MANAGED CARE September 2017
How doctors get paid | Direct Primary Care Is About To Take Off–or Maybe Not
Some call it concierge care for the masses. Born out of physician frustration with insurers, ‘DPC’ could become more popular if Congress passes legislation that allows people to use HSA funds to pay the monthly fee.
By Charlotte Huff is a freelance health and business journalist in Fort Worth, Texas. She has written for Health Affairs, Stat, and Slate among many other publications.
Direct primary care, sometimes described as concierge care for the masses, is still a relative newcomer to the health system. But despite its currently small footprint and the recent closure of one of the larger providers of direct primary care, several political and insurance trends appear to be shifting to the model’s advantage.
Direct primary care, which enthusiasts like to shorten to DPC, is not insurance. Instead patients pay participating doctors a monthly fee—typically less than $100—for a range of primary care services. As of 2017, nearly 3% of family physicians operated DPC practices, according to survey data from the American Academy of Family Physicians (AAFP). This summer’s closure of Seattle-based Qliance—one of the earliest providers with a chain of DPC clinics—reignited the debate over whether DPC is the coming thing or just a boutique item with a rather uncertain future.
Some trends are playing to DPC’s strengths, most notably high-deductible insurance and health savings accounts (HSAs). An increasing number of people who have insurance through their employers are covered by high-deductible plans. According to the 2016 survey by the Kaiser Family Foundation and the Health Research & Educational Trust, 29% of American employees have high-deductible plans. High-deductible plans also figure prominently among the policies sold on the shaky ACA exchanges.
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“There’s no stopping DPC,” says John Bender, MD, a Colorado family physician and AAFP board member whose practice has started converting to the model. “High-deductible health plans are not going away regardless of whether the ACA is repealed.”
The future of the DPC model, in terms of its ability to capture the interest of employers and other large payers, will likely depend upon whether it clears a few hurdles. Can DPC providers build a convincing case for employers that a monthly DPC fee on top of their share of an insurance premium will save them money overall by increasing utilization of primary care, thereby decreasing hospitalizations and episodes of pricey specialty care?