March 22, 2017

RALEIGH — An increased use of Direct Primary Care could lead to better outcomes for treatment of patients with chronic diseases. That could mean cutting the incidence and severity of disabilities, according to a new John Locke Foundation Policy Report.

“For the nation’s health care system to slow the growth of health care spending and better manage the prevalence of chronic disease and its association with disabilities, patients need better access to health care,” said report author Katherine Restrepo, JLF Director of Health Care Policy. “In turn, providers need the flexibility to spend more time with their patients. Direct Primary Care has a good record of addressing these concerns.”

The report recommends that N.C. policymakers pass legislation that would help DPC providers avoid regulation from the state Department of Insurance. The report also explains how the state could extend DPC access to Medicaid patients.

DPC is a health care business model that removes insurance companies from basic primary care. Patients pay a monthly fee averaging $75, Restrepo explained. “In exchange, they have unrestricted access to their physician and unlimited access to a defined package of services,” she said. “In most cases, primary care physicians are available around the clock, whether that’s in person or by phone, text, or email.”

This model proves especially helpful in addressing the key problem of access to health care, Restrepo said. “Having health coverage does not guarantee timely access to health care,” she said. “The existing barriers to health care, notably at the primary care level, are problematic for many patients. These barriers severely impact those with chronic illnesses.”

Patients with chronic illnesses face a higher risk of developing disabilities and other medical complications, Restrepo said. “Since primary care physicians can help manage chronic care, treating over 80 percent of patients’ needs, a model that improves patients’ access to these physicians makes a lot of sense.”

Restrepo’s report details problems that reduce access to primary care in today’s standard health care delivery model. A recent report suggested patients across the country face wait times of nearly 20 days to see a family physician.

“Once patients see a doctor, many feel rushed through their appointments,” Restrepo said. “Primary care providers treat more patients each day just to keep up with overhead expenses. Studies show that more than 40 percent of physicians spend more than one-third of each day dealing with tasks outside of actual visits with patients. It’s no surprise that 87 percent of surveyed physicians feel professional burnout due to the inefficiencies of administrative demands.”

The report also documents links between poverty and disease. Chronic disease and associated disabilities have a major impact on Medicaid spending, Restrepo said.

Direct Primary Care has delivered good news in addressing these challenges, she said. “The available qualitative and quantitative data make a compelling case that chronically ill patients value DPC from a quality and cost perspective.”

Opting out of insurance contracts allows smaller DPC practices to break even by treating as few as four patients a day, Restrepo said. “Compare that with the average of 32 patients per day in today’s typical practice setting,” she said. “DPC heightens providers’ professional satisfaction because they can practice with more autonomy and fewer administrative demands.”

Patients also benefit. They can spend more time with their doctors. They have easier access to services such as annual physicals, EKG testing, joint injections, and skin biopsies. Many practices dispense prescription drugs and provide discounted imaging and lab work, Restrepo said.

“Existing research concludes that DPC patients enjoy improved health outcomes and can save on overall health expenditures,” she said. “A university study found that patients treated in one Apex practice enjoyed average 35-minute office visits, more than four times longer than the average visit in a more typical practice. They also spent 85 percent less money.”

Employers also see benefits from Direct Primary Care. Restrepo details Union County government’s estimate of $1.28 million in annual cost savings linked to DPC. “If other counties across North Carolina adopted a DPC option, savings easily could reach tens of millions of dollars every year.”

Restrepo urges lawmakers to consider so-called “clarifying legislation.” “Seventeen states have enacted this type of legislation that specifically defines DPC as not acting as insurance,” she said. “Following suit in North Carolina would save providers from being subject to regulations from the N.C. Department of Insurance. This would likely lead to a stronger DPC presence in the state.”

The report explains how a voucher program could help Medicaid patients access DPC services. “Medicaid would deposit money into a patient’s account, and the patient could spend the money on any Medicaid-approved expense — including direct care membership fees,” Restrepo said. “All documentation and interaction with Medicaid would be the patient’s responsibility.”

Direct Primary Care could lead to significant benefits for North Carolina’s most challenging patients, Restrepo said. “As health care costs continue to rise faster than the rate of general inflation, state and local governments must necessarily consider new and innovative ideas,” she said. “The DPC model has the potential to go beyond reforming our nation’s health care system to effectively transforming it. This would reduce the likelihood of chronically ill patients developing disabilities.”

Katherine Restrepo’s Policy Report, “Direct Primary Care: A Simple Health Care Model Designed to Help Patients With Chronic Disease and Disabilities,” is available at the JLF website. For more information, please contact Restrepo at (919) 828-3876 or [email protected] To arrange an interview, contact Mitch Kokai at (919) 306-8736 or [email protected]