WOULD THE DIRECT PRIMARY CARE MODEL GROW IN AMERICA?

The Direct Primary Care (DPC) model is a promising way to improve access to medical care for Americans of all ages.

The American Academy of Family Physicians defines DPC as a “practice and payment model where patients/consumers pay their physician or practice directly in the form of periodic payments for a defined set of primary care services.” In this model, enrollees pay a pre-set flat fee (monthly or annually), often based on age brackets. The fee entitles them to access primary care services offered by the provider, including office visits, telehealth consultation, etc.

Health care costs in America have been rising for years. High health care expenses, including premiums, deductibles, and copays, eat up large chunks of patients’ budgets, often leading to financial setbacks. Many individuals, even with insurance coverage, may struggle to pay for out-of-pockets costs. For those without health insurance coverage, accessing primary care for minor issues or routine needs may be even more unaffordable.

Unfortunately, skyrocketing costs may compel many people to forgo purchasing insurance or avoid seeking health care altogether. Doing so involves great risks, as unexpected illnesses could hit anyone anytime. Furthermore, not going for routine visits to a doctor could result in a growing health care problem remaining undetected, possibly leading to more expensive treatments in the future.

Moreover, there are individuals who carry only catastrophic insurance coverage for the worst case scenarios. For them, going to see a doctor of minor aches and pains, or simple cold and flu may mean hefty bills.

The DPC model provides much-needed solutions for some of the abovementioned issues. By implementing flat monthly or annual fees, it provides some certainty to patients with regards to their budget. For those with no insurance or only catastrophic coverage, DPC allows them to seek affordable primary care services. The model provides convenience, because consultations could be in-person or via telehealth options, depending on the provider.

The simplicity of the DPC model lowers the administrative burden for the provider, allowing doctors to spend more time with patients and less time handling paperwork. According to a study cited by the New York Times, for every 10 physicians providing care, there are nearly seven more people who work on billing and related matters for the practice. A huge part of these tasks involve working on insurance paperwork to ensure complete payment for services delivered. Because DPC involves patients making monthly or annual payments directly to the practice, there is virtually no time spent on insurance issues. Hence, doctors in the DPC model can focus on devoting more time to treating patients and addressing their needs.

Direct Primary Care is not a substitute for emergency or other services that address chronic and acute health care needs for those suffering from broken bones, heart attacks, cancer, etc.

The DPC model, through its subscriptions options, offers freedom for basic primary services. It is available to both by people with or without insurance coverage. Most notably, it is quite suitable for young and/or healthy people who need affordable primary care, and not necessarily the wide networks of doctors and facilities for complex needs.

While fairly new, the DPC model has potential for expansion. According to Dr. Allison Edwards, the next few years would show steep growth in DPC. Therefore, in the world of large health systems and insurance plans offering a wide range of basic and complex health care services, the Direct Primary Care model is finding its acceptance for those who prefer its simplicity.

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