A new concept called direct primary care be a viable option to costly health insurance.
Direct primary care works like a health care gym membership. In exchange for a membership fee (the industry average monthly payment ranges from $25 to $85), patients have access to around-the-clock primary health care. They can even schedule same-day appointments and longer office visits with their doctors as needed.
A major reason why monthly fees are affordable for the masses is because many DPC practices follow a micro-practice philosophy in which most resources focus on patient care. By opting out of insurance contracts and accompanied claims personnel, a DPC practice can sustain itself while devoting just one-third of revenues towards overhead.
Dr. James Breen, co-founder of Vitral Family Medicine, a direct primary care practice located in Greensboro, NC, provides an example of how DPC provides fast access to care for patients who need lots of medical attention.
One of his current patients, a 50-year-old male, initially scheduled a visit with an insurance-based primary care practice to be seen for complaints of blurry vision and was referred to an ophthalmologist. He left his specialist appointment without a diagnosis.
Dissatisfied, the patient decided to see what Vitral Family Medicine had to offer. At his initial assessment, he was diagnosed with diabetes for the first time in his life. His blood sugars read above 500.
“It’s pivotal moments like these where DPC doctors can get back to the heart of doctoring,” says Breen.
“I don’t want this to be a matter of ‘Oh, we’re better diagnosticians’ or anything. It goes beyond that. We’re talking about a system of care. The processes of care in most conventional practices are unwieldy and make it difficult to allot the kind of high-touch and timely care that we were able to provide in this case.”
Fortunately, large-scale DPC organizations like Paladina Health have compelling numbers suggesting that patients who are chronically ill find that direct care is more beneficial compared to accessing care in the traditional health system.
Union County, a self-insured employer located outside of Charlotte, has contracted with Paladina to offer its workers an additional health benefit option to seek direct primary care at Paladina’s near-site clinic. The local government saved $1.28 million on health care claims in one year when board-certified physicians provided care for 44 percent of Union County’s 2,000 covered lives.
This is what can happen when primary care physicians opt out of insurance contracts. Less paperwork means more time to spend with patients as needed to effectively prevent at-risk health conditions or manage comorbidities. More time means better access which yields fewer specialist referrals, unnecessary hospital admissions, and emergency room visits.
Studies show that in the traditional system of care, 43 percent of physicians spend more than one-third of their day on data entry and other administrative tasks. Other surveys say primary care physicians spend upwards of 50 percent of a patient’s office visit on the computer. No wonder 87 percent of surveyed physicians feel professional burnout due to these administrative demands.
Although control group data is not available at this juncture to compare the number of average annual in-office visits for chronically ill patients with Paladina’s statistics, it’s important to point out that Paladina’s patient population, including those who have complex medical needs, are voluntarily electing direct care. DPC attracts these patients because this method of health care encourages them to feel more empowered over their health care. The evidence also tells us that patients realize the value direct care has to offer and can make good medical decisions for themselves.
(Katherine Restrepo is the director of health care policy at the John Locke Foundation.)