Direct Primary Care Increases Patient-Centered Care Access

Direct primary care (DPC) services may boost care access in Massachusetts by providing the most vulnerable populations with cost-effective, patient-centered care, according to a new Pioneer Institute study.

Under direct healthcare models, patients pay providers a monthly fee that covers a predetermined set of services. While it is most used in primary care, it can also be applied to physical therapy, dentistry, and behavioral and mental health. 

Currently, there are 1,200 direct primary care practices in the country and at least 16 are located in Massachusetts.

“This approach to investing in primary care has been shown to reduce costs, emergency room visits, inpatient care, and visits to specialists, all while increasing patients’ satisfaction with their care,” said Josh Archambault, co-author of the study.

Patients choose a PCP and purchase a complementary insurance plan. Usually, patients can buy a much less expensive plan with a higher deductible because a wide array of services are covered under direct primary care agreements. Usually, these services include annual physicals, vaccinations, routine lab tests, and care for fractured or broken bones.

Additionally, direct primary care patients have access to unlimited office visits with same- or next-day appointment availability. On average, DPC patients have four, 35-minute visits with their PCP annually. Patients have far less time with their PCPs under the standard fee-for-service model, with an average of 1.66 visits every year that last around 15 minutes.

Under DPC agreements, patients also have access to home visits, 24/7 emergency triage support, and assistance navigating the rest of the healthcare system. Some agreements include access to generic prescription drugs at affordable prices. The study authors also noted that many DPC physicians give patients their personal cell phone numbers.

In 2018, nearly 80 percent of DPC monthly subscription fees were between $51 and $99 per month. Costs have remained stable over time. DPC agreements do not have deductibles, co-pays, or third-party insurance claims, allowing for price transparency that can ease patient anxieties surrounding cost of care and surprise bills.

Direct primary care services could promote care access for a variety of patient groups, according to the study. Pre-COVID-19, the average wait for a doctor’s appointment in Boston was 50 days. Meanwhile, many providers do not accept Medicaid patients. Therefore, access to same- or next-day appointments under DPC agreements would be particularly helpful to MassHealth members. 

DPC agreements also could provide convenience and patient-centered care to Medicare beneficiaries. Older adults often have trouble finding transportation to appointments, so home visits usually included under DPC agreements would allow them to mitigate transportation as a social determinant of health. With longer and more frequent appointments, DPC allows for personal management of chronic illnesses and more robust patient-provider relationships.

The study found that in addition to providing affordable care for underserved patients, direct primary care results in far less physician burnout. While “status quo” providers report that a third of their day is spent on arduous administrative tasks, the researchers said, direct care providers are able to spend much more time with patients because there is no insurance paperwork to complete.

Direct primary care also has the potential to reduce healthcare spending for hospitals. Pioneer Institute noted a study published by the American Journal of Primary Care that shows a small subcategory of direct health care arrangements in five states resulted in an almost $120 million decrease in preventable hospital use in these practices. More than 90 percent of the savings came from Medicare patients ($2,551 per patient).

Archambault urged the Commonwealth to take four steps to embrace direct healthcare. First, the Division of Insurance guidance should be updated to match 35 other states by clarifying that any form of direct care should not be regulated like insurance.

Next, the Group Insurance Commission should adopt direct healthcare arrangements for public employees and offer it as a lower-cost option.

Third, MassHealth should explore DHC arrangements, especially for the sickest patients on the program.

Lastly, the Legislature should consider requiring that insurance companies offer at least one product that wraps around direct healthcare arrangements, especially DPC. This would introduce a new, affordable option for consumers, as the product would feature a higher deductible than most plans offered in Massachusetts.