Thursday, January 03, 2019

Direct Primary Cult? A Reality Check [UPDATED]

[Please scroll down for Update]

In which its adherents fall into the same trap as those who conflate health insurance and health care.

Look, I have long been a fan of the Direct Primary Care (DPC) model: in fact, we were among the first to interview one of its pioneers, way back in Aught 12.

There is much positive to be said about DPC: it satisfies the ObamaTax mandate (which may or may not matter for this year), and offers the opportunity for better clinical outcomes based on more patient-focused care.

Unfortunately, it seems that its advocates think a lot more highly of the model than is actually justified. For one thing, it is literally a blip on the health care radar: there are about a quarter of a million primary care doc's in the US, and less than 1,000 of them are DPC (that's about 4/10's of 1%). As I recently pointed out to one of the more outspoken DPC folks, it's not that DPC is a bad thing, it's just not a thing. And the idea that it can be easily or quickly (or realistically) scaled up to meet a meaningful number of patients' needs is, frankly, laughable.

And of course, we've discussed numerous times (here for example) how DPC folks continue to make the fallacious argument that it makes economic sense for patients*. Until true Catastrophic medical plans are allowed once again (they're currently illegal under ObamaCare), then one of two things will continue to be true:

1) That folks will be double-paying for primary care (since it's already covered under ObamaPlans) or

2) They'll drop their major med plans in favor of DPC only, leaving themselves exposed to potentially massive catastrophic claims.


So what's your point here, Henry? Or are you just blowing off steam?

Good question - mostly the latter.

Happy New Year!

UPDATE: From our friend Mike Bertaut (an economist with Louisiana Blue Cross):

"Insurance carriers depend on primary care docs with a free flow of patient health data via EHR's to keep patients healthy. A huge slice of care coordination (especially post-discharge) and much of predictive modeling, both of which are now big contributors to keeping claims costs down require in-network, EHR sharing PCP's. To me this makes the idea of carving out primary care not only counter-intuitive, but bad for the patient and his healthcare costs overall."

I can see that, although I do see a role for DPC in the area of access and more patient-centered care.

*To be fair: Many (most?) DPC practices do offer discounted rx options, which has the net effect of lowering the subscription cost.
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