As Republicans were gathering in Cleveland, Ohio in July to adopt repeal of the Affordable Care Act (ACA) as a plank in the party’s 2016 platform, health care professionals met elsewhere to advance a model they say could revolutionize health insurance, save states billions of dollars, and render Obamacare obsolete.
Doctors, practice administrators, and other health care industry professionals converged on Kansas City, Missouri July 8–10 to promote direct primary care (DPC) as a medical practice and payment model superior to the prevailing fee-for-service system.
“Direct primary care (DPC) is no longer a trend,” read the tagline for the 2016 Direct Primary Care Summit, hosted by the American Academy of Family Physicians (AAFP), the Family Medicine Education Consortium, and the American College of Osteopathic Family Physicians.
“New practices are opening monthly, existing practices are growing, states are passing positive legislation, and people are taking notice,” the summit website states.
Big Rise in Attendance
The event drew 254 attendees, 17 exhibitors, 17 faculty, and 10 staff, Bethany Burk, a staffer at AAFP, told Health Care News. The first annual DPC Summit, held in July 2015, drew more than 100 attendees, Burk said.
Under a DPC model, patients pay a monthly membership fee of between $50 and $125 directly to a physician in exchange for certain preventive care services, including a fixed number of visits, consultation by e-mail or phone, and in-office procedures and diagnostics.
As agreements between patients and physicians, DPC contracts bypass insurers, although some members also purchase “wraparound” insurance or a less-expensive wraparound health care sharing ministry (HCSM) membership to help cover their non-primary medical needs.
Relieves Doctors, Patients, System
Dr. Phil Eskew, vice president of clinical development and general counsel at ProactiveMD, spoke at the summit on legal considerations for DPC physicians and how doctors can afford to opt out of Medicare’s payment system.
Doctors reduce their overhead 20–40 percent by converting their conventional practices into the direct primary care model, Eskew told Health Care News.
“We do not have a lot of published data here yet, but I think 20 percent is a conservative estimate,” Eskew said. “Some smaller practices, anecdotally, have had much better outcomes. Think closer to 40 percent. This is the power of effective, broad-scope primary care.”
Eskew, a doctor of osteopathic medicine who has a law degree and is the founder of the advocacy group DPC Frontier, says the model is attracting new doctors to enter primary care and enticing experienced primary care doctors to keep practicing.
“DPC improves the primary care crisis in two ways,” Eskew said. “First, primary care becomes attractive again so medical students want to enter this field, older primary care physicians decide not to retire ASAP, and specialists decide to return to primary care. Second, more primary care time equals less stress on the remainder of the health care system.”
Driving Innovation, Savings
Chad Savage, a DPC physician in Brighton, Michigan says DPC providers’ embrace of telehealth demonstrates the model is more conducive to innovative, patient-centered health care reforms than conventional practices.
“While the insurance model is lumbering along trying to figure out how to compensate for telemedicine, we have already solved this issue by including it in our membership models, not with some unfamiliar or distant physician but with that patient’s own personal physician,” Savage said. “This results in more convenient and prompt medical care.”
The time patients spent in a doctor’s office and traveling to and from appointments amounted to $52 billion in lost opportunity costs in 2010, according to a study published by the peer-reviewed American Journal of Managed Care in August 2015. The average patient lost $43 in opportunity costs per visit between 2003 and 2010, which “exceeds the average patient’s out-of-pocket payment,” the analysis states.
Budding ‘Wraparound’ Market
Many patients who want to pair their DPC membership with wraparound insurance—a high-deductible health insurance plan to cover catastrophes—may once again be forced to wait for the insurance industry to catch up, Savage says.
“Members of the [Michigan Association of Health Plans] have little incentive to create [wraparound plans] at this time, as they would compete with their existing, more costly products,” Savage said. “However, all it takes is for one clever plan administrator to realize that if they created such a plan, on day one they would have the most cost-effective plan on the exchange.”
“Barring collusion, I believe it is simply a matter of time,” Savage said.
In contrast to mainstream insurers, the HCSM Liberty HealthShare offers DPC members a wraparound product called Liberty Direct (LD). Patients who combine LD with membership at Dr. Michael Stevenson’s DPC practice in Poplar Bluff, Missouri can save between $492 and $720 per year, and Dr. Brian Forrest’s patients in Apex, North Carolina can save as much as $5,200 per year in out-of-pocket costs, Health Care News reported in June.
Forrest spoke at the DPC Summit about a grant from the Centers for Medicare and Medicaid Services providing incentives for doctors to try DPC.
Eskew and Savage are scheduled to speak at a DPC summit hosted by Docs4PatientCare Foundation and the Texas Medical Association for sharing “start up basics and challenges and advanced practice strategies for established practices,” according to the summit’s brochure.
The summit, called “Direct Primary Care: Nuts and Bolts to 2.0,” will take place October 14 and 15 near Dallas, Texas at the Omni Mandalay Hotel in Irving.
David Grandouiller ([email protected]) writes from Cedarville, Ohio. Michael T. Hamilton ([email protected]) is managing editor of Health Care News, author of the weekly Consumer Power Report, and a research fellow at The Heartland Institute.
Jenni White, “Patients Save as Docs Combine Direct Primary Care with Cost Sharing,” Health Care News, The Heartland Institute, June 2016: https://heartland.org/news-opinion/news/patients-save-as-docs-combine-direct-primary-care-with-cost-sharing
“Registration Brochure: Direct Primary Care: Nuts and Bolts to 2.0 [October 14–15, 2016],” Docs4PatientCare Foundation, July 2016: https://heartland.org/publications-resources/publications/registration-brochure-direct-primary-care-nuts-and-bolts-to-20
Kristin N. Ray, et al., “Opportunity Costs of Ambulatory Medical Care in the United States,” American Journal of Managed Care, August 18, 2015: https://heartland.org/publications-resources/publications/opportunity-costs-of-ambulatory-medical-care-in-the-united-states
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This article has been updated.