The United States, and the Midwest specifically, has a shortage of primary care providers. Big Tree Medical Home, based in Columbia, Missouri, is trying to solve that problem.
Big Tree offers direct primary care and wholesale-priced pharmaceuticals for a low monthly payment to more than 5,000 patients nationwide. The innovative health care solution, which was founded in late 2017, gives members the majority of their health care coverage for a fraction of the cost of traditional plans.
Big Tree co-founder and practice pediatrician Dr. Adam Wheeler says, “We felt there was an opportunity to create a new type of primary care where the provider and patient have aligned incentives and employers have a lower total cost of care, but a much better experience for employees.”
Wheeler’s past experience as a managing partner of a large pediatric practice in Columbia enabled him to see how drastic the primary care shortage in the Midwest really is. He then created a solution that helps patients see a doctor when and where they need it.
Filling a Void
According to Wheeler, 111 of 114 counties in Missouri are primary care shortage areas, and practices are expecting a need for an additional 1,000 primary care providers in Missouri by 2025.
“The model just doesn’t work because the payments to primary care providers are not designed to promote health,” he says. Wheeler says primary care providers are paid a fraction of the cost of their specialist peers, despite requiring almost as much education and training: general practice doctors who work in urgent cares make almost double the salary.
The solution? Nurse practitioners as primary care providers. “That allows us to have a lower price point,” Wheeler says.
Other primary care solutions typically use doctors to provide care, which Wheeler says ultimately exacerbates the problem. “When doctors move from traditional to a more innovative solution, they move from having about 2,500 patients to about 800 on their panel. We are trying to provide a scalable solution that could be used to meet the needs of the entire country.”
While Big Tree has five clinics in Missouri where patients can be seen in-person if needed, their clinics in 40 other states are virtual, with nurse practitioners seeing patients via video or answering questions via text. “What we like to say is virtual care isn’t fundamentally better or worse than in-person—it’s different,” Wheeler says. “It provides better, quicker access but there are some things you need in-person for.”
The Package Deal
Another feature of Big Tree Medical Home is its in-house pharmacy. Through most of the membership plans, patients can get generic prescription medications for either free or wholesale costs. Employers have the option to bundle Big Tree coverage with dental, vision, and other specialist plans to provide complete coverage.
A primary care solution that’s a fraction of the cost of more traditional care, has access to affordable prescriptions and easier care—why isn’t every company using Big Tree? “Our biggest challenge is helping employers think about health care outside of the box,” Wheeler says.
While traditional health insurance plans have been rising in costs every year, ultimately the human resources employee responsible for deciding the coverage isn’t responsible for the balance due.
“It’s the same if they have an easy-for-them but expensive-for-company solution or a hard-for-them—in that it’s different—but less-expensive-for-the-company solution,” he says. “Even though there is published research that something like Big Tree as part of a health plan will lower costs by 20%.”
Taking the Gamble
Wheeler says it can be difficult to convince businesses to try Big Tree, but once they sign up, there is a high retention rate. While they also measure the standard metrics such as net promoter score and other surveys, the biggest goal is patients renewing their monthly plans.
“We are a monthly payment that the patient has no commitment to—they have to continue to want to participate and that’s how we want it,” he continues.
Wood haven, a Columbia-based company that provides support to adults with disabilities, has seen a savings of $750,000 since switching to Big Tree as their employee health plan. Dan Soliday, the chief executive officer of Woodhaven, says with Big Tree as their employee benefit, they’ve gotten nothing but great feedback from employees.
“Before Big Tree, we kept having to raise the staff portion of insurance to a point where staff were then leaving,” he says. “Working with Big Tree not only saved our organization and staff money, but our employees also get better service.”
In terms of funding expansion, Big Tree has looked into venture funding and private equity, Wheeler says, but instead depends on the profits from its existing clinics. “In our experience, the organizations that provide funding have a tough time grasping our model,” he says. “We haven’t met a partner who is interested in expanding primary care in the way that we are.
“Our goal is how low can we get our prices, and then we are going to apply that to everybody.”