Proactive MD: Getting Creative with Onsite/Near-site Employer Clinics

Introduction

Blazing the trail for a better way of care through advanced primary care

Proactive MD is on a mission to reinvent healthcare by offering high-quality, low cost primary and preventative care directly to employers in onsite and near-site clinics across the country. They’ve pioneered a form of Direct Primary Care (DPC) that they call "advanced primary care." Like DPC, Proactive MD's care model empowers physicians to practice broad-scope primary care. Members come to their clinics for everything from routine annual check-ups and health screenings to nutrition counseling, acute care, and vaccinations.

Proactive MD partners with companies to provide employer-sponsored plans, decreasing costs and making their healthcare benefits more efficient. Understanding that employers are their largest business opportunity, Proactive MD developed innovative solutions improving access to care across rural populations by combining multiple employer groups under a single clinic. Additionally, they welcomed non-employer sponsored patients to become “retail” members at their clinics, further expanding care to their communities.

Combining so many employer groups under one roof introduced complexity that required a solution that would be invisible to patients and physicians, yet precisely support the nuances of different employer plans. Additionally, integration needs—such as tying into the EHR and syncing employee eligibility files—called for a more scalable tech-enabled solution than their manual processes, unruly spreadsheets, and scrappy work-arounds.

The challenge

Diverse Employer Groups Drove the Need for Customization

Tricia Stanley, DNP, Proactive MD’s Director of Clinical Integration, explained the challenge of managing a diversity of employer groups. “Before Hint Core it was difficult keeping track of membership details, eligibility, and what to charge. We had one system just to collect the payment, but the staff would have to look at a separate spreadsheet to see if the patient was eligible. It was a 12-step process just to say ‘this is what you owe today’ and collect the payment.”

The company also faced unique challenges associated with managing many small and medium employer groups under one roof. Not only is each employer plan unique, even within employer groups there are internal complexities, like a university offering different benefits for faculty and staff. Additionally, smaller employers often don't have the internal resources to stay on top of changes to their employee rosters, which can lead to billing mistakes in both directions. 

Stanley continued, “In our model, every client has a different contract. Before Hint, more times than not, if we couldn’t find the source of truth, we’d err on the patient's side and not charge additional fees. It happened every week across our health centers to some degree, and I suspect care was given away. It wasn’t scalable, and we were not all on the same page.

Igor Kozunov, Proactive MD’s Chief Administrative Officer, likens managing the complexities of different employer plans to constructing a new building without good plumbing, “We designed this elegant healthcare solution for an entire market. Everybody is ready to join. Best doctors in the state. Beautiful facilities. But if you screw up the billing process, the whole operation can fall apart. It’s that invisible plumbing that makes it all flow. When it works, nobody cares. When it doesn’t work, everybody cares.”

Finding a technology partner with the ability to support the behind-the-scenes “plumbing” of their direct primary care business—from enrollment to billing to eligibility management—was instrumental in Proactive MD’s ability to scale their unique onsite/near-site model. Hint Core became a “mission critical” component of their operation.

Why Hint Core

Hint’s expertise in direct care and development resources made them the best choice to handle the complexities of the Proactive MD business model.

Bi-directional EHR integration - Tricia Stanley, DNP, explained the importance of their willingness to develop a two-way sync with their athenahealth EHR. “That bidirectional integration with athena is critical. Clinical staff live and die in the EMR system. Every extra system that they need to log into is extra work. It’s cumbersome and clunky. Everything we do touches patients. Scheduling, calling with results, it never stops. Every step adds extra administrative overhead. Think about how many patients come in with name, address and insurance changes. With the integration, things only have to be changed in one place and it flows in both directions.”

Hint also shaved weeks off of Proactive MD’s migration from their previous EHR to athena thanks to the data portability that Hint Core enabled.

But Jeremy VanderKnyff, Proactive MD’s EVP of Health Data Science, Value, and Validation, sees another major benefit of Hint’s integration with the athenahealth EHR.

