As a young girl, Kimberly Legg Corba liked taking care of people. So much so that by middle school she knew she would follow in her late grandfather's footsteps and become a doctor.
Now, after 15 years in traditional primary care practice, Dr. Legg Corba took a chance this month and transitioned her Upper Macungie office into Green Hills Direct Family Care Inc. – becoming the region's first direct primary care physician.
Direct primary care is not a substitute for health insurance, but rather a medical service that was developed 20 years ago to act as a backup mechanism for primary care patients who have high-deductible health insurance plans.
The practice charges a monthly fee to its patients, who get full access to primary care, including longer visits, 24/7 access, no co-pays and no restriction on the number of office visits. The direct primary care physicians benefit by eliminating third-party payers or health insurance companies and the complexities, costs and delays in health care that can come with them.
Most important for Legg Corba is that direct primary care empowers the doctor-patient relationship – her favorite part of being a physician, she said.
“Even if I was making less money, I am spending more time with patients,” she said.
Before switching to direct primary care, Legg Corba had to maintain a high number of patients in order to keep up with the rising overhead costs of health care. But, with the new direct primary care model, it has been liberating for her, she said, giving patients an opportunity to save money while still getting effective, personal health care.
“I didn't go into medicine to bankrupt people,” said Legg Corba who has 154 patients, a fraction of the 1,200 active patients she was seeing in her previous practice.
Legg Corba said she is still trying to grow her patient membership, but will be able to maintain a similar income with a significantly smaller number of patients. And this means more quality time with patients.
Phyllis Leibensperger, a patient of Legg Corba's for about nine years, said being a member of Green Hills Direct Family Care is money well spent.
“I like the way that I get treated,” she said. “I don't feel like a number or like I am holding anyone up.”
Under the new model, Green Hills' patients pay a membership fee that can range from $10 to $100 a month, depending on how many services the patient wants access to.
Membership gives an affordable way to cover general adult physicals, women's health care, newborn and pediatric care, wellness education, chronic disease management, minor procedures and coordination of care with specialists. Legg Corba's plan also offers discounted rates on lab testing, radiology and prescriptions.
There are more than 4,000 direct primary care physicians nationwide – up from 756 in 2010 and 146 in 2005. There are about 150 direct primary care doctors in the Philadelphia area, Legg Corba said.
To prepare her patients for the change to direct primary care, Legg Corba sent out an informational letter, followed by three more letters, and held three well-attended town-hall meetings.
“A natural reaction is for physicians, employers and consumers to look for ways to access basic care in a more affordable and efficient model,” said Robert Laszewski, president of Health Policy and Strategy Associates LLC, a Washington, D.C.-based consultant. “I expect these kinds of programs to continue to grow.”
For employers who struggle with rising health care costs, direct primary care could be another avenue to pursue as they devise health insurance plans for employees.
“The unabated rise in health care costs … have forced employers to look at other options,” said Tom Croyle, president of Lehigh Valley Business Coalition on Healthcare, a nonprofit organization in Bethlehem that represents businesses and strives to improve the delivery, cost and quality of health care. “I favor changes in care delivery that improve quality, efficiency at a reasonable cost. Those must be the deliverables.”
Legg Corba stressed that direct primary care is not a substitution for health insurance, as it is recommended that each patient still buy a basic health insurance plan that covers catastrophic illness, emergency room visits, specialist care, hospitalization or other services outside of what the membership covers – to avoid gaps in care.
“The direct primary care model is attractive to doctors who want to remain independent, are frustrated by the limited amount of time spent with patients, and administrative work,” Croyle said.
Although the concept began two decades ago, direct primary care has picked up speed significantly in the last five years – on the heels of the 2010 Affordable Care Act – which is producing high-deductible plans that are forcing employers to pass more expenses on to employees.
“There has been a clear trend toward employers moving to plans that require workers and their families to pay for more basic care out of pocket,” Laszewski said. “That has been reinforced by Obamacare, that offers policies with even higher deductibles, co-pays and narrower networks.”
According to Legg Corba, there is no legislation in Pennsylvania regarding direct primary care or a state policy that defines direct primary care, but for her, this is a positive thing, she said.
“This is a good situation because no regulation is good regulation,” she said.
Legg Corba was scheduled to meet last week with state legislators to start talks about getting legislation in place to protect direct primary care from being labeled as insurance.