This month, a couple members of the PCP national team had the pleasure of attending the Direct Primary Care Summit. Direct Primary Care is a non-insurance-based model of care that many are saying will improve outcomes, quality, cost and physician burnout. Here, Brian Forrest, M.D., who told us about his direct primary care practice in an earlier post, tells us about the summit and why so many are so excited about this model.
By Brian Forrest, M.D.
This month marked the first Direct Primary Care Summit. As one of the organizers of the first meeting of this type, I was humbled by the turnout, enthusiasm, and success of the conference. About a year ago, a few of us that had lectured about direct primary care (DPC) in Cleveland for the Family Medicine Education Consortium got together and decided it would be a good idea to have our own “summit” devoted to this new type of practice movement.
DPC takes a number of forms, but the basic premise is that DPC practices don’t take health insurance. Many speakers at the summit likened the model to car insurance: Car insurance covers major accidents, but it does not cover routine upkeep, such as oil changes and tire rotation. For those services, we have a direct relationship with the mechanic who provides the services. Primary care is routine upkeep for our bodies. And many primary care providers, like me, feel this care should be delivered via a direct relationship between patient and provider that eliminates the middleman.
In most DPC practices, patients pay a monthly fee for access to comprehensive services and extensive – often round-the-clock – hours that include same-day appointments and in some cases house calls when necessary. Some practices offer levels of payment where a higher monthly rate would include access to more services. Other practices offer “a la carte” care for those who might not find a monthly membership cost-effective for the type of care they need. The result is that patients get a higher quality of care for less. And doctors get to spend more time with patients, take on smaller patient panels and reduce their staff size and overhead because there is no paperwork like that associated with billing and filing claims.
Erika Bliss, M.D., from Qliance, Pat Jonas, M.D., who runs a private practice, Gabriel Fine from Access Rhode Island, and I were convinced there was a need and opportunity to gather together to discuss the issues relevant to the practice model. We didn’t realize, however, how many different members of the health care community would come together for this discussion. We had representatives from unions, such as Freelancers Union; insurers including Centene; investors like Leavitt and Cambia; tech companies, including Twin Oaks Software and Practice Fusion, that support DPC practices; suppliers and lab companies like McKesson and LabCorp; and a ton of medical students, residents, and physicians that are all excited about being a part of this practice model. We exceeded our exhibitor expectations by 300 percent and went well beyond what we were expecting for attendance. I have attended a lot of medical meetings. I have never been to one in which every session was standing-room-only, or in which every seat in the ballroom was full even at the end of the last day. So why would a bunch of people fly into St. Louis to spend two days cooped up in an airport Marriott? Because, as Gabe Fine said during a standing-room-only panel discussion at the meeting, “Direct primary care is no longer a movement in our health care system; it is a solution!”
Why is it a solution? Several presenters showed data that demonstrated fewer surgeries and hospitalizations and lower costs among DPC patients. Data also demonstrate improved quality including better blood pressure control and longer visits for patients in DPC models.
But DPC isn’t just a solution for outcomes, quality and cost. We heard stories during the meeting that showed DPC is a solution for burned-out physicians that might otherwise leave primary care and for students who might never have gone into primary care in the first place. One medical student, Brian Lanier from UNC, said he had almost given up on his dream of practicing primary care before learning about this model. Many students said they felt both financial and collegial pressure to go into other specialties until DPC showed them there was a light at the end of the tunnel. They now believe that they could practice the way they wanted to – spending time with patients and truly caring about them, rather than caring about what insurance they had or how many more co-pays they had to see that day to break even. Physicians told stories about almost retiring due to burnout, but then realizing that DPC was an option for them to continue to enjoy medicine. Chad Krisel, M.D., shared the story of how he came straight out of residency with the plan to practice in this model. Now successful with three physicians in his office, he said that he “cannot imagine practicing family medicine any other way” and that he never would.
A week later, I was at a conference entitled “Innovative Practice Models to Improve Cardiovascular Outcomes.” The meeting wasn’t supposed to be about DPC. It was supposed to cover ACOs, PCMH, blended payment, and team-based care. But as I was waiting to give my lecture, one of the other presenters, Saria Saccocio, M.D. and C.M.O. of Danville Regional Medical Center, was highlighting the pros and cons of the above models and said, “The model that probably solves all of the problems [cost, quality, access, and transparency] best is direct primary care. I almost flew out of my seat! What a set-up for my lecture about two hours later.
I will echo her sentiments about the key problems that the model fixes, and add one more: workforce. I have not seen as much enthusiasm about family medicine in the eyes of medical students in my career as I saw at the DPC summit. When students are drawn into our most important specialty, we all win. They see a bright and optimistic future for primary care in a direct care model and so do I.
Brian Forrest, M.D., is a pioneer in direct-pay primary care and membership model medicine. He has practiced exclusively in that model for 11 years and helped physicians nationwide transition to third-party-billing-free practices. Named one of
Triangle Business Journal’s 40 under 40, Dr. Forrest serves as Board Chair of the N.C. Academy of Family Physicians. He is an Adjunct Associate Professor in the Department of Family Medicine at UNC Chapel Hill and precepts for the BCBSNC Family Medicine Scholars Program.
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