Direct Primary Care: The Big Picture

A med student on the road to practicing in the direct primary care model, Brian Lanier answers the three questions he always hears about the model.

By Brian Lanier

I was honored to be asked to serve on the steering committee for this year’s Direct Primary Care (DPC) summit, which will take place in Washington, D.C. in June. I’ve written here before about about DPC, how I became aware of the practice model and how I felt that it was the only solution that truly addresses the problems plaguing primary care. DPC will allow me to practice in a way that makes the patient, not the third-party payer, the center. However, I often hear the following three questions about DPC: (1) How will it survive under the Affordable Care Act? (2) Isn’t it just for rich people? and (3) How can old-fashioned primary care embrace innovation? So I want to answers those questions here.

But first, direct primary care is a model that removes the third-party payer from the equation. Third-party involvement in primary care adds an enormous burden of cost and time – a burden that doesn’t add to, but actually detracts from, the quality of care. When that burden is removed, the savings are dramatic, and the whole physician paradigm shifts from chasing reimbursement to providing the best care possible. In DPC, the patients pay the physician directly for service through an affordable subscription or transparent a-la-carte pricing. A subscription might include same-day or next day appointments; little or no wait time; email, phone, text or even Skype access; and sometimes house calls. 
 
Now that most Americans are required to have health insurance under the Affordable Care Act (ACA), many people wonder what role a practice that doesn’t take insurance could have. Direct Primary Care has an important role in health reform.  There is a provision in the ACA that allows for DPC services to be offered with policies sold on the exchanges, and this is already happening in the state of Washington.  The Direct Primary Care Coalition is working feverishly to enact or modify legislation to allow more people to benefit from DPC. 
 
Even when the ACA is fully enacted, there will be many people left uninsured, and DPC can help fill that void.  Even those who are insured will feel the sting of high deductibles now common under the ACA. People will rightfully ask why an office visit should cost $200, or a simple X-ray should cost $300. DPC’s answer is that it shouldn’t.
 
One common criticism of DPC is that it is only for the affluent, but nothing could be further from the truth.  While it may sound like “concierge” medicine, and there are some DPC practices that do cater to the well-off, most DPC practices offer services at a very affordable price.  What’s more, Qliance in Seattle, WA, has contracted to provide DPC to Medicaid patients. Dr. Marguerite Duane has written extensively about how DPC can benefit poor patients (here, here, and here).  PanZoe.org is a new organization that seeks to improve primary care for low-income patients by connecting them with DPC providers and charity funding.
 
While DPC is reminiscent of old-fashioned primary care, it also excels at modern facets of care improvement.  Physicians are free to communicate via phone, email, Skype, or text message, opening access to care in ways the traditional model discourages. Without the constraints of current reimbursement models, physicians are able to connect with patients in the way that they need. Companies like Amplify Health are working to provide powerful informatics to DPC practices to improve care and measure outcomes. New electronic health records have been developed for DPC practices that are patient-centered instead of reimbursement-centered, making the use of the EHRs truly meaningful.
 
When I first learned of DPC, I read everything I could about it and still wasn’t satisfied until I saw it in action.  If you feel the same way, there is a great opportunity to hear about the exciting things happening with DPC first-hand at the Direct Primary Care Summit 2014 in Washington DC June 20-21.  If you attend, you can expect to hear working DPC physicians talk about their practice and how they have implemented the model. You will hear experts like Dr. Chad Krisel give nuts-and-bolts guidance on starting a DPC practice right out of residency. You will hear updates on efforts to build on the success of including DPC in the Affordable Care Act and further integrating DPC into the mainstream. You will hear about innovations embraced by DPC practices that allow them to be truly patient-centered. You will hear doctors talk about how they went from being at the end of their rope with the insurance-based system to finding joy in caring for patients again.
 
I would love to answer your questions about Direct Primary Care and get feedback on what students and residents would like to get out of the conference. Please contact me via the Twitter handle or email address below.  I hope to see you in DC in June.
 
Brian Lanier is a graduating medical student at the University of North Carolina School of Medicine and will be training in Family Medicine in Wilmington, NC.  He can be found on Twitter @lanierbrian or by email at blanier.dpcsummit@gmail.com.
 
Check out other blog posts on direct primary care.
 
Posted by Sonya Collins on Apr 24, 2014 9:16 AM US/Eastern
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