This confusion among consumers is especially significant as we introduce a new delivery model into our nation’s healthcare debate. Direct Primary Care (DPC), is on the list of health innovations that lead to high-value primary care for consumers around the country. During our nation’s ongoing debate on health care, it will be increasingly more important for us to make the clear distinction to our consumers and healthcare professionals that DPC agreements between healthcare professionals and their patients are mistaken for as insurance. The importance is evident with the passing of the new state legislation (SB 80 and HB 37) in March 2018 that specifies that DPC agreements are not insurance. The State of Florida has now joined 23 other States in this movement.

 

DPC is a delivery model that allows patients to manage their primary and preventative healthcare services outside the traditional health insurance model. DPC enables patients to pay an affordable membership fee to their primary care professional (usually on a monthly basis) that allows them complete and direct access to their doctor. They can call, text and video chat their doctor at any time while having unlimited office visits with no co-pay. Patients can spend significantly more time with their doctor (30-60minutes) that allows them to get their questions answered while their primary care providers have the time to manage their complex conditions. Patients also have access to low-cost lab and radiology tests as well as wholesale pricing on generic medications. Subsequently, this allows patients who are enrolled in a DPC practice to have increased satisfaction while saving more money in their pockets, specifically those consumers with a high deductible plan.

 

DPC coverage is intended to work with insurance coverage while driving down cost and increasing the quality of care. DPC does not cover catastrophic incidences such as a heart attack or cancer. DPC coverage allows patients to get services without using their deductibles on their insurance coverage. Patients save money by using their DPC program. They benefit directly from the unlimited access to their providers without co-pay, the low-cost tests, and the wholesale priced medications. Insurance companies have less expensive claims to deal with such as ER visits and possible hospitalizations which ultimately drives down cost and increase the quality of care of the beneficiaries in the insurance plans. DPC also encourage policymakers to allow health insurers to continue to design policies that support consumers who seek to enroll in a DPC program.

 

Hospitals would see cost savings as well since studies have already shown a decrease in the inappropriate use of emergency rooms and urgent care facilities by uninsured patients. Chronic disease management has also improved where there are decreased sentinel events and improper utilization of emergency rooms such as readmissions to the hospitals within 90 days.

 

Hospital systems would have the opportunity to identify services for their uninsured and underinsured populations. Hospitals would have a place to care for their numerous high-risk underinsured individuals who would have access to a provider that would deliver necessary and timely services upon discharge.

 

The Affordable Care Act has already demonstrated that increasing insurance coverage to people led to an increase in accessing health care which resulted in an improvement of a wide range of health outcomes.

 

Although multiple studies have shown the health benefits of merely having insurance coverage, we also know that quality care does not stop there. There is an opportunity to evaluate the impact of DPC coverage +Insurance coverage in our state as a way to reduce our cost and increase the quality of the primary care services provided. It is our responsibility as healthcare professionals to make a clear distinction between health care and health insurance as they are not synonymous but most importantly to identify permanently that DPC is health care with multiple benefits. As we work together to achieve High-Value care in our community, there will be an increasing need for this distinction as well as innovations such as DPC.