Quick Hits:

  • Direct Primary Care is a subscription model increasingly used by employers to reduce costs and improve care
  • Employees enjoy increased access to physicians with usually no copays
  • Physicians like it because they get to practice medicine, not insurance

Written by Dr. Tolu Abikoye of Alliance M.D.

What is direct primary care?

Direct primary care (DPC) is a cost-effective way for self-insured employers to deliver primary health services to employee populations. For a monthly fee (usually $50 – $75 dollars), employees get access to a board-certified physician who provides all their outpatient health care needs and provides access to discounted labs, prescriptions, and imaging.

This is effective for several reasons:

  1. Unlike traditional fee-for-service physician groups, DPC practices have no incentive to order unnecessary tests and procedures that increase costs.
  2. Employees enjoy access to same or next day appointments — often with no copay — and Physicians are able to spend more time with patients.
  3. DPC practices usually have relationships with labs and imaging centers where they are able to get services at a fraction of the cost compared to commercial health plans.

Even a small local hospital integrated DPC into their benefits, saving them $1.2 million dollars last year.

Here’s a real-life example of a 58-year-old man with diabetes who visited the ED for chest pain and compared it to his projected bill if he visited my direct primary care clinic.

Who will heal the healer? Why I started a DPC Practice:

My journey into medicine started 21 years ago, I was inspired by my father, a general surgeon. He stressed the importance of ‘preventing loss of happiness’ which could occur when medical problems are either undiagnosed or as a result of medical errors. Both problems can occur when the physician does not have enough time to listen to the patient.

Fast forward to 21 years later, I was working in the fee-for-service (FFS) model of health care delivery and felt like I was just moving along a ‘production line of patients’ not having enough time to address all their medical problems. I was spending more time ensuring I write the medical notes in a way that was pleasing to insurance companies which took up a huge chunk of my time and had nothing to do with improving patient care.

For example, I had an encounter with a patient in 2016, he was a 35-year-old hard working employee. He unfortunately did not have good coverage and so he deliberately did not go in to see his physician for many years despite having symptoms of diabetes and peripheral artery disease. He subsequently developed diabetic foot and had to be admitted to the hospital for several days for diabetic ketoacidosis. He unfortunately had to have his foot amputated because of complications from diabetes and peripheral artery disease. In addition to the trauma of amputation, he was hit with a huge medical bill which bankrupted his family.

I was not alone. Many physicians are reporting increased job dissatisfaction as a result of cumbersome insurance requirements for coding and billing which does nothing to improve patient care. A recent study by the American Medical Association revealed that male doctors have suicide rates as much as 40% higher than the general population, and female doctors up to 130% higher.

I left the traditional fee-for-service system in October 2020 and am happy because I am now in a position to improve the financial and physical health of our community. 

– Dr. Abikoye

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