A New Model For Primary Care: Direct Primary Care Medical Home

By Randy Robinson, M.D., and Mason Reiner, Physicians News Digest, May 28th 2013

“Dear, how much were the groceries?”

An efficient, effective healthcare system is built upon an enduring relationship between patients and their primary care physician. CMS’s Comprehensive Patient Care Initiative (CPCI) rightly states that risk stratified care, access and continuity, planned care for chronic conditions and preventive care, and coordination across the medical environment are the hallmarks of good primary care. Unnecessary healthcare expense in the US because of the inefficiencies in the system lead to over $910 billion in waste due to unnecessary services, excessive administrative costs, inefficient care delivery, missed prevention opportunities, fraud and inflated pricing (Don Berwick, JAMA. 2012;307(14):1513-1516.)

To illustrate differently, if you were to buy a dozen eggs, a gallon of milk, and a small basket of oranges with pricing paralleling the growth of healthcare costs of the last 60 years, you would pay $237.(IOM)

Today’s rapidly evolving and unsustainable healthcare climate is pushing us to look at healthcare differently. In many ways, we are experiencing ‘the perfect storm’ – new regulations, and more than ever, patients eager for better health care options.

One new model that directly addresses the concerns of access, quality, and affordability is the Direct Primary Care Medical Home. This is not patient-centered, nor is it physician centered. It is relationship centered. Care is delivered and pivots around the axis of an enduring relationship between the patient and his/her primary care physician. Direct Primary Care (DPC), as a retainer-based payment model, is not inherently anti-insurance. It simply strives to reposition insurance for what it is meant to do-pay for the unpredictable and the expensive. It places medical management where it belongs, between patient and physician. This model works to correct our current dysfunctional healthcare framework, which has positioned doctors as part of the business transaction and patients merely as consumers. DPC realigns healthcare delivery incentives away from fee-for-service (do more-earn more) at one end of the spectrum and still avoiding modified capitation such as the ACO model, at the other (do less-earn more). The focus is now health-based, relationship based.

A patient told us about a recent experience she had with her primary care practice when she received a call from her doctor’s office weeks after getting a cholesterol screen to inform her about her high cholesterol.  The Medical assistant said to “cut out the fat.” Mind you, the patient is a mere 5 ft. 6 inches and weighs 110 lbs. Sadly, the assistant could not differentiate between HDL and LDL, nor did she ask questions about fasting, family history, etc. If there were a well communicated, bi-directional relationship in place the outcome would have more likely been “following up in six months” and delaying statin initiation.

With physician led care management, effective coordination across the healthcare system and an overall better health care experience for patients, the dream of the patient-centered medical home becomes an affordable reality for all.

The successful DPC model is built on several key building blocks…..


Authored by Dr. Randy Robinson and Mason Reiner, co-founders of Philadelphia’s first Direct Primary Care Practice. Visit www.rhealthconnect.com for more information.

About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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