The Advantages of Working in a Direct Primary Care Model

October 28, 2016

Once considered elitist, direct primary care practices are gaining ground with physicians and patients alike.

Physician acceptance of direct primary care (DPC), a practice model that does not accept health insurance and bills members a monthly membership fee, is on the rise according to the 2016 Great American Physician (GAP) Survey. While only 5 percent of responding physicians said they were currently in a DPC practice, 62 percent said they would consider switching to the model if the circumstances were favorable, which is a 44 percent increase over the 2015 GAP survey.

Clint Flanagan is a family medicine and emergency medicine physician who has practiced in Colorado for 15 years. He is also founder and CEO of Nextera Healthcare, a DPC organization with clinics throughout Boulder, Longmont, and Ft. Collins, Colo. Physicians Practice recently spoke with Flanagan about the advantages of practicing in a DPC practice model in anticipation of his presentation at the Medical Group Management Association (MGMA) 2016 Conference, Tuesday, Nov. 1, at 1:30 pm Pacific time.

Physicians Practice: Why did you change your practice model to direct primary care?

Clint Flanagan, MD: I had been doing fee-for-service (FFS) primary care for many years, as well as working as an emergency room physician. And through all that experience, I just saw so many patients having barriers to access to their primary-care provider. And often times cost is a big issue. There were many patients that had lost jobs, [and] patients that were now on high deductible health plans and were concerned about what the cost would be to visit the physician. And having seen many of those challenges, I really felt there needed to be a solution that would allow for that physician-patient relationship to essentially be revitalized in a way that was different than what was happening.

This was back in 2009. We essentially landed on a monthly membership [DPC model] and at the time we didn't even know what DPC was. But I knew that we needed to [transition to] monthly membership primary care and charge a very affordable fee. We like to say "If you can afford a cell phone, you can afford what we do in DPC." And that fee would allow patients to have access to their family medicine physician and have a relationship. By no means were we innovative on that front, in fact we were pretty old fashioned in that we just felt that it was important that patients have that connectivity and trust and relationship [with their physician], and do so in a way that didn't have barriers [like] the other business models ...

PP: How does DPC benefit physicians?

CF: [DPC] frees up the physician to have longer visits, for example. So I used to be a physician who saw 30 patients a day. And do a lot of, I call it pecking for payment on our computers, [entering data from the patient visit into the EHR]. Unfortunately as we are pecking for payment we are taking away from the most important thing and that is our patient. And that data entry requires a lot of time. Fortunately, DPC is a model where there's a medical record which is very important to make sure that you document the visit, but you don't have to do all the other details that are required or oftentimes needed in the FFS model. Plus it streamlines things.

For example, let's say the patient needs an MRI. The traditional FFS system requires oftentimes a prior authorization that can take the physician or nursing staff a significant amount of time prior to getting that test ordered and done. Contrast that with DPC: I can order the MRI today, the patient knows what the cost of the MRI will be, they can get that done, and it will be much more streamlined. So what you see with DPC, and what we've seen, is that there is less administrative time and overhead that is devoted to the day. And that frees one up to spend more time with patients. Which is what many of us went into this for, was to take care of people and have a relationship.

PP: Do your patients carry insurance to cover catastrophic care for things like hospitalizations?

CF: Yes, the majority of our patients carry insurance. I like to look at it as, we provide the care at Nextera Healthcare and the insurance is the coverage in case, God forbid, a person gets cancer or has a heart attack or a major medical challenge. Now your family medicine physician, internist, or your DPC doctor is still going to be your quarterback, taking care of you through all of that and assisting along that pathway, but obviously there will be other specialty physicians involved during those challenging times.

*Editor's note: Flanagan's practice does not accept insurance for its services.

And for those high-dollar, major-medical circumstances, you definitely want to have an insurance policy. Just like for your home you have a fire insurance policy or your car you have an automobile policy in case you have a wreck. But using that automobile policy to pay for gas or to wash your car would be kind of crazy. But that's kind of what we've done in healthcare for decades, we've used insurance to pay for primary care. In primary care we are the lowest cost doctors out there for the most part. And using insurance to pay for us comes with a lot of challenges.

PP: What are the top three things that doctors like about DPC?

CF: So number one is the relationship with the patient. Number two is the business model which allows independent practices to remain independent. Number three, I would say that the model not only makes an impact on the patient and the physician, and the physician's practice, but the model is making an impact in our communities because we are spending less money on healthcare, and we are getting better healthcare which allows the family and the community to move forward in a way that is much different than the current [way]. Which is truthfully a pretty dysfunctional healthcare ecosystem where we are spending $3.5 trillion [on healthcare].

PP: What is it about a DPC practice that patients like?

CF: One, what I think they like is the transparency. They know the cost, they know what they are going to get for their money. They definitely like the convenience and the connectivity and the relationship with their physician. They like the fact that they can have peace of mind and trust in knowing that their provider is available for them. You know when I speak to crowds, I ask them, whether they are physicians or business men and women or patients, "How many of you have your doctor's cell phone number?" And of those that do have their doctor's cell phone number, "How many of you when you text your doctor [will get a response] in five or 10 minutes?" That's not too many people. So you can have that kind of convenience and connectivity. And patients really love it.