by Jordan Roberts
Director of Government Affairs, John Locke Foundation
Direct primary care (DPC) is the Netflix of primary care. In exchange for a small monthly fee, patient members of the DPC clinic have around-the-clock access to the services that their physician offers. There is no health insurance – just the patient paying the doctor a monthly fee in exchange for health care.
The fact that there is no insurance in the direct primary care model may concern some people. The thought of health care without insurance usually elicits thoughts of large, surprise medical bills. However, by removing insurance from the equation, many of the problems that exist in the traditional model, which involve a primary care doctor and a third-party payer, disappear. Direct primary care can offer less costly and more consumer-friendly primary care services that are tailored to individuals’ desired health outcomes.
In 2015, the Union County government began to offer a direct primary care (DPC) health benefit option to their county employees. I recently obtained some new data detailing Union County’s health plan cost and utilization for 2018. Union County employees have the option of choosing from a direct primary care option or a more traditional, consumer-driven health plan with a health reimbursement account. The results of adding a DPC option have been an overwhelming success.
The main reason for switching to a direct primary care model is cost. Providing primary care services is less expensive when a doctor can skip insurance paperwork and contract directly with other health entities to conduct business. Moreover, it can be less expensive for a patient to pay a monthly fee to the direct primary care doctor than pay copays and fees toward meeting a deductible. Union County employees covered by the DPC option cost 26 percent less per member, per month to cover than employees covered by the consumer-driven option. DPC participants that had a chronic condition cost 22 percent less to cover than those in the consumer-driven option. The group participating in the DPC option also had a lower medical risk score than the group who chose the consumer-driven plan.
Because direct primary care is an alternative model, participants must not be satisfied with their care, right? Wrong.
In the DPC option, 99 percent of participants reported a positive overall experience, 99 percent of participants reported high satisfaction with provider access, and 97 percent of participants reported a high level of trust in the care they received. Participants of the direct primary care model reported that they spent almost double the amount of time with their DPC physicians compared to their traditional primary care physicians. And a note for employers who are thinking of adding this option: 77 percent of employees said that their opinion of their employer had improved since Union County offered a DPC option.
The cost of care is lower, and patients are happier. But does that mean that patients can get the same level of care as they do in a traditional primary care office? Yes, and in many cases, the care is even better. Seventy-nine percent of employees reported that their health has improved after adoption of DPC. Further, because wait times in the DPC setting are minimal, those with chronic conditions, that is, the most high-risk participants, were able to visit with the doctor on average of seven times during the year. Also, 41 percent of the of the participants in this program have multiple chronic conditions and were able to be easily managed by the direct primary care
Direct primary care has the potential to bring many health care benefits to the American health care system. Regardless of your political affiliation, everyone can all agree health care costs are too high, and conventional primary care often is not the personalized care we want. Alternative delivery models such as DPC can bridge all of those gaps by offering less expensive and higher quality care.
As in the case with Union County, public health plans could save substantial amounts on their plans by contracting with a DPC doctor. If you tease this scenario out even further to larger plans, such as the state health plan, the savings realized by the state could be monumental. That means state employees would receive more benefits at lower costs. Including a DPC option in Medicare and Medicaid also may fundamentally change the way the underserved populations could get care.
Now imagine a private setting. If you receive health insurance from work, the premiums paid on that plan are paid by your employer. The more expensive the care, the more your employer must contribute, which often comes at the expense of salaries and other benefits. With health care costs on the rise, a higher proportion of wages are paying for employer-sponsored plans than ever before. That means less money in the pockets of employees.
As health care costs reach peak levels, innovation will drive alternative ways of delivering health care. DPC is one of those methods, and the evidence is plain and simple that this type of primary care can provide safe, less expensive, and higher-quality care that patients desire. In addition, the plan sponsors save money, which could reduce taxpayer expenditures on health care or increase wages for employees. Regardless, DPC is an innovative way for care to be delivered and will continue to grow as traditional methods of providing care break down due to high cost and low satisfaction.