Direct Primary Care Services

Direct Primary Care Services (DPCS) provide primary care services in a manner that returns the focus of healthcare onto the doctor-patient relationship. Under traditional insurance plans, patients provide third party insurance cards to govern payments for services. Under DPCS, enrollees dispense with the insurance card for primary care visits. Enrollees in a DPCS agreement simply provide a monthly fee ranging from $50-$125/month for a transparent list of routine health care services. These healthcare services can include screenings, assessments, diagnoses, or treatments and are often supplemented by medical supplies, prescription drugs and lab work. In order to comply with the Qualified Health Plan requirements of the Affordable Care Act (aka Obamacare), enrollees would also need to purchase an insurance plan to cover those services not provided through their DPCS agreement, but the cost of these insurance plans is often available for reduced rates when used in conjunction with a DPCS agreement.

The Heritage Foundation has issued a study summarizing the findings to date in regards to cost savings and quality of care. They have found savings on the order of $2,551 per patient which exceeded the cost of the DPCS memberships. It goes on to show that patients experienced 35% fewer hospitalizations, 65% fewer emergency department visits, 66% fewer specialist visits, and 82% fewer surgeries.

In addition, Seattle-based Qliance Medical Management, LLC recently released a study of the impacts of DPCS. In this study, Qliance reports that the adoption of DPCS as a component of employer-sponsored health plans resulted in a 20% reduction in healthcare costs, increased patient satisfaction, and better care consistent with the Heritage Foundation findings.

The practice of medicine is already regulated under state law so this is not an issue of quality of care. In fact, studies to date clearly demonstrate improvements in quality of care under DPCS agreements. Physicians would still need a license issued by the Health Professions division of LARA to practice medicine in the state of Michigan. Furthermore, physicians are often certified by independent medical boards. In short, DPCS agreements are a win-win for patients and doctors by providing better care at lower costs.

Direct Primary Care Services are currently allowed under Section 10104 of the federal healthcare law, however, there is currently ambiguity in the federal statute as to what constitutes a Direct Primary Care Medical Home Plan as the HHS Department has yet to define the requirements pertinent to this plan. PA 522 of 2014 sponsored by Senator Colbeck provides clarity for residents of Michigan in this regard.

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