The Best Kept Secret in the Health Care Industry

Inaccessible physicians. Rushed office visits. Endless paperwork. Exorbitant bills.

For many Americans, these words reflect their experience with primary health care.

But an innovative delivery model promises to bring affordable primary care to millions of Americans, if only lawmakers will get out of the way.

Direct primary care (DPC), sometimes known as “concierge medicine,” abandons the usual insurance structure of health care in favor of a simple, flat monthly fee paid directly by the patient to the physician. The fee, usually about $60 per month, covers all primary care services, including screening, assessment, diagnosis, and treatment. DPC practices typically don’t accept any third-party payment, either from private insurance companies or government programs like Medicaid and Medicare.

By adopting a simple payment mechanism that excludes insurance companies, the DPC model eliminates one of health care providers’ most time-consuming tasks: processing insurance claims. In many cases, insurance processing and other administrative work can consume in excess of 30 percent of a traditional practice’s revenue, and take up one-sixth of physicians’ working hours. By contrast, DPC cuts down on paperwork and allows physicians to focus on caring for their patients.

Patients in DPC practices can schedule appointments as often as they like, and physicians are usually accessible by email, text, or phone. Unlike the traditional insurance-based model of care, DPC provides complete price transparency, so patients don’t receive unexpected or indecipherable bills.

To be sure, DPC has its limits. Since the model only covers primary care services, patients usually enroll in a high-deductible health insurance plan that covers prolonged hospitalizations, surgeries, and expensive procedures that are beyond the scope of a doctor’s office.

Still, DPC practices, with their emphasis on close doctor-patient relationships, are better able to monitor existing illnesses, coordinate treatments, and quickly address emerging issues than traditional primary care practices that are often forced to concentrate on reactive, superficial care. Traditionally, primary care physicians are responsible for approximately 2,500 patients, resulting in office visits too brief to provide detailed information or develop a long-term wellness plan. DPC practices, on the other hand, typically have only 200 to 600 patients, which allows for more personalized care.

DPC practices are exceptionally successful at managing chronic conditions like diabetes and heart disease and preventing costly emergency department visits. One study found that urgent and avoidable hospital admissions were 62 percent lower among DPC patients compared to traditional patients. As a result, DPC patients incur about 20 percent fewer health care costs.

Despite the many benefits that DPC offers, many states have so far been unwilling to remove regulatory obstacles that make it difficult for DPC practices to flourish. In particular, some states continue to categorize DPC as a form of health insurance and impose on small DPC practices burdensome rules that were designed to regulate large insurance companies.

But DPC practices do not provide insurance — they provide regular, foreseeable medical care and are more akin to a gym membership than to insurance. Thankfully, laws have already been passed in 25 states, including two this year alone, exempting DPC practices from insurance regulation. It’s time for lawmakers in the remaining states to pass similar legislation.

In the past decade, DPC has seen explosive growth. And with health care costs continuing to spiral out of control and patients becoming increasingly dissatisfied with their care, DPC could be a lifeline for millions of Americans. Policymakers should do all they can to make this model of care more widely available.

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