Uncertainty in healthcare driving DPC growth

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, who is also past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

Glen Stream, MD, FAAFP, MBIIt’s often called “concierge medicine for the masses,” the colloquial name given to direct primary care, a growing practice model that charges patients a flat monthly fee-averaging $25 to $85 a month-for office visits, lab tests and even phone or email communications. In some respects, direct primary care (DPC) harkens back to the way medicine was practiced decades ago when patients paid their physician directly.

Further reading: Is DPC a viable way to MACRA-proof your practice?

Today, insurance mostly dictates the way we pay for healthcare-from basic primary care to hospital stays and treatment for cancer and other catastrophic illnesses.

To Garrison Bliss, a Seattle internist and one of the early leaders of the direct primary care movement, the changes in the way we pay for healthcare have had a profound effect.

“To a very real extent,” Bliss told Forbes several years ago, “when patients do not pay or control the payment to their physicians, their power and influence in health care declines.”

The result, according to Bliss, has been a decline in the perceived value of primary care, a massive dependency on medical technology and a focus on higher-cost medical procedures over prevention and results-oriented care.

In the news: Bill could allow health saving account use for DPC

Today, while only a small percentage of the country’s 926,000 physicians are involved in this type of membership-based practice model, a growing number have embraced direct primary care-from small offices to large mass market practices like Qliance, the practice in Seattle that Bliss helped establish in 2007. For a flat age-adjusted monthly fee, Qliance members get 24/7 access to primary care doctors and health care teams for “the care you need when you need it.”

Next: DPC may not be the best option for all patients or practices

Qliance, which operates seven clinics, including one that exclusively serves Seattle firefighters, says its innovative approach has increased patient satisfaction, improved outcomes and driven down costs. The company points to an analysis of insurance claims data for 4,000 Qliance patients covered by employer benefit plans showing they had 27% fewer emergency room visits, 60% fewer inpatient hospital days and 20% fewer claims than non-Qliance patients working for the same employers.   

In case you missed it: Obamacare is severely holding DPC back from succeeding

Studies of other direct primary care practices show similar results, confirming that access to personalized and accessible primary care can keep people healthier while lowering health care costs.

Nextera Healthcare, Colorado’s first direct primary care provider, evaluated the effectiveness of DPC membership for employees and dependents of one of its self-insured clients, DigitalGlobe. It found reductions of 25.4% in claims costs and 4.7% in risk scores for the 205 employees and dependents who enrolled in the employer’s DPC program.

Physicians like DPC because it helps them cut overhead costs, including the cost of processing insurance claims. It also gives them more time to do what they were trained to do-care for patients. Patients get greater access to care since physicians who practice under the DPC model typically have fewer patients than doctors in traditional insurance-based practices. DPC also strengthens the doctor-patient relationship, empowers patients and, as the studies have shown, improves patient health and wellbeing.

Given the obvious benefits of the DPC model, both to patients and physicians, it’s perhaps somewhat surprising that the direct primary care model has such a small, albeit growing, footprint in the nation’s healthcare universe.

One reason is the regulatory obstacles that thwart access to direct primary care. In the debate over health care, policymakers would do well to recognize that eliminating those barriers would be one way to improve access to care, help slash costs and go a long way toward improving the health of millions of Americans.

DPC may not be the best option for all patients or practices, however, it is one path forward as we look to reconstruct the nation’s healthcare system away from fee-for-service and toward value-based payment. Supporting primary care with a better payment system and getting off the fee-for-service hamster wheel is in everyone’s best interest.

Glen Stream, MD, MBI, FAAFP, a family physician practicing in La Quinta, California, is past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health.