Direct Primary Care

Whether You Call It “Direct Primary Care” or “Concierge Medicine,” Is It The Future?

Screen Shot 2013-09-08 at 12.30.49 PMFor a while now I’ve been meaning to write a post about “Direct Primary Care” or “Concierge Medicine.” This is a trend that doesn’t get enough attention at a time when everyone is talking about creating sustainable models of care. Recently I received the nudge I needed to write this post. Patrick Jonas, MD, (@apjonas on Twitter), sent me a Tweet about the Direct Primary Care National Summit coming up October 11 & 12, 2013 in St. Louis, MO. (You may know of Dr. Jonas from his Dr. Synonymous Blog and the Dr. Synonymous Show on Blog Talk Radio.)

Here’s how Direct Primary Care is explained on the Direct Primary Care Coalition website (http://www.dpcare.org/):

“Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.

At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.”

Within this care model, patients pay a monthly membership fee and have nearly unlimited access to their primary care physician. The fee varies based on the profile of the patient.

One of the principles driving the move to direct primary care is the view that it is not pracitcal to have insurance pay for primary care and preventative medicine:

“Imagine if we relied on auto insurance for “primary care” for our vehicles (fluid changes, tire rotations, wiper blades). Think of the paperwork and billing hassles we would endure for each little oil change. The overall cost of auto maintenance would increase to cover the business overhead. Soon, fewer Americans would be able to afford auto insurance, with serious ramifications for liability, setting the stage for a national crisis. It’s a ridiculous idea, isn’t it? Yet this is the way that health care works in America today.

Approximately 90 percent of health care services provided today are referred to as primary care or preventive medicine. Placing these services under the umbrella of health insurance has driven up the cost, making even basic care unaffordable for many Americans.” (Source: dpcare.org website)

Physicians who run Direct Primary Care practices spend less time on paperwork and insurance issues, and have the opportunity to put more time into patient interactions. Typically, these physicians reduce the size of their patient panels and see far fewer patients. However, although patients are paying cash for primary care, they are encouraged to maintain a high deductable, low premium health insurance policy to cover emergencies and acute illness.

This is a fascinating trend, and one that is not without controversy. I’ve heard many stories about patients receiving letters from their physician stating that he or she is moving to the concierge model and to remain a patient, a $1500 per year retainer will be required. This happened to my parents and they paid the retainer. They saw this as a good thing, but not everyone does. To hear some of the criticisms of direct primary care, check out this Boston Globe opinion piece, “The Concierge Doctor Is In.” (At one point the author equates concierge medicine to gated communities. Wow.) And here’s a post from the Kevin MD blog, “Common criticisms of concierge medicine that deserve to be answered.”

Here are some great resources for learning more about Direct Primary Care:

My thanks to Patrick Jonas for giving me the nudge I needed to finally write this blog post introducing Direct Primary Care.

16 comments on “Whether You Call It “Direct Primary Care” or “Concierge Medicine,” Is It The Future?

  1. Dan, I also think that Direct Primary Care, if done correctly, has the chance to reduce some of the strain on the ED…

  2. Very nice article – thank you for introducing your audience to what will eventually become the nation’s private source for primary care. Direct Primary Care (DPC) is growing exponentially across the country, and for good reason – the model helps employers attain significant savings, physicians enjoy medicine again, and patients access quality medical care at reasonable cost.

    A couple of important points – concierge medicine is a different industry entirely from DPC. The latter doesn’t utilize any insurance for primary care medical services, as opposed to concierge medicine, in which a monthly subscription is on top of what is billed to insurance for visits (in most cases). DPC monthly fees can be as little as $69/month, whereas concierge medicine fees are usually over $100/month. DPC is included in the upcoming Affordable Care Act, whereas concierge medicine is not. The confusion is common, and even many DPC doctors themselves don’t know how to delineate the difference, which can sometimes confuse patients in terms of expectations.

    The Direct Primary Coalition is a subsidiary of Qliance, a DPC company with clinics in Washington. The coalition is not a true representation of DPC, with many Qliance competitors left out its directory, which is also inclusive of non-DPC, concierge practices.

    The father is DPC is likely Dr. Fine of Health Access RI, in Rhode Island.

    Great article.

