Crawl, Walk, Run: Operationalizing Direct Primary Care
By Naveen Rao

InCrowd has teamed up with Naveen Rao, the editor of Tincture, a website covering healthcare and humanity, for a 3-part series on perceptions of Direct Primary Care. This is the third and final article of the series. 

Setting up a new practice model is not easy. In the survey we administered to primary care physicians about Direct Primary Care (DPC), respondents cited overhead costs and extra work as the second largest potential barrier to success. (See our infographic below for more findings and details.)

As with most challenges, the flip side of the coin is opportunity. Numerous companies are racing to provide IT, legal, and marketing services to doctors looking to make the leap to DPC. Just as many independent physician practices decided to join larger hospital or health system-owned groups over the last twenty years, it is possible DPC might see a similar trend in the years ahead.

A look at the kinds of companies popping up to offer services and support around the DPC model offer some indications of how this market might develop in the years ahead.

For example, the Manhattan-based UmbrellaMD is a startup that matches patients seeking health care services with physicians who are able and willing to make a visit. UmbrellaMD is not offering a DPC model per se, but rather building an enabling technology to allow interested parties on both sides of the patient-physician relationship to try something new.

It’s a form of consumer tech, like a telehealth platform offered by vendors like American Well or Teladoc. That is, patients can pick a specialty (primary care, ENT, orthopedics, dermatology, etc.) a day and time, and physicians can pick up the visit based on their schedules. Unlike telehealth, visits through UmbrellaMD are held in person, according to both parties’ schedules. And in a twist on the traditional direct-to-consumer play, UmbrellaMD’s platform allows providers to compete with each other by discounting the price for consumers.

This sort of dynamic match-making might be exactly what some physicians need–a more practical test and transition that allows them to dip their toes into the waters of DPC versus jumping in head first.

Another sign of experimentation with this model is the emergence of several dedicated consulting practices focused on helping physician groups or individual practitioners plan for and navigate the transition to DPC or other alternative models. One such group is MedFirst Partners, a Massachusetts-based firm that offers “practice conversions” consisting of an operational review, business model restructuring plan, and transition support. According to MedFirst Partners CEO Bill Cossart, the end goals of a practice conversion for a primary care practice are two-fold: streamlining and out-sourcing the administrative portion of managing a practice, and arming the practice with the ability to attract and retain new patients. Other firms offering similar services are springing up in markets like Seattle, Chicago, Los Angeles, San Francisco, New York, and Boston.

Other consulting firms, like Employer Advantage Health Care Solutions, are targeting self-funded employers and offering DPC contracts as a more cost-effective way to care for their employees. Their pitch is that direct contracting for DPC is much less expensive than using an insurance company as a third party administrator, or contracting done directly with hospital-dominated health systems.

One of the largest questions at this stage may be whether there are enough patients willing to pay for this model to make it a sustainable venture. Legislation introduced in the senate seeks to incorporate DPC into existing payment channels like Medicare, as well as make health savings account funds eligible for DPC co-payments.

Sensing this opportunity, UmbrellaMD has, for one, made sure their credit card authorizations are classified as health expenses to qualify for HSA deductions. Beyond that, they leave the insurance reimbursement up to the patient and the doctor. Their founders view their role as more of a preliminary matchmaker, rather than a replacement for insured care.

Over the coming years, service-level companies who can help primary care practices with basic front-office functions to bring patients in the door – from marketing to appointment scheduling – may find themselves in demand. A recent Health Affairs study suggests that only 30 percent of newly enrolled patients could get easy access to a new primary care physician, due to network adequacy issues, patient saturation, or simply poor customer service. This includes overworked outpatient practices that don’t pick up the phone or return voice messages left by prospective patients.

Around the country, wait times to see physicians for non-urgent care run well into the two-week timeframe. In some cities like Boston, Denver, or San Diego, wait times can be nearly a month. This is not because there are no doctors available in those states; more likely it’s due to insurance-restricted access, network design, and the timing of enrollment and new appointment demand.

All this indicates that entrepreneurial doctors who are willing and able to implement flexible, responsive scheduling, particularly in urban settings like Boston, Chicago, New York, San Francisco, will have a ready supply of patients. A critical piece of the puzzle for DPC practices to succeed may be educating the public about the availability of quick, convenient (and tax-deductible) alternatives to the traditional gatekeeper model.


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