There is a growing trend among primary care doctors which has started because of the frustration of the red tape of insurance requirements. Instead of having concierge care available to just billionaires, many primary care physicians are bringing concierge care to the masses including people on Medicare and Medicaid and State employees. What is it? Doctors generally won’t take insurance, instead promising personalized care while charging a flat fee on a monthly or yearly basis. Specifically, patients pay $100 a month or less directly to the physician for comprehensive primary care, including basic medication, lab tests and follow-up visits in person, over email and by phone. The idea is that doctors can focus on treating patients, since they no longer have to wade through heaps of insurance paperwork. They spend less on overhead, driving costs down. And physicians say they can give care that’s more personal and convenient than in traditional practices. My first thought was – is this legal under Obamacare? It apparently is. According to the Affordable Care Act, which identifies direct primary care as an acceptable option. But since it doesn’t cover specialists or emergencies, consumers still need a high-deductible health plan. Still, the combined cost of the monthly fee and that plan is often cheaper than traditional insurance. Currently, the total number of participating doctors may exceed 1,300. The American Academy of Family Physicians estimates that 2 percent of its 68,000 members offer direct care. Doctors already offering direct care say they see patients across all incomes. They expect the numbers will continue to grow but they need groups to make it available to get more data since there is little data so far.
Before launching the Medicaid pilot, Qliance contracted with some companies that provide insurance to their employees, and found that employees who opted for direct primary care cost about 20 percent less than employees in traditional health insurance. Because patients get better care upfront, the theory goes, they’re less likely to develop expensive chronic illnesses.
Still, expanding this approach is tricky. The number of participating physicians is low. There’s already a nationwide shortage of primary care doctors. In this model, physicians see fewer patients, potentially exacerbating that shortage’s impact. Direct primary care is also finding traction with Medicare Advantage, the private health plan alternatives to traditional Medicare. Iora Health, a direct primary care system that contracts with unions and employers, a year ago launched clinics in Washington and Arizona catering to Medicare Advantage patients.
Iora is setting up similar clinics in Colorado and Massachusetts. Despite its potential, the direct care model faces the challenges of integration into existing payment systems and attracting more participating doctors. And navigating Medicare and Medicaid rules can deter physicians.