FederalHealthcareIssuesDirect Primary Care Offers New Way Forward for Cutting Healthcare Costs

As the cost of healthcare and health insurance skyrockets, some doctors and patients are end-running the system in favor of direct primary care.
May 14, 2019
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The cost of healthcare continues to rise, not only in Texas but in the United States overall.  From 1991 to 2014, healthcare spending per capita in Texas rose nearly 200 percent. In that same period, the national per capita spending on healthcare increased by over 225 percent.

And since the implementation of Obamacare in the fall of 2013, health insurance premiums have more than doubled on average according to the federal government’s own analysis. The law’s one-size-fits-all health insurance regulations have even resulted in some cases where monthly insurance premiums are higher than mortgage payments.

In Texas, the Legislative Budget Board’s original projected Health and Human Services budget for the 2020-2021 biennium suggested appropriating nearly $85 billion in state spending — a 14.6 percent increase from the 2012-2013 biennium. And as costs rise for consumers and taxpayers, a relatively new trend, modeled after an old way of doing business, is making waves for its innovative approach.

Direct primary care (DPC) facilities are general practice offices that do not rely on the insurance-focused model familiar to most patients when visiting the doctor. Instead, patients pay the DPCs directly on a monthly “subscription”-like basis, which then offers as many visits as is needed to receive care. The concept is similar to the on-demand product/service offered by streaming services in the entertainment market. 

Rather than pay the insurance company through premiums and deductibles, which then pays the physician after churning through various layers of bureaucracy, direct payment streamlines the process and reduces cost by eliminating the middleman altogether.

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The Texan interviewed Dr. Jill Clay, of Uncommon Healthcare in Waco, TX about what DPC offers.

Clay, who came from a more traditional medical practice, said some of the “typical frustrations” in traditional clinics are “a quantity over quality focus,” as well as “dealing with the requirements of insurance companies and government health programs.”

About the latter, Dr. Clay said, “every time you order a test you have to make sure you have a diagnosis that the insurance company deems necessary.”

Pricing can vary since patients that join are placed in various categories based on age, and some services — like lab tests — can run extra.

Another benefit Clay emphasized was that DPC allows practices to be more fiscally responsible. Since in the traditional model the patient-to-provider payment is not direct, neither the patient nor the doctor really knows the true cost of any given service or product.

“In our practice, [both parties] know the cost of the test and it will probably be close to 80 percent cheaper than if it had been billed through insurance,” Clay continued. This allows her to be more cognizant of how much money is coming out of her patient’s pockets.

“The transparency makes everything so much simpler,” Clay added.

Uncommon Healthcare provides longer appointment times and can even provide same-day or next-day appointments — a service which is notably few and far between in typical doctors’ offices.

“The biggest benefit lies in the personal relationship between the doctor and the patient,” Clay said of her practice. Clay stressed that doctors in traditional practices want to be able to provide that personal touch to their practice, “but there is so much demand on their time that it’s not reasonable to expect someone [in that position] to be able to do that.”

Dr. Clay likened her DPC practice to that of insurance on a car. “You don’t expect your car insurance company to pay for oil changes,” Clay said in describing her business model.

“Most of our patients have insurance, but it’s basically catastrophic coverage,” Clay went on. However, “Health insurance is not designed to cover things like a cold anymore,” she added.

What DPC practices offer is a similar service to that of an oil change or flat tire, but for health — taking care of the rather minor issues, while still allowing patients to have insurance for large, unexpected healthcare costs.

Uncommon Healthcare was started by Dr. Felicia Macik in 2014. Dr. Clay joined a few years later and together they serve between 1,100 and 1,200 patients.

Some proponents believe this to be an especially valuable option in urban areas.

Charles Blain,  founder and executive director of Urban Reform, a Houston-based 501(c)4 nonprofit that “focuse[s] on identifying free-market reforms to urban government and engaging community members to implement them,” sees direct primary care as a solution to a growing urban need.

“Roughly 22 percent of people living in Harris County are uninsured, that’s higher than the statewide average, and according to researchers, some parts of Harris county see uninsured rates as high as 30 percent,” Blain pointed to in a statement to The Texan.

Blain said of DPC services specifically, “Direct primary care facilities allow affordable, convenient options for people who can’t afford traditional healthcare insurance or who would otherwise be deterred from visiting their doctor’s office because of the cost or other constraints.”

Blain sees the healthcare industry as one of many that could benefit from more providing options to patients. “As we see with many services provided in cities, innovation almost always brings costs down and produces better options for consumers, and direct primary care is no different.”

Patients say they are most impressed with the amount of attention they receive from their DPC doctor than ones at a traditional medical provider.

Tom Banning, CEO of the Texas Academy of Family Physicians — and a patient at a DPC facility himself — told The Texan, “Direct primary care is a tool or an option for both physicians and patients that want an enhanced experience without third-party involvement.”

That third party is insurance companies and government bureaucrats. Banning said that around 30 percent of fees in traditional doctors’ offices come from administrative costs dealing with insurance. Not involving the insurance middlemen, coupled with cutting out the costs associated with them, is what allows DPC practices to provide service at such a discounted rate.

This, along with near 24-hour access to his doctor, is the biggest value Banning sees from his perspective as a patient.

While this fills a need for some individuals, some healthcare professionals believe DPC is a niche solution. Anne Dunkelberg, associate director at the Center for Public Policy Priorities, told The Texan she thinks the DPC model provides consumers with two things they are looking for: cheaper cost and a more personal relationship with their doctor.

But she went on to say, “There are so many different components going into us spending 40 percent more than any other country per patient on healthcare.” Dunkelberg suggested that while the DPC model fills a need, it does not address the whole healthcare issue.

And according to a report by Hint Health, from 2014-2017 the number of DPC patients nationwide only increased by .05 percent while the amount of DPC practices nationwide increased over eight percent in the same time frame.

While Clay doesn’t believe the DPC model can be applied to every aspect of the medical field, she thinks it could work “in other specialty practices but would require some creativity,” in the business model.

The idea, however, is trailblazing another path to meet the needs of some patients — one of which is to personalize care in a manner that’s more affordable.

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Brad Johnson

Brad Johnson

Brad Johnson is an Ohio native who graduated from the University of Cincinnati in 2017. He is an avid sports fan who most enjoys watching his favorite teams continue their title drought throughout his cognizant lifetime. In his free time, you may find Brad watching and quoting Monty Python productions.