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Making the Case for Direct Primary Care

Making the Case for Direct Primary Care

When M. Samir Qamar, a family medicine physician, was in residency in Lancaster, Pa. and contemplating his future, he started questioning the way things were with fee-for-service medicine.

"The response I got was, 'That's the way things are when you get into the real world. You'll have to see an average of 25 to 40 patients per day.' That wasn't good enough for me," Qamar recalls.

He came across the newly emerging idea of concierge medicine and decided to start his own practice. The practice started up in Monterey, Calif. and by the time he got over there from Pennsylvania, he had already had patients by advanced advertising while he was in residency.

For a while, Qamar had a nice job, catering to the rich and famous of central California. He even served as the house doctor for the famous Pebble Beach golf resort. However, he said there was more that he wanted to do with medicine. His vision included offering patients lower-cost premiums per month for high-quality primary care. At the time, the idea of a direct primary care (DPC) practice was even more nascent than concierge.

"Very few doctors were doing something similar around the country. Most doctors who were doing memberships were charging excessive fees, typical of concierge, which also requires patients to have insurance to be billed for medical visits. We wanted to offer a simple membership fee for primary care, with no copays and without confusing it with concierge medicine," he says.Dr M. Samir Qamar

With this in mind, Qamar and his wife Hisana Qamar, a family medicine physician who had gone into fee-for-service medicine before seeing a decline in patient visits from the economic downturn, began MedLion, their DPC medical group. Qamar has taken a unique approach to growing MedLion: He licenses the model to solo, independent, and larger group-practice doctors in other states. In a few years, he has gone from contracting with doctors in four states to 25 states.

"We started as solo practitioners ourselves and we are a little ahead of those trying to get into this now. One of the things direct primary care doctors learn quickly, the reason they get into [DPC] is to practice medicine for the reasons they went to medical school," says Qamar. "The problem is when you are trying to grow your practice, you end up having to play salesperson as well, especially to employers, which is the most sustainable way to grow a DPC practice, rather than go after individual patients … Doctors have a difficult time doing both at the same time; practice medicine and obtain new patients."

MedLion acts as the healthcare benefits arm for these DPC practices, explains Qamar. They can speak and sell to employers and work with them to package MedLion's services with an outside insurance product, such as catastrophic wrap plans, which don't include coverage for primary care.

The company also knows the rules surrounding DPC legislation, or lack thereof, in the different states, which are not universal across the country, making it hard for physicians to set up shop. "We know those rules. While many states have passed DPC legislation, there are many that have not for DPC. For doctors in those states that want to get into DPC, to give them mental piece of mind, we guide them in proper structuring of patient agreements, so they don't violate catastrophic insurance rules," says Qamar.

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