"Prior to using Hint’s member management and EHR integration across our entire organization, calculating member engagement—one of our most important metrics—could take hours for a single employer or health center because members had to be manually matched across systems. Now, we can calculate that metric for every employer and health center in seconds—a savings of hundreds of person-hours a month. This has freed our data science and analytics teams to spend our time discovering new insights to better serve our patients and clients, rather than just wrangling spreadsheets.”

Eligibility management - Keeping track of all the changes to member eligibility and personal information was once an error-prone and time-consuming process involving multiple teams at Proactive MD. The Eligibility AutoSync™ feature of Hint Core allows for seamless automated updates to employee census files, including eligibility status and changes to personal information. And Hint's integration with athenahealth ensures that Proactive MD's clinicians and administrative staff are always operating off the same, up-to-date member information across systems. Today, over 73% of all Proactive MD members are automatically synced and processed through Hint's Eligibility AutoSync engine.

Collaborative product development - Van Laecke cites Hint’s solution-minded approach as one that has helped them evolve as a business. “What I’ve always appreciated about Hint is that there is a solution mindset around everything they do. It’s not a fixed conversation. It’s always up for discussion. The problems and the issues we are tackling now compared to three or four years ago are night and day. There’s always this openness of how to solve the problem. It’s a mentality. It’s not just words.”

Interconnectivity - Van Laecke refers to Hint Core as a “PRM”—a patient relationship management system. “HintOS allows us to understand what our relationship is with our patient. Did they come in through a sponsor? How are we delivering care? Do we route them to an affiliate network? What are the integration points? The defining part of Hint is the element of interconnectivity. Hint Core connects the dots throughout our entire ecosystem—finance, IT, care navigation, etc. Hint reconciles everything.”

Results

In 2021 Proactive MD will increase their number of locations by 20%, and the fast-growing company will expand to 12 additional states since the beginning of 2020. Their success is due in large part to their ability to constantly demonstrate value to their employer groups. Today, Hint Core makes this once herculean multi-team effort a relative breeze by providing an interconnected source of truth for membership and billing data, piped directly into their athenahealth EHR. And based on that activity, Proactive MD's member advocates perform outreach and ensure that patients are engaged and receiving the care they need. In the long run, this data-driven yet personal approach to primary care helps manage expensive downstream healthcare costs.

In fact, Proactive MD’s primary care model was twice validated by the Validation Institute for demonstrated cost savings—the only employer-sponsored primary care organization to achieve that distinction. In the most recent validated study, after adjusting for the effects of COVID-19, after just one year with Proactive MD one employer saw an 11% decrease in total per employee per month costs (net of Proactive MD fees) – an average savings of $415 per member per year. When looking solely at Proactive MD members, average per member per month costs decreased by more than 30% (after adjusting for the effects of COVID).

In addition to making their data more accessible and malleable, Hint Core has also introduced meaningful new staffing efficiencies and billing accuracy. Stanley estimates that without Hint, Proactive MD would need to hire an additional full-time employee per clinic. Another substantial benefit of Hint Core is accuracy in billing for ancillary charges. “We would lose twice as many charges because no one knows what we need to know. If that part isn’t quick and easy, we lose time and we can lose track of charges.”

With the ability of Hint Core to easily manage an unlimited number of plan and pricing details out of a single location, Proactive MD can make employer-funded clinics more financially viable by offering direct-to-consumer memberships to fill excess provider capacity and subsidize the employer's fixed costs of running the clinic. Van Laecke explained the novel approach, “Employer clinics often carry some budgetary constraints that the CFO doesn’t want to carry. We’ve worked with groups that have a wide footprint serving a rural community. We may start with a part-time health-center in two locations, but over time it evolves. We had one company set up a consumer product using Hint Core. We staffed it and took the risk together. We gave them the offset of supporting it with a consumer wing. It’s a big win for both of us. It’s more profitable for us and they get full-time hours for their employees. The retail side can subsidize the fixed cost of the clinic.”

Through technology, data and Hint Core, Proactive MD is delivering high-quality healthcare in rural settings while also managing the financial expectations of their employer groups. It’s a “win/win” that lets them concentrate on what they call their “Northstar”—to provide care without compromise to their communities.