The Legislative Council Study Committee on Direct Primary Care (DPC) held its second meeting August 29 (see full agenda and presentations here
). DPC Committee members heard from State Representative Joe Sanfelippo (R-New Berlin) and State Senator Chris Kapenga (R-Delafield), who coauthored a proposal last session to define state law governing DPC agreements, as well as order the State to research a DPC Medicaid pilot.
Maureen McNally of Froedtert Health asked the authors what led them to introduce this legislation last cycle and where they envisioned a Medicaid pilot operating. Sanfelippo and Kapenga said they want to make it clear that DPC is not insurance per Wisconsin state law, and they hope to prove its value with a Medicaid pilot, which they envision operating outside of Milwaukee due to the lack of DPC providers in the city.
Representative John Nygren (R-Marinette), who is the Committee Vice-chair, remarked that while he understands the appeal of this model of care, it does not seem to incentivize care coordination among hospitals and health systems, unlike the care coordination pilot legislation Sanfelippo authored and the Legislature passed last session. Sanfelippo acknowledged the two bills were different approaches but shared similar goals of decreasing costs and improving care.
The Committee also heard perspectives from the insurance industry and academia, including the UW Madison School of Business and the Wisconsin Association of Health Plans (WAHP). Justin Sydnor, who is an Associate Professor in Risk Management and Insurance at the UW School of Business noted that DPC usually requires an additional investment for consumers above and beyond insurance, which limits who can afford the added expense. The WAHP presentation relayed concerns that exempting DPC from insurance laws could unintentionally give them an advantage over insurance plans if DPC practices begin to offer services more closely resembling insurance.
Representatives from Waukesha County and the cities of La Crosse and Milwaukee, all of which offer onsite clinics with DPC contracts, also presented to the Committee. These local government representatives said they were pleased with how direct primary care contracts work for their employees and suggested any legislation should protect such current models without restricting future innovation.
The meeting concluded with a review of recommendation options. While some legislators on the panel expressed a desire to make it clear in state statute that this model is not insurance, Coreen Dicus-Johnson of Network Health suggested that recommendations should not unintentionally restrict market innovation, and that Wisconsin may be better off waiting to see how the practice develops. Senator Alberta Darling (R-River Hills), who is chairing the Committee, expressed her desire to allow the free market to work, and noted that, while the Committee could recommend statutory changes, one option would also be to decide legislation is not needed at this time. Due to the lack of time, Darling suggested members review such options to further discuss at the next hearing, which will be held September 18.
WHA will continue to closely follow this study committee and urges members with questions or concerns to contact Jon Hoelter
or Lisa Ellinger
for more information.