As Wichita physician and former lieutenant governor candidate Josh Umbehr spoke Wednesday about integrating direct primary care into KanCare, members of the Vision 2020 Committee from both parties could be seen nodding their heads.
Josh Umbehr, who runs a direct primary care practice called Atlas MD, gleaned 4 percent of the vote in November while running on the Libertarian ticket with his father, Alma attorney Keen Umbehr.
Josh Umbehr used the campaign in part to tout the benefits of the direct primary care model in which family physicians avoid the complexities of fee-for-service insurance reimbursement by charging their patients an all-inclusive monthly membership fee instead. Umbehr charges a monthly membership fee of $10 for children and $50 for adults for visits, discounted prescription medications and in-office services.
Umbehr told legislators Wednesday that by eliminating the fee-for-service reimbursement model, and all the paperwork it carries with it, direct primary care doctors could serve Medicaid patients better without worrying about the program's reimbursement rates keeping up with costs.
"We're paying for patient care and paperwork right now and we can't pay for both," Umbehr said of doctors who take Medicaid. "If I had to choose, I'd rather pay for patient care."
Rep. Larry Campbell, a Republican from Olathe who is vice chairman of the committee, called that a "great point."
After the hearing, Campbell said he was impressed by Umbehr's testimony and interested in the idea of a direct primary care option for Medicaid.
"I'd love to explore it," he said.
Campbell wasn't the only one interested. After Umbehr testified for more than half an hour, five legislators on the 13-member committee gathered around him to ask more questions.
Josh Umbehr told legislators Wednesday that a direct primary care option in KanCare could work somewhat like food stamps, with Medicaid recipients given a card to pay for their primary care that the physician could bill monthly.
Josh Umbehr and his father also have been trying to connect with members of Gov. Sam Brownback’s administration to talk about incorporating the direct primary care model into KanCare, the state’s $3 billion privatized Medicaid program.
“We have had limited talks about KanCare but would like to explore it further and talk with Lt. Gov. (Jeff Colyer) about it in more detail,” Josh Umbehr said.
Keen Umbehr said recently that he and his son already met with former Brownback administration official Steve Anderson to discuss integrating direct primary care into KanCare.
Anderson, Brownback’s former budget director, is now an analyst for the Kansas Policy Institute, a conservative think tank.
Keen Umbehr said Anderson suggested he and his son propose a pilot project with 1,000 Wichita-area Medicaid recipients. Anderson also said he would contact Colyer, who has been the governor’s point man on KanCare, about the idea.
Eileen Hawley, a spokeswoman for Brownback, said she is “unaware of any dialogue between Mr. Umbehr and the Administration.” Hawley said primary care under KanCare already is working well and keeping more Medicaid patients out of emergency rooms.
A spokeswoman for the Kansas Department of Health and Environment said that in 2013 the three MCOs paid out about $174 million in reimbursements to primary care doctors.
Rep. Tom Sloan, a Republican from Lawrence who chairs the Vision 2020 Committee, said the Washington example shows that a practice like Umbehr's could be included in Kansas Medicaid as well.
"I think it's viable," Sloan said.
The Affordable Care Act includes a provision that allows direct primary care practices to offer plans in state health insurance exchanges.
In Kansas, direct primary care would have to be integrated into the contracts the state has with three private insurance companies, known as managed care organizations (MCOs), that administer KanCare.
Keen Umbehr said he’s not yet been able to talk to officials from the three companies: United HealthCare, Amerigroup and Sunflower State Health Plan. But he said that if a pilot program can be formed, he’s confident the costs of primary care in his son’s model would get the companies on board.
“When one of these MCOs sees that this works, suddenly they’re the beneficiaries,” he said.
Campbell said integrating a direct primary care option into KanCare might have been easier before the state contracted with the three MCOs, but he still thinks it's worth trying to remove whatever hurdles might now exist.
"I found what we heard today very interesting," Campbell said. "From a practicality standpoint, I would love for us to put into place the necessary policies and laws to where we could give these guys a chance."
Because direct primary care practices remain rare in Kansas, many more direct primary care physicians would be needed throughout the state to support the Kansas Medicaid population.
But Keen Umbehr thinks plenty of physicians would switch to the model if they knew they would get guaranteed monthly payments for each of their Medicaid patients, rather than fee-for-service reimbursements that aren’t keeping up with the cost of care.
“They would switch over in a heartbeat,” Keen Umbehr said.
Direct primary care options in Kansas now are limited to a few urban areas.
Josh Umbehr’s practice, AtlasMD, has three physicians. He’s helping a number of doctors in the Kansas City area get started with the model. In Lawrence, Ryan Neuhofel runs a direct primary care practice.
In Topeka, Jennifer Harader is preparing to open her direct primary care practice, Oasis, in March. Harader said she’s been practicing medicine using the traditional insurance reimbursement model for seven years and can’t do it anymore.
“I just reached a point where I felt like I need to go do something different,” she said. “I was spending all my time doing paperwork and fighting insurance companies for what I wanted to do for the patient, and less and less time directly caring for patients.”