New health care model sets out to reduce fees, increase personal relationships
Kene Booker-Mahatha battles chronic pain. She went looking for a way to control it without powerful medications and ended up at Paladina Health in Hamilton — a new, for-profit clinic offering direct primary care. The clinic just opened in June.
“I had a doctor that I really liked, but you know, you rushed in, you got five minutes, he goes through whatever it is and then you’re gone,” said Booker-Mahatha.
That’s not the case at Paladina, where the doctor sat with Booker-Mahatha for an hour as they talked about different options, including diet and physical therapy. She said it was like family doctors from back in the day.
“And, you feel like you’re the only one here. And she actually worked with me,” Booker-Mahatha said.
“There’s a chance with Paladina to develop a personal relationship with your doctor, which is pretty unique. With Paladina, you end up having 24/7 access to that physician for urgent needs. And generally, there’s no out-of-pocket costs for patients,” said Paladina Health CEO Chris Miller.
That’s right. No co-pays or fees. The company’s paid per enrolled member, per month through an arrangement brokered by school and public employee unions and state government. Paladina’s doctors offer general care and preventive medicine, pediatrics and management of chronic conditions — better overall continuous care at a central clinic.
“And in doing so, obviously they can get healthier employees and a real goal over time is to help bend that cost curve in health care,” said Dr. Eric Miller.
Paladina held its official ribbon cutting Tuesday. Direct Primary Care in New Jersey is also available from a second company called R-Health, which will soon have seven clinics operating in the state. R-Health’s CEO Mason Reiner explained why it’s cost effective.
“In a typical primary care practice about 30 to 40 percent of the cost of operating the practice is insurance billing overhead. That’s totally eliminated from this process because it doesn’t add any value for the patients,” said Reiner.
Plus, direct primary care doctors get paid a flat salary to see 70 percent fewer patients.
“That’s a huge and striking difference from the average of 3,000 to 3,500 that doctors typically see in the fee-for-service world, so they have a chance to develop a greater and more intimate relationship with their patients,” said Miller.
Paladina says each doctor has to have a patient list of about 500 in order to make this business model work. And it’s confident enough to be planning a new clinic, opening next month in Clifton.
Currently, direct primary care is offered to any employee or family member enrolled in the State Health Benefits Program, the School Employees Health Benefits Program, or the OMNIA plan through Blue Cross Blue Shield of New Jersey.
“We’re happy to be here, we’re happy to be able to recommend this form of care to our members. We think it’s going to be really good for them. It’s going to be good for the state and at the end of the day we’re going to change the way health care, primary health care, is delivered. Kene’s sold,” said Hetty Rosenstein, state director of CWA New Jersey, the state’s largest public worker union.
“I like it. I just like it,” said Booker-Mahatha.
The program could eventually cover 50,000 school and government employees and save an estimated five to fifteen percent in health care costs.