Frustrated with the burdens of insurance, an increasing number of primary care doctors are bringing affordable, quality health care to all people, including those on Medicare and Medicaid. Direct primary care is modeled after concierge medical practices, with a flat monthly or yearly fee paid directly to the physician for comprehensive primary care. For $100 or less, this includes basic medication, lab tests, and follow-up visits, and communication over email and phone whenever needed. Since doctors are spending less on administration overhead, they can focus on treating patients in a more personal and convenient way.
Direct primary care doesn’t cover specialists or emergencies, so patients may want a high-deductible insurance policy. The cost of the monthly fee plus that policy is often cheaper than traditional insurance. There are now more than 400 group practices using this model and more are in the works. Participating doctors exceed 1,300.
Patients from all income brackets use direct primary care. Some companies are experimenting with integrating Medicaid and Medicare patients into the program. Qliance, based in Seattle, operates a network of primary care doctors who are blending direct pay with Washington State Medicaid. They have 15,000 patients signed up so far, who get a Qliance doctor, unlimited office visits, and physician contact by phone and email. The local Medicaid carrier pays the monthly fee for the primary care, as well as specialty and emergency services. It is estimated that using this program will cost 15% to 20% less than traditional Medicaid.
Qliance also found that employees spend 20% less when they use direct primary care instead of traditional insurance. Since they get better care upfront, more serious conditions are less likely to develop. The state of New Jersey is launching direct primary care for all state employees this year, including firefighters and teachers. These plans will be run through Aetna and Horizon, which will cover specialists in those networks. Other states are interested to see how this works and may consider in the future.
Iora Health is a direct primary care system which started clinics in Washington and Arizona, mainly for Medicare Advantage patients, and future clinics are coming to Colorado and Massachusetts. Private alternatives to traditional Medicare are gaining interest.
The direct primary care model has great potential. The challenge is integrating it into the current system and attracting more physicians to participate.
Luthra, Shefali. “Would Paying Your Doctor Cash Up Front Get You Better Care?” Health Shots. NPR, 13 Jan 2016. Web. 14 Jan 2016.