Direct Primary Care: A possible alternative to fee-for-service, burnout

Direct primary care (DPC) is a physician-led movement that gives forward-thinking providers the ability to operate outside of one of the biggest headaches in healthcare today: the insurance middleman. Under this rapidly growing business model, providers collect a monthly fee directly from their patients, or their employer sponsors, in exchange for a predetermined list of services. It’s completely transparent, there are no guessing games, no copayments, no insurance claims submitted, and no third-party billing of any kind.

It’s ultimately a big shift away from the fee-for-service challenges that most physicians are familiar with, and is helping providers achieve the quadruple aim: better outcomes, lower costs, and a better experience for both patients and physicians alike. In fact, under the DPC model, patients and physicians can spend more quality time together and better foster their relationships.

DPC can help reduce burnout risks

Physicians enter their field to make a difference for patients, but when they’re constantly forced to choose between making the right choices for patients or what will drive the most profit, it leads to an incredible amount of emotional strain that can lead to burnout. This has a huge impact on healthcare organizations as physician turnover is extremely expensive and doctors can make more clinical errors (opening liability). Many physicians in training avoid specialties that have a high rate of burnout leading to staffing problems. Patients are likely to leave if their physician also departs, especially if they’ve built strong relationships and trust.

While there are many aspects to burnout, the only way to tackle this growing trend is to address the root cause: eliminate perverse financial incentives and enable physicians to work for their patients rather than the healthcare system. DPC is one of the only models that truly overcomes these challenges by allowing physicians to operate outside of today’s traditional payment models by:

• Moving physicians off the volume treadwheel that forces many to focus on simply maximizing revenue rather than focusing on health outcomes.
• Reducing the administrative burden that often takes up one-third of a physician’s time and is required for reimbursement.
• Providing physicians with a population’s health to manage instead of a volume to simply process for claims.
• Enabling physicians to provide quality care and practice at the top of their license with routine activities that utilize the full extent of their education, training, and experience.

Unless a healthcare organization begins to move towards models like DPC that eliminate the root causes of burnout, there shouldn’t be any surprise when physicians leave so that they can prioritize the needs of their patients—and their own mental health—rather than a health system’s bottom line.

DPC hesitancies

One of the biggest barriers for physicians considering transitioning to a DPC model is the risk associated with no longer accepting insurance, or only accepting insurance for some services, which has typically been the biggest foundation of a practice’s revenue. We understand it may seem like a daunting task since this business model is fundamentally restructuring the way that primary care is being paid for and delivered.

While many physicians are exhausted with the dystopian way in which they’re forced to practice medicine today, change can be scary, and many want to know that DPC is a successful alternative to the status quo. There’s no shortage of physicians who can speak to the results of their transition to DPC. Just consider Nextera Healthcare, which saved a school district in Colorado over $1.4 million after rolling out a membership model without sacrificing quality. By setting up on-site and near-site clinics for the school, there were 72 percent fewer hospital claims, a 62 percent reduction in surgical care, and a 74 percent decrease in ER claims.

Additionally, as DPC has gained traction over the past several years (and now includes practices in nearly every state across the country), so too has the number of partners willing to support these physicians. For instance, member management platforms can create a roadmap for physicians and help eliminate the complexity and administrative challenges of adopting a DPC business model.

No longer will physicians need to worry about the complexity of direct-to-consumer membership management and employer direct contracting. Instead, there is an entire ecosystem of partners who are helping ensure that physicians will soon be able to have a population already waiting once they make the switch, along with the tools that already exist to ensure a seamless way to securely handle member enrollment, employer plan administration, eligibility management, billing, invoicing, payments, collections, and much more.

Advice for those considering a DPC model

DPC is becoming increasingly common across the country, with nearly every state having at least one practice that has adopted this business model. Physicians who are interested in hearing from others who have transitioned to DPC need only to look to their neighbors to hear firsthand how the business model was adopted and its performance since. They can provide advice and support to those who are considering taking this journey.

Additionally, there is a growing number of bite-sized, step-by-step training and coaching programs designed to help physicians succeed with DPC at all stages—whether they’re designing their business model, launching a practice, or seeking to grow.

Looking to the future

Physicians should expect to see DPC continue to gain traction—not only from the wave of practices that are embracing this model, but also the growing number of recognizable names in healthcare (such as athenahealth) providing support to those making the transition to this business model.

This includes growing interest from the federal government and, specifically, the Centers for Medicare & Medicaid Services (CMS). The agency recently released a new Medicare program that allows for the formation of “Direct Contracting Entities” that contract with Medicare in the way a health plan does.

Ultimately, this means that some of the most important stakeholders in our country’s healthcare system are taking notice of DPC and validating this model as one that prioritizes “value over volume.”

_{About the Author}

_{Zak Holdsworth is the CEO of Hint Health}