Nebraska state employees may have a direct primary care option if the Nebraska Legislature approves a bill that allows the state to pilot the concept.
Blue Cross and Blue Shield of Nebraska Executive Vice President Dr. Joann Schaefer recently testified before a packed Government, Military and Veterans Affairs committee public hearing in support of the concept
“Direct primary care is still a relatively new concept in Nebraska, but it’s one we’re excited about,” Schaefer said. “We’ve worked closely with physician partners to stand up one of the state’s first direct primary care operations. We think that it will be a good solution for some patients and physicians.”
Schaefer was referring to Nurture Health, the direct primary care operation that opened in February in Omaha.
Under the direct primary care model, a variety of primary care services (e.g., doctor office visits, preventive care) is provided in exchange for payment of a monthly membership fee. It isn’t an insurance arrangement, so there is no insurance paperwork or claims to file. Insurance coverage would still be needed to help pay services not included in the primary care package, such as specialist care, prescription drugs and hospital stays.
“We’re particularly interested in coordinating the direct primary care idea with insurance,” Schaefer said. “So there’s coverage in case of catastrophic illness or accident. We know, having an ongoing relationship with a physician does lower costs and improves care by simply making primary care easier to obtain.”
The bill before the Legislature would allow state employees to pick from two direct primary care plans over a two-year period. Bryon Diamond, director of the Department of Administrative Services, said the state would pay 79 percent of the costs, with employees responsible for paying the other 21 percent.
State Senator Merv Riepe, the bill’s sponsor, said the pilot program will give state employees options.
“It can bring more stability and predictability to health care costs,” Riepe said. “With no copays and deductibles you don’t have to forgo groceries to see the doctor.”
To make the direct primary care option Work on the federal government level also needs take place, according to Schaefer. Direct primary care isn’t covered by the Affordable Care Act. And Health Savings Accounts can’t be used to pay for services.
The next step for the Nebraska legislation is to receive a “priority” designation that increases the odds that it will be debated by lawmakers yet this year.