direct primary care

Health Plan Rorschach Test: Direct Primary Care

By Dave Chase CEO of Avado, on Forbes.com July, 6, 2013

Despite its inclusion in Obamacare, Direct Primary Care (DPC, aka Concierge Medicine for the Masses), it’s surprising how few health insurance executives know about DPC. Once I explain it to them, I have found it’s an excellent Rorschach test reflecting whether that executive’s organization is playing to win or is back on their heels regarding the wrenching changes that are reshaping healthcare from the DIY Health Reform movement as well as the effects of Obamacare. For example, rapid growth of self-insuring by corporations is a trend pre-dating Obamacare but many expect it to accelerate as self-insuring gives companies down to 20 employees more flexibility than Obamacare rules allow.

Forward-looking health plans view DPC as part of a broader strategy to reinvent themselves. For example, the parent company of a large Blue Shield recently invested in the pioneer of DPC, Qliance. Conversely, health plans that are back on their heels simply look at it as a way they will get disintermediated. This DPC Rorschach test will presage how that health plan will fare in the coming years. For example, some will discount it as only applicable for a certain segment of the population such as the “worried well” yet I’ve found the exact opposite. For example, the Grameen Foundation (famous for its Nobel Prize-winning founder known for microfinance) has brought it to low-income populations in New York that the Financial Times reported on. In Washington state, DPC is now being used with Medicaid populations.

Over the years, the California Health Care Foundation (CHCF) has commissioned many excellent reports outlining trends affecting healthcare. Just as they wrote about retail clinics several years ago as they began to emerge, they wanted a similar analysis done for DPC. The CHCF asked me as I’ve studied DPC perhaps more than anyone other than those operating DPC businesses. Many ask why I have OCD on DPC. My answer is twofold.

1. There is a lot to learn from organizations demonstrating the Triple Aim (lower costs, improved outcomes, better consumer experience). I’ve yet to see any model that more consistently delivers on the Triple Aim than DPC.

2.When you found a tech startup, you make a bet on how the future will unfold so that you can get there before your competition. Our bet a few years ago when we began has now become obvious — healthcare will become more patient-centric, accountable and coordinated. In other words, virtually the opposite of the “do more, bill more” model that is bankrupting our country. My belief is DPC is a microcosm of the future healthcare system so I’ve been studying it and working with DPC providers the last few years. Naturally, DPC providers have a fundamentally different set of requirements than traditional players so it is helpful in shaping our decisions. See The Marcus Welby/Steve Jobs Solution to the Medicaid-driven State & County Budget Crisis for what I wrote earlier.

The CHCF published the DPC report I wrote in April. It is a good summary of what I have learned. CHCF papers have a neutral, objective tone which is appropriate for their role. However, I have formed opinions about DPC so I’m publishing here my raw perspective on DPC starting with an introduction. Please see the introduction and history of DPC below.

READ FULL REPORT for a look at the history and size of the direct primary care industry.

Contact Dave Chase via LinkedIn if you’d like a copy of the full seminal study on the Direct Primary Care model and follow him on Forbes for more commentary and outakes from the report.

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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