Building Modern Health Plans around Direct Primary Care (Hint Summit 2022)

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Building Modern Health Plans around Direct Primary Care (Hint Summit 2022)

Beth Holmes, Head of Network Development at Hint Health introduces the opportunity for innovation of health plans that revolve around DPC to present to employers instead of pairing DPC with existing traditional health plans. Both are difficult to implement, but the former is much more beneficial and ideal for optimal health outcomes. This panel, “Building Modern Health Plans around Direct Primary Care” took place at Hint Summit 2022 and features speakers, Nick Soman, Founder & CEO of Decent, Olivia Cameron, Co-founder of Poppins Health, and Cedric Kovacs-Johnson, Founder & CEO of Flume Health.

Decent and Poppins Health design health plans that have DPC at the center while Flume Health supports organizations on the execution of bringing new health plans to market ensuring legal compliance and the fulfillment of insurance requirements and administration.

The discussion begins around the benefit of DPC and why these organizations decided to focus on direct primary care as a model of healthcare delivery. Olivia of Poppins Health emphasizes that with DPC, it simply makes for a better experience for both patients and providers and it also “lowers the unit cost” for their small business clients and their members.

“We want to work with DPC because it works. We’re able to save employers about 35-40% while providing an ACA compliant plan.” - Nick Soman, Decent

Decent has a net promoter score of 79 versus the health insurance industry average of 19, which is the worst of any other industry. People dislike dealing with health insurance companies and they’d prefer not to go through insurance to get referrals for care. With DPC at the center, patients can rely on their primary care doctor and they want to go where their doctor recommends. Cedric comments that currently when it comes to receiving healthcare, insurance is the entrypoint for most patients, which often limits the quality and cohesiveness of care resulting in detrimental or less than optimal health outcomes.

Beth Holmes asks the panel why DPC providers who moved away from insurance should work with a Decent or Poppins Health. Nick states that at Decent, their objective is to bring DPCs to more members, take care of these members for emergencies and hospitalizations, and build a network of high quality specialists with the DPC provider at the center, without changing the way they practice. Olivia shares that at Poppins Health, they work similarly and want to understand where DPCs would like to refer their patients, so that the DPCs are truly “baked into the benefit design.” Both organizations are willing to provide data to participating DPCs for insights on downstream referrals.

“In addition to sending data around what the referral network could look like, we also send claims data, so that the DPC has a more comprehensive picture of [patient care].” - Olivia Cameron, Poppins Health

Cedric explains how Flume Health enables organizations who want to start a health plan that has DPC at its core. Flume Health understood that having the administrative process run smoothly is paramount by starting their own health plan, working with employers across 38 states with thousands of health plan members and processing tens of millions of dollars in claims per year.

“We saw firsthand that if you do the administrative job well, nobody notices. If you do it poorly, you get fired, you get fined, and everything goes wrong, so it’s truly a commodity, utility layer that has to be done correctly.” - Cedric Kovacs-Johnson, Flume Health

Watch this video to learn how innovative health plan providers, Decent and Poppins Health along with tech platform, Flume Health are helping to redesign health insurance with DPC at the center including insights on predictions for the future.