In fall 2019, a pair of doctors from WellSpan Health set up a table at an insurance enrollment fair for the health system’s employees. Their goal was to recruit the first customers for a new online primary care practice.
It took a bit of explaining even to an audience familiar with the ins and outs of health care, said Dr. Brian Pollak, one of the WellSpan doctors staffing the practice. His partner is Dr. Quincy Harberger.
People would at first confuse the practice with online urgent care, said Pollak, an internal medicine physician and medical director of WellSpan Innovations, an arm of the York County-based health system. “They’d go, ‘Oh, I used you last week.’ And we said, ‘Well, this is different.’”
The primary care practice – now known as Duo Healthcare – seeks to streamline access to routine medical attention using digital tools, creating what is essentially an online practice. It is an increasingly crowded field, with national players like Teladoc and AmWell, formerly known as American Well. Pittsburgh-based UPMC also offers a virtual family medicine practice called Virtual Primary Care-UPMC, which is available in Central Pennsylvania.
WellSpan officials believe they can make inroads by combining the ease of digital access with the convenience of physical offices and doctors who know the region.
So far, about 250 WellSpan employees have signed up for the online primary care practice. And the practice has attracted its first employer, Littlestown Area School District in Adams County, with the goal of enrolling a few more by the end of this year, according to Kyle Letner, senior director for research and development at WellSpan Innovations.
“We’re going out and we’re talking to employers that we think would be a good fit,” Letner said, adding that interested employers can learn more at duohealthcare.com.
Pollak and Letner dove into more of the details in an interview with biznewsPA. The following Q&A is edited for length and clarity.
Q: Duo was developed in-house at WellSpan. What was the initial motivation?
Dr. Brian Pollak: The real drive started when you look at the way payment is changing. Payers are moving toward quality outcomes and moving away from per-episode reimbursement. When you change the payment model, the incentives also change. We are no longer incentivized for churning more patients through the office and doing more tests, more procedures, more interventions.
Kyle Letner: Part of it, too, is recognizing that there’s been a lot of studies about primary care being a major contributor to reducing the total cost of care. Preventative measures, access to primary care, that means, in general, healthier populations. What we were doing is looking for ways that we can improve access. For some people, going to the doctor once a year or once every three months is an inconvenience. When I talk to potential new members, I say, “Imagine if you had a doctor that you could just send a text message whenever you wanted and say, ‘Hey, what do you think about this?’”
Q: Is it hard to convince people that it can be that easy?
Letner: That’s the biggest barrier that we face. Everybody has a preconceived notion of what going to the doctor means. “I have to pick up the telephone and call someone to make an appointment. And then I have to go and wait in the waiting room, and in the exam room.” And it’s also the payment. “What is my copay? How do I know what that is? What am I going to be charged?”
Q: What was your original schedule for bringing this to employers? Did the pandemic affect it?
Letner: We were starting in February and March of 2020 to talk with some employers whose plans renewed on July 1. A lot of people do this around their annual plan renewal with their insurance product because it is an add-on benefit related to their health plan. That got completely derailed because of the pandemic. All of a sudden, nobody was concerned about their health plan. They were concerned about, “How do I get people working from home?” Everything just got disrupted. But what this did is it exposed a huge consumer group to the idea of online care, of being able to do a video visit with your doctor. It was January of 2021 that we picked it back up and started on rebranding to the Duo Healthcare platform and starting to seek employer partners in the marketplace.
Q: What are you hearing from employers that you’re talking with?
Letner: Everybody is looking for any way they can to save money on health care. A lot of them also are seeing the ability for employees to see doctors from the workplace and maybe that means less time off of work, increased productivity, things like that. We’re going in and trying to help them see past that that. Your employees don’t have to be at work to use Duo. They can be at home, they can be at work, they can be wherever they are. So that tends to be pretty enticing. They also understand that access to primary care can result in lower total costs of care.
Q: How does the payment structure work for employers and what does it cost?
Letner: It is extra on top of insurance, but it’s an alternative. You’re paying a per-member, per-month rate. But that covers all access. You don’t pay every time you send a message or every time you have a video visit. From a dollar amount, there are a couple factors that go into that. But it’s in the range of $30 to $40 per member, per month. And we charge employers based on the number of members that have signed up, not total employee population.
Q: Will there be a cost to employees? Or would the employer cover this?
Letner: We’ve left that up to each individual employer. If they want to require some portion of it be paid by the employee, they could do that. It really depends on what the employer wants to do.
Q: What do you see as the competition?
Letner: The job here is providing better access to care for the employee. There’s lots of products out there that can do that. Teladoc will claim to do that, American Well will claim to do that. The difference is, they don’t have a local, in-person option available. They’re more of a national provider. They also typically don’t work on that one-on-one relationship type of primary care. Theirs is a lot more ad hoc, you get the next available doc type of thing. There are other players. Amazon Care is one that’s coming into the market. There are direct primary care options. A lot of those are in-person options that are more like concierge medicine. Some employers see that as an alternative. There are people that are looking at a virtual onsite clinic.
Pollak: Being regional has more benefits than just having a physical presence. Our electronic health record is Epic, and it can communicate with other healthcare systems that use Epic. UPMC uses Epic, and so we can see what was done there. Lancaster General Hospital uses Epic, so we can see test results, and notes from them, as well. And so, if someone is new to me, I still have a lot of information, as opposed to someone being new to one of the national telehealth providers, where they have whatever is in their system. They have whatever is in their own proprietary health record.
Q: Do you see other benefits from having this as a local offering versus a national offering?
Letner: One of the value propositions of this is really the relationship. You’re forming a relationship with the doctor and the care team. And two, when you need to get labs done, or imaging done, or whatever, Brian will often ask, “Would you like to do this closer to work, closer to home?” That’s not always the same place.
Pollak: We had a patient who lives in Harrisburg and was having some palpitations, some heart-rhythm disturbance. We wanted to do a heart monitor with her. She was going to be down in Gettysburg for work on a given day. And so, the medical assistant that works with the practice was able to arrange for her to pick up the heart monitor in Gettysburg.
— by Joel Berg, editor of biznewsPA.
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