issues, retails for over $45 for a month’s supply while the wholesale cost is less than $1 for 30 pills. The antibiotic Amoxicillin, used to treat a variety of bacterial infections, retails for $61 for a 10-day supply, while its wholesale price tag is $7.40. 

Montana joins 44 other states in authorizing this cost-saving approach to filling prescriptions. “We can’t expect the health of our patient populations to improve if they can’t afford the cost of the medications that help treat chronic illnesses,” Harrop says. 

Implicit in her approach to delivering medicine is a deep frustration with the current system. She blames the exorbitant costs of healthcare, in part, on the extra layer of expense that goes to the industry that’s typically in between patients and their doctors: insurance companies. 

Insurers need to sell their products, evaluate risk and design and administer benefit plans; in some cases, they also choose to pay CEOs multi-million dollar salaries. 

At the same, providers navigate a mind-boggling array of usage and billing requirements from multiple payers, ranging from Medicare and Medicaid to private insurers. Meanwhile, family physicians are forced to see more and more patients per hour in order to keep their practice, clinic or hospital afloat. 

A recent national study of 100 million patient visits in the U.S. revealed that doctors spend an average of just over 16 minutes on patient encounters, with nearly 70 percent of that time devoted to chart review, documentation and ordering tests or prescriptions. 

Harrop believes it’s a system that ends up emphasizing “volume over value.” She also notes that the U.S. spends about three percent of its healthcare dollars on primary care, compared to 8-10 percent in other wealthy nations. 

Harrop knows firsthand how the system works. She serves as the chief medical officer for MONIDA, a regional association of healthcare providers serving residents of Montana and Idaho, and also spent the first 14 years of her career working as a family practitioner in a variety of rural healthcare settings. 

In 2017, she made the decision to take a sabbatical from her practice and pursue a master’s degree in healthcare innovation from Arizona State University in Phoenix. The course offered “an opportunity to look at things with a systems lens instead of my own little microcosm of existence.”

During her year away from practicing medicine, Harrop was trying to answer a fundamental question: Is there a model for delivering healthcare that can lower costs while allowing her to spend more time with her patients?

She opened Pure Care in July 2018, just three months after completing her master’s. The clinic not only gives her more autonomy, it allows her “to be able to take care of patients the way I want to take care of patients.” 

With its third anniversary nearing, Pure Health has more than 500 patients cared for by a two-person staff of Harrop and Vanessa Sandoval, her “Girl Friday.” The full-time, nationally certified medical assistant runs the office, answers the phone, schedules appointments, draws blood and performs in-office tests. Harrop plans to hire a receptionist in the near future and anticipates that she may need to add another physician as the practice continues to grow. 

She estimates that 40 percent of her patients have at least two chronic conditions, while up to 10 percent are considered high-risk with four or more chronic conditions. To offer the level of care those patients require, “we use all kinds of outreach” between office visits, including secure email, texting, phone calls and telemedicine.  

“My own personal approach to healthcare is one of shared decision making – it’s not me telling you what to do,” she says. And at Pure Care, “I have more time to have an informed conversation with you.”

It’s an approach that’s catching on. When she launched her business, it was the third DPC clinic in Montana. Now, there are eight, “with more coming on line all the time.”

Of course DPC clinics aren’t going to fix all the problems with healthcare. But with much lower overhead, better physician access and now, cheaper prescription costs, it’s part of the puzzle. 

Even Medicare, through its CMS Innovation Center, has launched a pilot project called Primary Care First that provides a monthly stipend to physicians for various levels of patient care, depending upon risk assessments. “Being able to provide primary care for a predictable amount every single month is a no-brainer,” says Harrop.

Nor does it undermine essential healthcare institutions. “We’ll never be able to provide all of healthcare in the doctor’s office,” says Harrop, who notes that she sends patients to the local hospital daily for lab tests, imaging and consultations with specialists. 

“The synergy I see is that I’m keeping people from going to the hospital when they don’t need to and can’t afford to pay their bill.” 

“The end result of us saving money needs to be that patients pay less to have insurance,” she adds. “Have you ever paid less for insurance? We’ve got some big infrastructure changes to embrace.”

 

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