SOLVING PROBLEMS FOR BUSINESSES AND EMPLOYERS

The focus of our practice at Wimberly Lawson Wright Daves & Jones, PLLC is primarily on Labor & Employment law and Workers’ Compensation, together with General Liability defense, for businesses and professionals, insurers, and governmental entities. We have offices in Knoxville, Cookeville, and Nashville, Tennessee, and serve clients both nationally and internationally. Our attorneys use a number of preventive and cost-effective methods to maximize employee benefit dollars as well as avoid costly legal problems. We also present educational seminars on a wide variety of topics, including critical issues for employers regarding the current COVID-19 situation. The Firm has been recognized for various coveted rating awards including:

• U.S. Top Ranked Law Firms by Fortune Magazine;

• Best Law Firms by U.S. News & World Report; and

• Martindale Hubbell Peer Review Rated Award by Martindale-Hubbell.

For more information or to sign up for our free newsletter, please visit us at www.wimberlylawson.com

The Benefits of Direct Primary Care for Employers

Perhaps you’ve heard of Direct Primary Care. You have wondered what it is and contemplated if you should research it for your organization. What are the benefits, and what are the drawbacks? In this brief article, I hope to provide some better insight as well as tell you about a new hybrid that we have had our eyes on. Ready? Let’s go!

Having a primary care physician is one of the most important things an individual can do for their health, as it helps ensure they receive regular check-ups, aids in preventive care and allows for intervention before more intensive treatment is required. However, according to a recent study by nonprofit organization Kaiser Family Foundation, 17% of women and 28% of men in the United States don’t have a primary care physician. Compounding concerns, there is a scarcity of primary care physicians across many regions of the country, which the Association of American Medical Colleges expects to worsen by 2025.

Many employers recognize the value of primary care for their workers and, therefore, have adopted direct primary care (DPC) arrangements to increase employee access to such care. In addition to improving primary care access, DPC enables employers to manage their rising health care costs without shifting these expenses onto employees, all while ensuring high-quality care.

What Is DPC?

DPC is an alternative health care payment model to traditional fee-for-service insurance that’s intended to improve health care affordability and access to primary care for a flat fee. This has mainly been a strategy for self-insured health plans. But don’t stop reading just yet. You don’t have to be self-insured to enjoy the benefits of a DPC model (see the last paragraph).

Typically, under a DPC model, employers pay fixed monthly membership fees for their employees, which are typically less expensive than most health plans’ monthly premiums. These fees generally cover all primary care costs for employees. As a result, DPC is often more affordable and cost-effective than other forms of health insurance, such as preferred provider organization plans.

Under DPC arrangements, employers typically have no direct relationship with the health care system, meaning there is no thirdparty billing or fee-for-service payments. Instead, these arrangements center around the relationship between employees and their health care providers, eliminating the need for insurance companies to act as intermediaries to approve procedures and medications. This allows health care providers to have more leeway in determining treatment options for patients, allowing doctors to deliver the attention and care they believe patients need. While DPC arrangements often complement existing group health plans, employers should note that some variations of these arrangements may still require providers to bill through insurance plans and exclude certain primary care services from coverage, including prescription drugs.

What Are the Benefits of DPC?

Employers can consider the following benefits when evaluating whether to adopt DPC arrangements:

Reduced Health Care Costs

DPC arrangements can help employers reduce their health care costs. Instead of paying for each service provided over the course of a year, employers pay a flat fee per employee. Additionally, DPC membership fees are generally much less expensive than typical health insurance premiums. And because employers do not have a direct relationship with the health care system under DPC arrangements, health care claims are usually easier to manage, which can help minimize administrative costs.

Strengthened Attraction and Retention Efforts

DPC is an attractive benefit for employees because it improves their access to health care and, in many instances, it costs them nothing to visit their primary care doctors. What’s more, the improved access and extra time employees have with their physicians can allow them to build strong, trusting relationships with these doctors, which can ultimately improve their long-term health. As such, by offering DPC arrangements, employers can demonstrate their commitment to employee well-being and bolster attraction and retention efforts. These arrangements are also often more affordable than traditional fee-for-service insurance.

Therefore, allowing smaller employers who otherwise may not be able to afford to offer health insurance to do so.

Improved Employee Productivity and Wellness

Employees typically have improved access to primary care physicians under DPC arrangements, reducing the amount of time they spend away from work to receive treatment. In addition to offering virtual or telemedicine services, DPC arrangements generally permit employees to visit their doctors the same or next day when issues arise.

DPC physicians also typically offer longer office hours than other physicians, allowing employees to visit doctors after their normal work hours. Additionally, many DPC locations are located near worksites, directly on-site or at shared multi- employer clinics, thus preventing employees from having to miss work or spend excess time traveling to see their doctors.

