DIRECT PRIMARY CARE: Back to the Basics

Proquest LLC

A newer development, and one that is likely to get more attention in the next two years, is direct primary care. Starting in 2014 direct primary-care providers will start competing for employers on the insurance exchanges established by the health care reform law.

patient guide dpc smallIt’s a twist on “concierge medicine” where wealthy patients pay a doctor a steep annual fee or retainer for unlimited access to medical attention. Direct primary care is the populist version with a more affordable monthly membership fee, usually less than $100. Typically, an employer picks up part of the cost. Doctors have lighter patient loads, and that means they are more accessible, including nights and weekends and through email and telephone consultations.

Direct primary-care providers receive a salary, unlike most physicians who are paid per service, which allows for more time with patients. Appointments typically last up to an hour. There are no insurance claim forms to fill out or deductibles to meet. Everything is covered by the monthly fee.

While direct primary care is not an insurance product, when paired with a “wrap around” insurance policy to cover specialized and emergency care, direct primary-care clinics will be allowed to compete on the exchanges. Such a product has yet to be developed, according to providers who envision a policy customized for direct primary-care practices that would cover services not offered by the practice.

Proponents, like Dave Chase, CEO of Avado, a health care technology startup, compare the direct primary-care model to auto insurance.

“Do you pull out your auto insurance card when you go to Jiffy Lube? Of course not,” he says. “So why do you do it for health care? You shouldn’t use insurance for the predictable day-to-day stuff, like changing your tire or getting a flu shot. Insurance is for the unexpected, catastrophic events.”

The concept is new enough that many in the insurance industry haven’t heard of direct primary care. A spokesman for America’s Health Insurance Plans, a health insurance industry trade association, says he has no information on the trend. “I haven’t seen the data.”

direct primary care journal2But in Washington state, the birthplace of direct primary care–the first clinic opened there in 2007–some insurers are wary of the concept, says Erika Bliss, a physician who is president and CEO of Qliance in Seattle. Qliance was the first direct primary-care network to set up shop in the state.

“We’ve said from the beginning that we’re not anti-insurance, but primary care is a routine and predictable event,” she says. “So, why not divide it up and let us handle the routine care and let insurance cover what they need to? We reduce risk for insurance companies, and that’s appealing.”


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