direct-primary-care

The Alliance hosted Dr. Kayur Patel of Proactive M.D. and Dr. David Usher, M.D., of ReforMedicine, for our first of a three-part series on Direct Primary Care June 8.   

Missed the webinar? You can view it here.  

What is Direct Primary Care? 

Direct Primary Care is an innovative primary care model that emphasizes developing and maintaining a trusting patient-physician relationship while utilizing an alternative payment method that greatly improves access to highquality care with flat, affordable membership fee. It significantly differs from traditional primary care, which uses fee-for-service payments and third-party payers. 

Employers are growing to identify the benefits of Direct Primary Care for their plan participants and their healthcare expenditure, and are adopting this model by utilizing an on-site, near-site, or shared-site clinic. In fact, in response to the ever-increasing demand for this model of care, The Alliance is launching a Direct Primary Care clinic for employers. Under this model, employers will only pay for the plan participants who access the health center. 

Increased Time and Trust for Better Health

Direct Primary Care places an emphasis on length and frequency of contact between patient and primary doctor. “There is no substitute for time spent with patients – building trust takes time,” said Dr. Usher. By increasing the time patients spend with their primary physicians, a trusting relationship develops, which enables a more fluid and seamless flow of information between the patient and provider. 

Practicing under this model, the physician inherently understands the patient and can make smarter recommendations and referrals. As Dr. Patel explained, “If the physician and patient spend more time together, they will intuitively make better choices for the patient and provide more complete care.”  

Primary Care Directs Total Health

In today’s complicated health care world there’s a significant amount of specialty care and referrals, and there needs to be someone directing and managing each part of that care. Dr. Patel explained that direct primary care acts as that link and likened the primary care doctor to the quarterback of a football team.   

“The quarterback has to be the family [doctor] who has the ability to navigate all the various specialty care, and soon as the patient is seen by the specialist, the primary care doctor needs to reprocess that information and figure out what the next move is going to be,” he said. In other words, the primary care doctor is the key to total health for a patient.  

More Preventative Care = Less Emergency Care

More importantly, because the physician is more in-sync with their patient, they’re now better able to direct focus on preventative care, which can negate the need for expensive ER and urgent care visitsmultiple and unnecessary tests and referrals to costly specialists.   

“If we more appropriately direct care and manage preventative care,” Dr. Patel elaborated, “we will reduce the higher-complexity, higher-cost care – like surgeries and ER visits – to less-complex, less-expensive physicals and medications.”  

Better Access for Patients 

Additionally, patients have more convenient ways to access care in a Direct Primary Care model, like 24/7 telehealth services and same-day appointments. Some Direct Primary Care clinics feature expanded services, like on-site MRIs and prescription fulfillment, which increases convenience and reduces costs. As Dr. Patel explained it, “Access to care is critical in terms of offered value.” said Dr. Patel.  

More Effective Payment Methods

Direct Primary Care providers pay for care on a per-member, per-month basis, as opposed to the traditional fee-for-service model. This reformed payment methodology rewards providers for quality of care, placing an emphasis on value over volume. There are no inflated costs due to third-party or fee-for-service billing because patients pay for their care directly to the physician. Most Direct Primary Care memberships/subscriptions cost less than the average cell phone bill, often for as little as $70/month. 

“I want to have more time with my patients,” Dr. Usher said plainly, “In the traditional health care world, you make more money with two 15-minute appointments than a single 30-minute appointment. That’s why we moved into a Direct Primary Care model.”  

Dr. Usher went on to explain that primary care is undervalued in traditional medicine due to the reimbursement structure in the fee-for-service model. “Primary care is often used as a referral engine to bigger, more expensive health systems,” he said. “For patients, this year’s charges become next year’s premiums – even with good insurance.”  

In fact, general deductibles have increased eight times faster than wage increases, and premiums have increased every year since 2008. These costs are causing patients to ignore symptoms and forego treatment on manageable symptoms until they become, what Dr. Usher referred to as, “medically homeless.” Ultimately, those patients will end up seeking costly emergency treatment when things get worse.  

Patients and Employers Prefer DPC 

However, the Direct Primary Care model combats those traditional health care inefficiencies by providing patients with:  

  • Better access to providers  
  • Deeper, trusting relationships with primary physicians  
  • Address root causes to health problems (not just symptoms)  
  • Produce fewer referrals and expensive tests  
  • Better affordability  
  • Better work and lifestyles providers  

As for employers, in addition to paying a simple monthly, per-member fee, they also experience reduced absenteeism due to happier and healthier workforces.  

Dr. Usher ended his presentation by explaining that by moving to the Direct Primary Care model, his patient satisfaction has skyrocketed: “This model is highly popular with patients who really enjoy the access to health care and more specifically, the lower costs.” 

In Dr. Patel’s closing remarks, he expressed that a good health plan heavily incentivizes direct-contracted primary care, and that employers need to take action for widespread acceptance. “As employers, you can make an impact as the largest purchaser of health insurance,” he concluded.  

Learn More

For more information on our new Sun Prairie clinic or to learn what it takes to start your own on-site clinic, please contact your Account Executive or reach out to Business Development.