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Tuesday Jun 17, 2014

Is Direct Primary Care Right for You?

I want to welcome you to In the Trenches, a blog devoted to providing family physicians timely information on health policy matters, the work being done on your behalf by the AAFP and insights into the advocacy and political activities that drive our national health care debate.

I promise this will not be your typical advocacy newsletter. I will focus on providing inside information on what the AAFP is doing to advance family medicine in public and private health care systems. This blog will be informative, deliver a perspective not found in other mediums and will include a healthy dose of commentary on those things that drive debate behind the scenes. Additionally, we will tap the inner health policy wonk in each of you by providing analysis and perspective on emerging issues that will drive the next generation of health policy.

Disruptive Innovation in Family Medicine

The AAFP has a distinguished history of driving innovation in health care. We are, as you recall, the organization that started a national discussion around “advanced primary care” and the need to transform our nation’s health care system and make primary care its foundation. Although this effort manifested itself through the patient-centered medical home (PCMH) during the past decade, the PCMH is not the only innovative delivery and/or payment model supported by the AAFP.

If you aren't already familiar, let me introduce you to a concept gaining strong interest among family physicians, policy-makers, business and -- most importantly -- patients: direct primary care (DPC). The AAFP views the DPC model as a significant and positive contributor to expanding access to primary care for millions of patients, improving the quality of care provided by family physicians, and increasing patient and physician satisfaction. In 2013, the AAFP Congress of Delegates approved an official policy on DPC.

In recent months, the AAFP has amped up its advocacy efforts with respect to DPC. We have met with numerous insurance companies to convey our support for this model and demonstrate the cost-saving potential it presents by reducing downstream health care costs. The Academy also has reached out to policy-makers to educate them on this promising model of care.

For example, the AAFP will host a briefing for Senate health care staff this week to educate them on DPC. Additionally, the Robert Graham Center will host a primary care forum focusing on Disruptive Innovations in Primary Care( DPC will be prominently featured at this event.

Also this week, the AAFP will participate in the Direct Primary Care Summit(, a program we are proudly sponsoring. Physicians from across the nation will gather in Washington, D.C., to discuss DPC and share information on this emerging practice model.

One of the driving factors in our interest in this innovative practice model is the shifting framework of health insurance. Since the enactment of the Patient Protection and Affordable Care Act, there has been an increase in the number of individuals who have high-deductible health insurance products -- many with deductibles greater than $4,000. This trend means more primary care, outside of the mandatory preventive services, will be provided on a cash basis. Therefore, patients will have responsibility for the cost of their health care, up to the deductible of their insurance plan, and physicians will have responsibility for collection.

DPC is well positioned to ensure that these patients have access to affordable primary care, while maintaining comprehensive insurance coverage through their high-deductible insurance plan. In addition, by creating a more direct relationship between physicians and patients, both parties are no longer obligated to deal with the complexities associated with insurance companies.

Before you label this as concierge care, please let me tell you why this is superior to concierge practices and why so many people are taking a hard look at this model as a contributor to improving access to primary care. Concierge care practices charge patients a monthly or annual fee for enhanced access to a physician or practice. Physicians participating in this delivery model have, in response, limited their panel to a select set of patients -- thus decreasing the overall capacity and effectiveness of the primary care system. Additionally, physicians in a concierge practice continue to bill their patients' insurance for services provided.

In comparison, DPC practices use a membership model where patients pay a reasonable, monthly fee for all their primary care services. Patients save on insurance premiums with a low-cost, wraparound policy to only cover subspecialists, hospitalization and catastrophic care.

The defining characteristic of a DPC practice is that it offers patients the full range of comprehensive primary services, including routine care, regular checkups, preventive care and care coordination in exchange for a flat, recurring fee. The most compelling case for DPC is it allows family physicians to do what they do best, care for their patients. Since physicians are no longer generating revenue solely on the basis of how many patients they see per day, many physicians in DPC practices report that they have significantly more time to spend with patients in face-to-face visits. To put it bluntly, this model is patient centered and genuinely affordable.

The AAFP has DPC resources available. Additionally, we are developing a comprehensive practice development program that will launch at AAFP Assembly in October in Washington to assist family physicians who are interested in this model. This resource will include toolkits and in-person education programs that will provide what you need to know as you evaluate this promising practice model.

Again, this model isn’t for everyone, and it does not replace the need for the PCMH and other advanced primary care practice models. It is, however, a model of care that is consistent with AAFP policies on advancing continuous and comprehensive primary care as the foundation of our health care system.

Wonk Hard

Castlight Health(, a San Francisco-based company that works with employers on controlling health care costs, has released a new analysis on price variations in health care. Using claims data, Castlight found wide variations in what patients pay for a variety of health care services -- including primary care. For example, the cost of a routine primary care visit ranged from $95 in Miami to $251 in San Francisco. Price transparency is an emerging policy issue, and reducing the wide variations in health care prices is seen as a means of controlling overall costs. You can read the report online(

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Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.