Direct Primary Care

An Alternative Care and Payment Model
by Dr. Michael Jongerius
Junction Medical SC

The growth in DPC is fueled by the benefits it offers three key stakeholders: physicians, patients and payers.

Although we can be overwhelmed by its layers of complexity, the challenge to our healthcare system is straightforward: How do we improve access to healthcare services while also managing its cost? The question does raise concerns about fairness, equality of access, affordability and sustainability, so it’s not surprising that the proposed solutions are controversial and complex. The Affordable Care Act provides ample evidence that current solutions aimed at solving the access-cost challenge are far from being realized.

Is there another option that can be implemented at the local level? An option that is less complex, simple to manage and easier to understand? Perhaps. Also known as concierge care, retainer-based or membership medicine, direct primary care (DPC) practices are gaining acceptance as an alternative to traditional health plans.

Catching On With Consumers
Dr. Erika Bliss, who helped pioneer Qliance, a successful DPC initiative in Seattle, says patients and employers are more open to exploring alternatives than ever before. “The idea was slow to catch on,” she says, “but with the recession and healthcare reform, people are a lot more open to innovative models of care delivery.”

DPC provides access to a full array of primary care services for a monthly fee paid directly to the physician. The fee, typically ranging between $50 and $100, covers office visits, basic lab procedures and wellness care, in addition to service enhancements such as same-day access, longer physician visits, virtual or e-visits, and direct physician access 24/7. Offering improved access, care coordination and communication, DPC practices have documented a reduction in the downstream costs. For example, Qliance has reported the following results:

  • Emergency visits declined by 62 percent.
  • Hospital days declined by 25 percent.
  • Specialty visits declined by 50 percent.
  • Imaging (MRI, CT) procedures declined by 50 percent.

Because the DPC does not cover out-of-office services, members are encouraged to obtain an HSA-eligible, high-deductible wraparound policy. Health insurance now begins to resemble car insurance—it will cover “mayhem” events, but not the minor fender bender.

Benefits to Stakeholders
The growth in DPC is fueled by the benefits it offers three key stakeholders who are directly impacted by healthcare services: physicians, patients and payers.

Physicians see an opportunity to get off the hamster wheel and focus on direct clinical care with engaged patients. By reducing the administrative burdens related to insurance, physicians now have more time for clinically-focused, face-to-face patient interaction. Many DPC physicians will spend 30 minutes per patient visit. Unrushed appointments are pivotal to reducing costs and improving clinical outcomes.

Patients have affordable access to a primary care physician who can treat and manage 90 percent of their healthcare needs. Due in part to DPC practices having smaller patient panels, everyone benefits from same-day availability without having to overcome the typical access barriers. Double-booking, work-ins and squeeze-ins are terms of a dysfunctional past. A full waiting room, once an admired characteristic of a “successful” physician, has evolved into an expanded reception area. The on-time visit is becoming the norm, not the exception.

Employer groups, faced with ever increasing healthcare costs, see the DPC option as an opportunity to bend the cost curve downward while assuring employees access to a primary care physician. One of the fastest-growing trends, especially among self-insured groups, is direct contracting with DPC practices. Qliance, for example, recently contracted with Expedia to provide regional and on-site services for its 3,000 employees. Lower costs and a healthier workforce are the projected outcomes.

A CORE Conversation
Critics claim that cost savings are the result of delaying or denying care—that direct care practices are just another step toward “rationing” care. Not at all, claim DPC advocates. Instead, it’s all about “rational” care. The office experience redesign encourages the patient (consumer) to have a CORE conversation with their physician:

  • C: What is the cost of test or procedure?
  • O: What are my options?
  • R: What is the risk of the procedure?
  • E: Is there good clinical evidence that can help me arrive at the best decision?

As an example, take the common problem of lower back pain. Many patients visit their physician fully expecting, even requesting, that an MRI be performed and covered by their insurance plan. In the DPC model, where patients have some direct financial responsibility for the test, a conversation about comparative costs (which in this case, varies from $1,200 to $5,000 in the Peoria area), diagnostic and treatment options, risks and benefits of any procedures, and the option of watchful waiting, is likely to take place.

Some claim DPC is disruptive. Yet, if you combine a trillion-dollar service in which costs increase 10 percent each year, with frustrated consumers, disgruntled payers and pressured providers, you have a system ripe for change.

Direct primary care replaces the hackneyed “patient-centered” focus with a consumerist approach. A DPC practice promotes a physician-patient relationship that educates, motivates and empowers the patient to seek value for their healthcare investment.

A disruptive concept? Maybe. But what seems disruptive to some can be viewed as an opportunity by others. iBi

Dr. Jongerius is a family physician who offers a DPC option for patients and employers. For more information, visit junctionmedical.com.

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