Recap: The #hcbiz Show! Episode 30: Direct Primary Care with FMEC

On episode 30 Shahid Shah and I discussed the Direct Primary Care movement with:

Laurence Bauer, CEO, FMEC
Kat Quinn MBA, a leading advocate for DPC in growing market awareness for the DPC model through engaging health literacy
John Chamberlain, Senior Healthcare Executive and Direct Primary Care Advocate

Check out the setup post for background: Making the Move to Direct Primary Care Here's a recap of our conversation: 2:49 Laurence Bauer gives us an overview of the Family Medicine Education Consortium (FMEC). It's a not-for-profit incorporated in 1994 to support the practice of Family Medicine. They formed the Innovators Network to find new primary care solutions and bring them to market. Through those efforts, they discovered the Direct Primary Care movement and found it to be "a wonderful vehicle for renewing the doctor-patient relationship and helping doctors deliver the care that they want." 4:56 How is FMEC supporting the DPC movement? They're efforts are centered around creating market awareness for the DPC movement. They want to "amplify and support the message". They produce videos to inspire patients and self-insured employers to want to go looking for a DPC practice. They also created the DPC learning community that provides 700+ doctors with regular educational newsletters. 7:30 What's keeping the DPC movement from really catching on today? First, it's culture. Bauer believes we have an "addiction to insurance". That is, people don't think healthcare can be delivered without insurance. He says you need insurance for the big things, but not all the small ones. He adds that patients who take advantage of DPC end up having a very close relationship with their doctor and that can prevent unnecessary treatment, tests, etc. Things that they might otherwise get, and pay for, in the traditional model. Second, it's regulations. Some states still consider DPC insurance, but that dynamic is changing. 12:00 If we get the employers on board, will everyone else fall in? Not exactly, says Bauer. We need the employees to want it and ask for it. That changes the dynamic and that's what needs to happen right now. That's why much of the DPC movement is focused on market awareness. 15:00 What's the insurance companies' perspective on DPC? Shahid Shah tells us that the insurers interested in access are very interested in DPC, but there are regulatory issues. It's a problem for the insurers if DPC gets in the way of reducing premiums or reduces the total number of people in the insurance population. Shah reminds us that insurers often want to do things that regulations prevent. They're not going to be happy if a DPC upstart begins to compete with them and doesn't have to follow the same rules. How do we level the playing field? If it turns out that DPC is working better because they don't have to follow this rule or that one, then maybe those are bad rules and we can adjust them for the insurers too. That could lead to progress for everyone. 17:30: What are the regulatory issues impacting DPC? As mentioned, some states treat DPC like health insurance. The IRS does too and that prevents patients from paying their DPC membership fees from pre-tax dollars in their Health Savings Account (HSA). Bauer believes that we will eventually get over these hurdles. He says DPC just makes "good business sense for America". The doctors understand the issues around financials; they understand the studies and outcomes. In the DPC model, they become the patient's insider and advisor. This helps the patient get the right care and only the care they need. And since the patient is part of the physician's DPC practice, they're incented to get them just that. 22:28 What prevents the doctors from getting on board wth DPC? What resources are available to help them? And who shouldn't be doing this? Bauer says "anybody who doesn't understand how to run a low overhead practice should not get involved in this. You will fail". Overhead can be as high as 57% in a traditional Primary Care practice. With DPC, you may see that overhead drop as low as 26%. The low overhead is necessary to stay profitable under your monthly membership fees. 25:45 Where can doctors get help in starting and operating their DPC practice? Bauer says that the #1 place to go for help is the Direct Primary Care National Summit. It will likely be in Chicago, July 2017. In describing the conference he says that "physician burnout is real and it's very serious; particularly for PCPs. When you come to the DPC summit there's none of that. These are happy doctors. They're alive. They're excited. They're people like Josh Umbehr at Atslas.MD. They're so pleased, it's like they're having so much fun they just have to share it". Bauer lists several more resources for DPC learning and support:

28:00 Audience question: What about the critics who say DPC isn't for everyone and that it separates the haves and have-nots? Is DPC affordable for the patient? Bauer says that fees are in the $50-60/month range. If the patient has a High-Deductable Health Plan (HDHP) then they're spending so much on co-pays right now that they'll probably save money. It may not be for the desperately poor, but there are programs to support the underserved too. Many DPC practices give discounts and free membership to the underserved patients in their community. John Chamberlain pointed out that patients will also get discounts on prescriptions, imaging, lab services and more. Those savings alone can make up for the monthly membership fees for many patients. 30:30 Tell us about the upcoming FMEC conference. The 2016 FMEC Annual Meeting will take place in Pittsburgh, PA from October 28th-30th. It will be a great learning opportunity current and perspective DPC physicians and they're planning some great innovations sessions. 31:12 Tell us about your involvement with The Big Heist Crowdfund. Bauer says that there's so much unnecessary care and wasted money in healthcare and we need to do something about it. We, who have grandchildren, need to leave something better than what we inherited. We think the film will take a big whack at the system to achieve that end. We're encouraging people to contribute to the campaign and stay in touch with the movement.