Working with Employers, Brokers, and Advisors

In your conversations with employers, brokers, and insurance advisors there are several things you need to talk about very early in the negotiations:

1. Will the employer or the advisor require data of some kind from your clinic? If so, what kind, and do you have that info available? Will you have to change your practice to obtain that data? Need a different EMR or additional software in which to enter data? Who enters it? Who pays them to enter it? Who pays for all of this new workflow and software?
2. Be sure both the advisor and the employer understand that your agreement is between the employer and your clinic; that is--the employer pays you. Avoid getting paid by a third-party administrator (TPA) or from the advisor. Also, have your employer agreement ready as soon as possible and allow the employers' legal counsel to review and sign off on it or things could drag out for months.
3. Have a clear understanding of the broker or advisor’s role:
   • Have they worked with DPC docs in the past? If so, who? Check references.
   • How are they paid? Avoid kickbacks and extra fees they may ask to bring you, patients.
   • Are they associated with any large insurance companies like the Blues, United, Cigna, Aetna, Humana (BUCAH)? Brokers or advisors that have allegiance to insurance companies will find it difficult to work with DPC clinics to lower costs.
4. Form a plan for patients that do not fit into the DPC model or that need to be dismissed from the clinic. We all know some people are never happy, always rude, or abusive. You need a way to dismiss them from your clinic and the employer and advisor must understand that. Make a clear policy and path between all parties on how to handle this issue.
5. Be sure you understand the insurance plan the advisor is forming around DPC. Will it require prior authorizations, step therapy for medications, ghost coding (avoid!), or medical management oversight? You must work these things out very early in the discussion to avoid returning to a traditional FFS clinic that you left to start DPC.
6. Finally, have a discussion about addiction medicine, opioids, anxiolytics, and mental health care. These are very difficult issues and you must have a clear plan. If patients come into your clinic on long-term pain medications, what is your plan for that? What about benzodiazepines? Is there a good referral source for mental health issues or addiction treatment?

All parties need to work together to have a clear plan for these issues early in the conversation of using DPC.