The average patient spends 121 minutes at each doctor visit, according to research from the American Journal on Managed Care. Of that time, the patient spends 37 minutes traveling and 87 minutes at the clinic. When at the clinic, the patient only spends between 8 and 12 minutes with a doctor. This means that the average patient spends less than 10% of the total time they invest to see their physician receiving care.

Fortunately, DPC arrangements provide on-demand services, which means employees spend less time waiting—and, in turn, less time away from work—when they need to see their physicians. By decreasing waiting periods and increasing time spent with physicians, DPC arrangements can encourage employees to see their doctors when needed, addressing health issues and concerns as they arise instead of waiting until they potentially develop into bigger problems. This can help keep employees healthier and more productive.

Further, most DPC providers have significantly fewer patients than other physicians; in many cases, they have less than half the average number of doctors. These smaller patient pools allow physicians to spend more time with their patients, enabling them to unearth possible health issues before they become chronic or catastrophic. Subsequently, patients are less likely to require emergency room or urgent care visits and specialist services. With more time, doctors can better coordinate care and advocate for patients when referring them to outside providers as well.

What are the drawbacks?

While DPC offers many benefits, there are certain concerns employers should consider when evaluating whether to offer these arrangements. Since DPC only covers primary care services, employers will likely still need to provide employees with additional health insurance to cover specialists, hospitalizations, and other health-related emergencies. While DPC arrangements are generally compatible with employers’ group health plans, there are some limitations. For example, DPC plans that cover all primary care costs among employees aren’t compatible with health savings account-eligible high deductible health plans. Further, these plans don’t accept Medicare, Medicaid, and other government funds, making them exempt from cost and quality regulations.

DPC is often a location-specific solution. As a result, offering DPC arrangements can be challenging for employers with workforces located in different cities and states. This also makes it more difficult for employees to locate providers. In addition, DPC can hamper an employer’s ability to access medical claims data, potentially limiting their ability to help employees make informed health care decisions.

Here is the ‘drop the mic’ part . .

What if we were able to offer all the benefits of the DPC model: lower premiums, lower deductibles, better relationships, AND the benefits of the traditional PPO model: more locations, ease of billing, traditional plan designs with deductibles and copays? WE ARE ABLE. In many states, and growing, we have partnered with today’s health marketplace thought leaders who develop solutions that include access to a local hospital system and providers at one low deductible (say $500) and then a back-up insurer for those times when you receive service outside of your local/community hospital network at a little higher deductible (say $2000). So, you have amazing coverage that combines the best of both worlds and is often offered at a price much lower than your ‘off-the-shelf’ PPO product.

Want to learn more? Reach out to us at 615-250-3334 or email will@benefits.place.com

Every HR professional is familiar with creating growth opportunities for employees. Mentoring, leadership development, tuition reimbursement and project-based learning are a few examples of ways that employers help employees advance in their careers. But what about HR? What contributes to your own professional growth and development?

This issue weighs heavily at HRCI. It’s why we commissioned a thirdparty research firm to survey HR professionals about how certifications support their career growth and whether they prepare them to lead their organizations. The research firm received 2,536 completed responses from HR professionals across various employment types, titles, educational backgrounds, and industries. Ninety-three percent of the respondents are employed full-time in an HR position and 31 percent hold manager titles.

What did we learn? I’ll fast-forward to the end result: 79 percent who added HRCI credentials after their name received the opportunity to pursue challenging assignments and jobs. Eighty-two percent said their HRCI certifications allowed them to engage in assignments that required new knowledge and skills. Delivering a competitive edge for HR leadership roles, complementing an existing or in-progress formal education, forging a path forward to higher pay, and greater career growth and satisfaction topped the list of key benefits provided by HRCI certification.

Why is all of this so important? The accelerated and unpredictable pace of work has created unprecedented change. As we strive to rebalance and recalibrate what work looks like moving forward, HR professionals are pressured to contribute to business outcomes through more strategic workforce programs and management.

Among the many changes are the increase in remote workers and corresponding requirements for virtual collaboration and engagement. Also taking center-stage are skills-based hiring, data-driven talent planning, and new employee benefits such as menopause support. Technology is yet another force to reckon: artificial intelligence is creating new jobs, with recent count 1of 77,000+ open in the U.S. according to LinkedIn. Top specialized skills that employers are hiring for include Figma and Jira Align2 – terms that were unfamiliar a few short years ago. “Digital nomads” – the trend of working remotely from anywhere in the world – is no longer a unique phenomenon. In fact, the number of these workers has significantly increased, having gone from 3.2 million in 2019 to 11.1 million in 2022 according to recent research

Our research underscored that HRCI certification is a strong indicator that an HR professional has both the competence and confidence to navigate the toughest business challenges. Certification can also be a conduit for historically underrepresented groups to improve their earnings and access to professional opportunities. A means to higher