Contrasting Empower3, DPC

Dr. Sean Hampton, who recently started what he said is the first “pure” Direct Patient Care practice between Harrisburg and Pittsburgh, called Empower3, a well-established practice in Altoona and elsewhere in the region, a “hybrid” DPC practice, because it retained some patients who pay for its services through insurance.

It’s not really a hybrid, said Empower3 co-founder Zane Gates, a primary care physician.

There are only a “tiny” number of patients on traditional insurance, retained on that payment basis out of loyalty, Gates said.

Empower3 is more like “a DPC on steroids,” Gates said.

“I like the DPC model, but I wanted to take it to the next level,” he said.

Empower3’s “prime package” includes not only primary care, but labs, radiology, drugs, cardiac and pulmonary testing, durable medical equipment, outpatient psychology and physical therapy at no extra cost to subscribers, Gates said.

There are no copays or deductibles, he said.

Empower3 also has care plans tailored for small businesses and big businesses, he said.

And it offers a “basic” plan at lower cost.

For the Empower3 “prime package,” individuals pay $150 a month; small businesses pay $140 a month per individual; and large businesses pay $128 a month per individual, he said.

Individuals pay $50 a month for the “basic” package, which is roughly equivalent to a regular DPC plan, although it includes more services at no extra charge, including labs, telemedicine, acute-care general drugs, dietetic services and telemedicine access to some specialists,

Empower3 prices don’t vary based on patients’ ages, like those of most other DPC practices.

“The simpler the better,” Gates said.

Empower3 offers the larger businesses a “wraparound” insurance option to cover hospitalization, brand name drugs, emergency room visits and additional specialists, Gates said.

It will offer that kind of insurance soon to smaller businesses, he said.

It may be able to offer that kind of insurance eventually to individuals, when it finds a company willing to underwrite such a plan, Gates said.

Unlike most DPCs, Empower3 accepts Medicare and Medicaid patients, based on a special contract with UPMC Health Plan.

UPMC Health Plan receives a flat payment from the government to underwrite health care for each of those Medicare and Medicaid patients.

Most insurers handling Medicare and Medicaid patients for the government pay the doctors who care for those patients on a fee-for-service basis, which leads to lots of administrative work on both sides, as the insurance companies demand documentation and authorizations from the doctors and the doctors must provide that documentation and seek those authorizations.

But in the case of Empower3, UPMC Health Plan pays a flat fee per month per patient, which eliminates most of the need for that administrative work on both sides, according to Gates.

UPMC also pays a bonus for good health results for those patients — results that minimize their need for hospitalization and emergency room visits, reflecting good preventive care and monitoring by Empower3, Gates said.

Such care is especially critical for patients with chronic diseases like diabetes, which, when under control, is less likely to lead to infections and the subsequent need for wound care, for example, Gates said.

Empower3’s arrangement with UPMC Health Plan reflects a cooperative strategy that Gates explained in a paper he co-wrote with a Penn State Altoona professor several years ago.

Traditionally, providers like hospitals and physicians work in opposition to insurers — with providers seeking as much money as they can for their services and insurers seeking to minimize their payouts, the dynamic that generates all that administrative effort, according to Gates. The benefit of one party is a loss for the other, he said.

In the cooperative model, both sides share their analyses of profit and loss and agree on a price — the cheaper the better, because, with so many patients unserved or underserved, there’s plenty to go around, and a lower price means greater volume and ultimately more success for both sides, according to Gates. The principle is the same as the one that has long operated in the technology sector, with ever-cheapening prices helping to saturate the world with more and better products, he said.

As far as he knows, Empower3 is the only U.S. practice that offers such a large network of services for direct payment by patients, with no copays or deductibles, Gates said.

“What we’re doing, nobody else in the U.S. is doing,” said Val Mignogna, chief operating officer at Empower3.

Mignogna is ambivalent about the kind of Direct Patient Care offered by Hampton.

It’s clearly superior to traditional primary care for the attention it lavishes on patients, because doctors reduce their rosters from 2,000 to 500, and everyone gets only the doctor, rather than “extenders” like physician assistants or nurse practitioners, he said.

But if all 43 of the current primary care doctors in Blair County suddenly did what Hampton did, only one-sixth of the population would have access to primary care, Mignogna said.

It would be great for those who got care, terrible for the community as a whole, he said.

Gates has about 2,400 patients, but he has two physician assistants, a nurse practitioner and a pharmacist, Mignogna said.