5 things to know about direct primary care practices

An increasing number of U.S. practices are offering direct primary care, although not all have had success with the model, reports Kaiser Health News.

Here are five things to know about direct primary care practices.

1. Direct primary care practices typically do not participate in fee-for-service insurance billing and charge patients a flat fee that covers all or most primary care services, according to the American Academy of Family Physicians. The flat fee is charged either monthly, quarterly or annually. The AAFP said since there are services not covered by a flat fee, direct primary care practices often recommend patients have a high-deductible wraparound insurance plan for emergencies.

2. Shawn Martin, a senior vice president at the AAFP, told KHN currently about 3 percent of primary care practices offer direct care services.

3. Many physicians and patients favor direct primary care for a number of reasons, including physicians' reduced administrative burden from fewer interactions with payers, according to KHN. However, the report notes, some healthcare experts contend the model urges the "worried well" to visit their physician more often and potentially receive unnecessary care.

4. The report cites Seattle-based Qliance as a pioneer in direct primary care, noting the company was founded in 2007 and by 2015 served 35,000 patients at multiple Seattle-area clinics. Additionally, Qliance said medical claims for the company's patients were 20 percent lower than claims for other patients "because Qliance members went to the emergency room less often, were hospitalized less frequently and saw fewer specialists, among other things." However, the company saw a decline in patients by early 2017 and ultimately closed five of its clinics this month, according to KHN. Qliance CEO Erika Bliss, MD, told KHN primary care practices are unsustainable in the current market, and payers sometimes were resistant to rewarding the company for exceeding targets on quality and savings.

5. A 2015 study published by the Journal of the American Board of Family Medicine, cited by KHN, revealed direct primary care practices charged patients $77.38 per month on average.

Read the full report here.


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