    Sam Qamar, MD
    CEO, MedLion Direct Primary Care

    • Sam,
      Thanks for you comment and valuable insights. The differences you point out between concierge medicine and Direct Primary Care are important. Additionally, I appreciate you addressing the Direct Primary Care Coalition. Important nuances, and some not so subtle. My thanks.
      Dan

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  4. Reblogged this on DIRECT primary CARE JOURNAL and commented:
    Good thoughts, Dan. I’ve been writing about these concepts for years. DPC is a ‘mass-market variant of concierge medicine, distinguished by its low prices.’ Simply stated, the biggest difference between ‘direct primary care’ and retainer based practices is that DPC takes a low, flat rate fee whereas omodels, (although plans may vary by practice) – usually charge an annual retainer fee and promise more ‘access’ to the doctor. This primary care business model gives these type of providers the time to deliver more personalized care to their patients and pursue a comprehensive medical home approach. One in which the provider’s incentives are fully aligned with the patient’s incentives.

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  6. Dan, Thanks for taking the nudge. You have a great understanding already of some pluses and minuses of DPC. Dr Samar, CEO of MedLion added nicely with the concierge vs DPC differences.
    The DPC landscape is evolving nicely with a wide variety of applications, from solo “micro practices” to multi-practice networks. Inclusion in The ACA brings attention (and some fears of eventual over-regulation) but it’s exciting and extremely cost effective for many, but not all patients/ employers and governments.
    The #DPCSummit in St Louis, which is a sampling of many current DPC practices, employer and policy perspectives, leaves out many DPC innovators (There are exciting ideas in lots of practices and networks- too many for any “Summit” to include).. We may answer many questions, but may generate many more. More meetings and summits will surely follow to continue to broaden the DPC conversation. It’s getting better as we go. Thanks, again.apj

  7. Thanks, Dan, for writing about DPC. Those of us doing this model have high hopes that it presents a viable alternative for primary care and a reliable method for delivering consistently high quality, patient-centered care while improving health outcomes and driving down costs system-wide.

    I’d like to clarify a couple of points made by Dr. Qamar above. The DPC Coalition is not a “subsidiary” of Qliance. It was formed during the ACA debate in DC to make sure that DPC did not get squashed inadvertently in the push to reform our healthcare system. At the time, Qliance, of which I am the CEO, reached out to as many DPC or similar practices we could find and asked them to join us in our lobbying efforts. While many loaned their names to the effort, including MedLion (which is listed on the site, http://www.dpcare.org), at the time Qliance was the only organization that was willing and able to provide the financial resources needed to have a voice and presence in DC. We understood that this was a nascent movement and were happy to do what needed to be done, and were also happy that so many providers around the country were willing to put their names out there in support. I am delighted to report that now, several years later, a larger group of DPC organizations has joined us and has committed to financially supporting these efforts, so we are in the process of forming this up into a true coalition with shared governance. This is a very positive sign, indicating that DPC is alive, well, and growing. We look forward to inviting other DPC providers to become official members of the DPC Coalition starting this Fall, and we will be updating the now very dated list of practices on the DPCare.org website with the new membership list, so stay tuned.

    I strongly encourage anyone and everyone to come to the DPC Summit in St. Louis, as referenced above – everyone is welcome, and we look forward to a spirited discussion and debate about the future of our healthcare system.

    • Erika, thanks so much for your comment. I appreciate you sharing so much information. This is very helpful.
      Dan

    • Dr. Bliss, thank you for your clarification. We were under the impression that the DPC Coalition was heavily assisted by Qliance, in part, due to a conversation I had with Norm Wu, Qliance’s former CEO.

      MedLion has had no luck for the last two years, despite continued efforts, to be listed accurately on the coalition’s website. We are in many more locations, and we have been unable to update our information, which misleads those interested in MedLion by ways of the coalition’s website.

      We look forward to seeing the coalition’s upcoming efforts with “shared governance,” as this is what makes for true organizations. I am sure you know MedLion was flatly declined all opportunities to present at the DPC Summit, despite being one of the national DPC leaders. It is important for all DPC pioneers to work together to ensure our new industry succeeds. Nonetheless, MedLion continues to grow at an exponential rate, and continues to fly the DPC flag as a dominating force within the industry.

      Thank you for your service to Direct Primary Care.

      Sam Qamar
      CEO
      MedLion

  8. Nice….Thank you for sharing. I think it would be helpful for all.
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