Direct primary care physician Andrew Hector, MD, of Indianapolis, said he typically leaves work by 5 p.m. Having more time to run makes it easier to counsel patients to lead healthy lifestyles.

Last month’s ISMA Reports revisited some Indiana physicians’ experiences with direct primary care first reported in late 2014. Today, the still-fledgling model is expanding in Indiana, slowly and steadily, along with others that bypass insurance. Physicians are finding success and renewed vigor with these models, while patients are gaining innovative options for quality medical care.

By all accounts, direct primary care is thriving and taking many forms as it evolves here. Freedom Healthworks, an Indianapolis-based health consultancy has helped manage Indiana direct primary care practices for a monthly, per-patient fee since 2015. The company has launched five practices with seven physicians, and more doctors are seeking contracts, attorney and co-founder Adam Habig said.

Priority Physicians in Indianapolis, an early adopter in 2002, brought in a fifth physician this year and opened a Fishers office with two physicians last fall, said co-owner Matthew Priddy, MD, an ISMA member interviewed in 2014. The practice expects to hire more physicians as its patient panel grows.

Hector Family Medicine owner Andrew Hector, MD, loves being able to do more medical procedures since converting his Greenwood practice three years ago. Dr. Hector, previously interviewed in 2014, also performs cosmetic laser procedures, which helped support his newly formed direct primary care practice. He recently hired a nurse practitioner and part-time physician and plans to build a larger building to accommodate growth.

And, in a model that offers advantages similar to direct primary practice, Activate Healthcare delivers proactive, preventive care at employers’ locations as part of workplace wellness programs. The fast-growing Indianapolis company operates clinics at 27 sites in Indiana and 10 in other states, with two more starting soon in Indianapolis.

“We’re expanding rapidly, and we’re always looking for new physicians,” said ISMA member Mary Jean Vorwald, MD, Activate’s Central Indiana regional medical director. “Salary is comparable-to-better-than what physicians get paid by hospital networks, and we work 40 to 45 hours per week.”

Advocates say these alternative practice models free physicians from dealing with insurance and offer patients quicker, unlimited access to care for a reasonable monthly fee. Often, patients have high-deductible, wraparound insurance policies to cover hospitalizations, surgeries and other costs. In Activate clinics, employers pay Activate a per-employee fee; most primary care is free, while employees carry insurance that sometimes helps subsidize the clinics.

While direct primary care is emerging here, it is more prevalent on the East Coast and in Florida, Wisconsin and Washington. As of August, at least 10 practices were operating in Indiana. That doesn’t include employer-based care or concierge practices that also bill insurance, so the number is likely higher.

Increased energy, lower costs
Supporters say direct primary care has energized them, allowed them to work more regular hours and helped them cut insurance-related costs up to 40 percent or more.

“Clearly, from a practicing medicine standpoint, it has been wonderful from day one,” said Dr. Hector. “You have a lot more time to see patients and do your job better. You can talk to patients longer, instead of rushing them out the door. I have the ability to have a larger scope of practice, since I have time to deal with complex medical conditions and perform procedures.”

Dr. Hector, who estimates his office’s patient load is 500 to 700, said he typically leaves by 5 p.m. and only gets about five after-hours calls each month. He is an avid runner, and having time to run makes it easier to counsel patients to lead healthy lifestyles. He added that he saves money for patients, especially those with chronic conditions, by providing in-office lab work and finding less-costly prescriptions and tests.

Physicians say that patients will pay their monthly fees, typically $25 to $85, to get same-day or next-day appointments, increased email and phone access, longer appointments, lower-cost lab tests and preventive care. Mike McShea, 42, an IT manager at Cummins Engine Co. who lives in Indianapolis and is a patient of Dr. Hector’s, said, “just the direct access to him through his email services has been a fabulous benefit. He responds very quickly. Scheduling an appointment is a dream, too.”

Dr. Priddy says he also sees those benefits, He believes direct primary care is growing because it accommodates serving diverse patients in diverse settings.

“Because there’s no insurance involvement, physicians can tailor it to the location, town and patient demographics they want to serve,” he said. “The model lends itself very well to innovation and to physicians saying ‘this is what I want to offer and to charge for those services.’”

ISMA members Matt Pflieger, DO, and Janelle Maxwell Pflieger, DO, a husband-and-wife family physician team, are finding success in the small city of Huntington, where Dr. Matt Pflieger grew up. They opened a new practice in October 2016, after moving from Denver. They sought an alternative to the typical medical practice and wanted to help fill a gap in Huntington, where small-business owners and others had few affordable options on insurance exchanges.

After six months, they were operating in the black. They had 230 patients at eight months but still were not earning “normal” physicians’ salaries, said Dr. Maxwell Pflieger. To contain costs, they have a small office with two exam rooms, buy medical equipment from auctions and hospitals and keep their overhead low. They provide services such as helping patients find low-cost imaging, first visits at home for newborns and home delivery of anti-nausea medicine.

“It’s old-school, in a lot of ways,” she said.

Within a couple of years, the couple expects to reach their goal of 800 patients. Dr. Maxwell Pflieger said word of mouth has been vital to their success, as has making connections within the community. Social media and the local Chamber of Commerce have also helped, she said.

“We’ve never been more satisfied in terms of the care we’re providing and our relationships with patients.”