Direct primary care model: Cutting out the insurer - ACA may provide a boost to direct care model

[Bill USA]

http://www.ama-assn.org/amednews/2011/08/01/gvsa0801.htm

Direct primary care practices are an offshoot of the retainer care model, which provides unlimited or less-restricted access to physicians for a set fee. Under direct primary care, patients pay a monthly fee -- sometimes less than $100 -- for unlimited access to a range of primary care services, possibly as complex as minor surgeries and x-rays. Patients at these practices are encouraged to have basic health insurance to pay for specialist and hospital care, otherwise uninsured patients pay out of pocket for care outside the practice.

Physicians running direct primary care practices say there's no reason for health insurers to be involved in primary care. Most people's needs for such care are predictable. The monthly fees mean doctors can maintain much smaller patient populations, spend less time billing payers and more time providing care, and communicate with patients more by phone and email.

"What you have is a patient and a doctor and nobody in the middle," said John Muney, MD, president of AMG Medical Group in New York, a direct primary care practice that charges between $79 and $129 a month per patient.

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But the model could become more popular in a few years. Under a provision in the health system reform law, direct primary care practices will be able to participate in health insurance exchanges that will launch by 2014. Those marketplaces are expected to provide coverage choices for tens of millions of uninsured people, as well as for many others who get their coverage from other sources now.
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Note patients still need to have insurance to cover medical needs not met by the Primary Care physician. The idea behind direct primary care is to take insurance companies out of the basic primary care medicine. Just use insurance for the more expensive and less frequently needed medical interventions.

Qliance Direct Primary Care Medical Home Model - http://qliance.com/pdf/Qliance+Executive+Summary+March2011.pdf
(emphasis my own)

Qliance, a Direct Primary Care Medical Home (DPCMH) based in Seattle, Washington, has
demonstrated substantial downstream savings in its first few years of operation. Analysis of internal data
as well as total claims data from self-insured companies whose employees select Qliance for their
primary care show that, under the Qliance model, utilization of emergency room, hospital, specialty
care, advanced radiology and surgical care are greatly diminished. This decrease in utilization
translates to a savings of approximately 22% in overall healthcare costs.

[SunSeeker]

1. Sounds great. Thanks for the post!

The more I learn about the ACA, the more I like it.