At the 2014 Patient-Centered Primary Care Collaborative Western Regional Conference recently held in Denver, health system executives were asked to discuss the changes that physicians will face in the shifting reality of healthcare reform. One presenting executive asserted that the direct primary-care model could be the wave of the future because it is an increasingly attractive option for physicians and consumers alike.

Direct primary care, which is often described as concierge care for the masses, is becoming a more popular model throughout the country. Concierge care has traditionally catered to the wealthy because patients pay a substantial fee to receive "luxury" services such as unlimited access to their physicians, decreased wait times, and more time with their providers. Under the direct primary care model, members typically pay a more affordable monthly fee for unlimited doctor visits, preventative care, help for chronic conditions, basic tests, and minor emergency procedures. Physicians using this business model usually contract directly with patients instead of going through an insurance company's network, and patients purchase a less expensive insurance plan with a high deductible, or a catastrophic plan, so that they have coverage for unforeseen events. Although this model is somewhat worrisome for managed care organizations because it cuts out the need for traditional insurance, it is an appealing prospect for patients, physicians, and employers.

The direct primary care model is designed to appeal to consumers. The transparent pricing and convenient office hours are a shift from how providers have historically run their practices. A greater portion of healthcare costs have been transferred to patients in recent years through higher deductibles and higher premiums, so consumers are also attracted to the direct primary care model simply from a cost standpoint. Patients are on the hook for more of their healthcare costs and have a greater stake in keeping themselves healthy. As a result, they will likely embrace a model that includes unlimited primary care and preventative services for a flat monthly fee.

Physicians are also attracted to the direct primary care model because they typically have fewer patients and are able to spend more time with each patient, which is becoming increasingly appealing as physician burnout has emerged as a greater factor in recent years. Direct primary care is even being presented to medical students as a way for them to maintain their idealism about what being a physician is all about, such as knowing patients personally and being invested in their health and well-being.

Employers are interested in the direct primary care model as a way to control their ever-increasing healthcare costs. Employers are able to pay the monthly fees to the direct primary care practices on behalf of their employees and then purchase lower-premium insurance plans that cover only major expenses, which is much less costly for employers.  This form of wrap-around insurance is especially popular in markets that have already embraced high-deductible health plans and are open to more progressive healthcare models. One example of a market that has seen an uptick in direct primary care practices is Denver, where this trend was discussed at the conference. Numerous direct primary care providers, such as Denver-based Paladina Health, Seattle-based Qliance, and Las Vegas-based MedLion, have begun promoting their practices and expanding their number of facilities in these cities. It will be interesting to see how traditional health insurance carriers react if the model expands as predicted, since direct primary care bypasses preventive care coverage offered through the traditional insurance market. As primary-care providers feel increased pressure to achieve the triple aim of decreased costs, better patient experience, and improved outcomes, the direct primary care model could prove to be the solution.

Follow AnnJeanette Colwell on Twitter @AJColwellDRG

DRG becomes Clarivate

View Now