From Maids to Tycoons: Direct Primary Care Expands Its Patient Base

Frustrated with insurance-based care, increasing numbers of physicians are turning to direct primary care to provide patients across the socioeconomic spectrum simpler, more personalized treatment.

Direct primary care is modeled on concierge practices, which have often been viewed as health care for the well-to-do. Similar to concierge care, patients in the direct primary care model can expect to pay a monthly or yearly flat fee. However, rather than tens of thousands of dollars annually, today’s direct primary care can be markedly more affordable.

“I see waitresses, maids and fishermen, as well as doctors, lawyers and business tycoons,” says Stanford A. Owen, MD, internist in Gulfport, Mississippi. “They are all treated the same, and the vast majority are not wealthy.”

Dr. Owen charges $125 for a-la-carte visits and a monthly fee of $56, or patients may pay a yearly fee of $672 — a pricing structure he considers far more transparent than insurance. Trade publication Concierge Medicine Today says 65 percent of retainer-based practices charge fees of less than $135 monthly.

Taking it a step further, companies such as Qliance Management Inc. — which manages a network of primary care physicians — are pursuing partnerships with Medicaid managed-care companies to bring Medicaid into the direct primary care model. Approximately 15,000 Medicaid patients are on board with Qliance, National Public Radio (NPR) reported in early 2016.

“Our patients come from all socioeconomic levels,” says Erika Bliss, MD, CEO at Qliance, based in Seattle. “We are able to serve low-income patients mostly through a partnership with a Medicaid managed-care plan in the state, but we also have some low-income individuals who pay out of pocket for our services.”

Personalized Care

Direct primary care patients frequently have access to perks associated with concierge care, such as same-day appointments, minimal wait times, extended time with the physician, and follow-up care that can be provided in person, by phone or even by email.

“We are able to handle, on average, 85 to 90 percent of a patient’s healthcare needs over the course of their care with us ...,” Dr. Bliss says, “and since we are able to spend more time and be more thorough with our patients, we reduce their need for specialty services, advanced imaging and surgery.”

More physicians are gravitating toward this model. A 2010 article in American Medical News noted that 146 U.S. physicians were providing retainer-based care in 2005. More recent estimates put the number at well over 5,000.

Jonathon Izbicki, DO, owned an insurance-based practice with his brother, Harry Izbicki, DO, before they switched to direct primary care.

“Our grandfather was a doctor and we had the chance to see what old-fashioned care was like and wanted to be a part of it,” says Jonathon Izbicki, President of Izbicki Family Medicine in Erie, Pennsylvania. “Insurance-based medical care is kind of like a machine — very impersonal. It’s a system that forces doctors to go through patients quickly.”

He found that with fixed reimbursement rates from insurers, the only way the practice could keep up financially was to cram more and more patients into the workday. The new model changed that calculus.

“I went from seeing roughly 20 patients per day to seeing just three to nine patients per day,” Dr. Izbicki says. “My patient volumes went down and length of visits went up from 15-minute appointments to half-hour and hourlong appointments.”

Not ‘Anti-insurance’

The expansion of direct primary care does not signal the end of the need for insurance, Dr. Izbicki notes.

“It may sound like we are anti-insurance, but that’s not the case,” he says. “People do need insurance, but they need it for the right reasons. They need it for the appendectomy that happens at 3 a.m. That’s what insurance is meant for, but we are using health insurance to pay for foreseeable care. It almost isn’t insurance by definition anymore.”

Even though patients may pay twice with monthly direct primary care fees and premiums for a high-deductible insurance plan to cover other medical needs, these costs can be lower than some insurance-only plans, NPR reports. Dr. Izbicki sees potential benefits not only for patients but for the healthcare system in general with the expansion of direct primary care.

“There will be better outcomes because patients have good access and more time with physicians,” he says. “This leads to better preventative medicine and reduces hospitalizations and overall healthcare costs to the entire system.”