February 3, 2016

Direct Primary Care: A Consideration for Rural Health

By Janelle Ali-Dinar, PhD

Is it possible that the until-now-unheard-of notion of simplicity has been introduced within the healthcare industry? If so, something accompanying it might be the movement of DPC, or direct primary care, through which unlimited primary care drives down overall costs while improving patient outcomes and experiences.

Hailed by Time as “one of the most intriguing experiments in the medical industry,” the notion is based on an analysis conducted by Qliance Medical Management. In the analysis, two years’ worth of healthcare claims data on thousands of patients, contrary to the prevailing view, revealed that the increasingly popular “direct primary care” model, with its emphasis on unrestricted access to primary care, would make healthcare 20 percent less expensive than traditional health insurance, yet leave patients feeling more satisfied with their care.

Legal under the Patient Protection and Affordable Care Act (which identifies DPC as an acceptable option of patient treatment), DPC’s breadth and depth includes 40-plus states currently practicing DPC; more than a dozen states that have gone so far as to pass and incorporate additional legislation for broader DPC usage, including DPC hybrid models/pilot programs for Medicare Advantage, Medicaid coverage and state employees; and 400-plus DPC groups, 1,300-plus physicians, and 2 percent of the 68,000 members of the Academy of Family Physicians/AAFP practice DPC. Additionally, DPC is gaining prominence at C-Suite healthcare strategy roundtables across the nation, in physician AAFP chapter meetings, and during discussions within PC-independent and group physicians frustrated by the demands of healthcare bureaucracy. Additionally, there has been recent media coverage, including an NPR story (Would Paying Your Doctor Cash Up Front Get you Better Care), pointing toward positive research support findings by the Heritage Foundation on outcomes, costs, and third-party paperwork.

While modeled after concierge medicine, which was once construed as “medicine for the elite,” DPC is far more cost-effective, and has evolved into personalized care for the masses. To be clear, it is neither a benefit nor insurance, but rather an agreement directly between the physician and patient. Contingent upon physician and location, patients typically pay a fee of $50-125 per month for comprehensive primacy care services – including lab tests, basic medication, 24/7 access and follow-up visits – in person, or via phone, email, tele-health, or virtual portal. It doesn’t cover specialists or emergencies, and patients still need a high deductible health plan/wraparound catastrophic policy, but the combined cost of the monthly flat fee and the plan is often cheaper than traditional insurance purchased within the marketplace.    

Simply put, according to its proponents DPC delivers the “right kind of care” in the “right place” at the “right time.” How? DPC:

  1. Reduces healthcare costs, ER visits, and hospitalization;
  2. Achieves triple aim by realigning incentives to focus on proactive interventions to achieve results and achieve population health;
  3. Creates increased patient satisfaction, physician engagement, and better patient outcomes;
  4. Achieves physician compliance;
  5. Changes patient usage patterns, with more personalized, home-based preventative care versus high-acuity episodic care;
  6. Incorporates community health via a collaborative model approach; and
  7. Can be used with population health platforms to develop a plan of care/proposed wellness outcomes. 

Physicians choose it because it allows them to: 

  1. Spend quality time with patients in meeting personalized and comprehensive care model needs.
  2. Spend less time with billing and tasks that take away from patient care.
  3. Work for patients, not the insurer.
  4. Enhance the patient/doctor relationship – “the root of medicine.”

Some who leverage DPC participate in ICD-10, but since DPC isn’t built on insurance, not all do; all keep paper records and some participate in electronic medical records (EMRs) or DPC tracking software. 

Additionally, from a rural standpoint, DPC works seamlessly with the Patient Centered Medical Home Model (PCMH) in the delivery of behavioral health services via tele-health and can easily be duplicated and expanded within the care treatment for rural veterans, tribal nations, and minority or underserved communities.   

One final thought: With PC shortage numbers ranging from 20,000-30,000 by 2030, can DPC solve PC recruitment/retention issues? On the one hand, if more PC physicians convert to DPC, fewer patients will be seen (average patient panel 600-1,000 versus 1,900-2,700 traditional), leaving a deficit of care for the most vulnerable patients, but on the other hand, with this growing movement being discussed even at medical schools for curriculum coverage, it would serve as a PC magnet of growth to address the very same supply shortage.

Either way, PC physicians play a pivotal role, now and in the future, in driving the delivery of care. DPC may not be for every physician or patient, as there isn’t a one-size-fits-all formula and more time is necessary to study and assess findings, but there is enough proof in the pudding that it is a new powerful gateway to achieving high-quality healthcare, operations, performance, and efficiencies results. 

Simply put, that would be simplicity at its finest.

About the Author

Janelle Ali-Dinar, PhD,  is the chief operations officer at MedFirst Partners and a senior rural health expert at Healthcare Solutions Connections. She has more than 10 years of experience in rural health policy, legislation, strategy, and operations, having served on the National Rural Health Association’s national rural congress. Dr. Ali-Dinar is also an NRHA Rural Fellow. 

Contact the Author

drjalidinar@yahoo.com

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