What is Direct Care? A Patient-Centered Approach to Healthcare

Did you know that over 145,200 clinicians, including a significant number of internal medicine and family practice doctors, exited the healthcare workforce in 2021 and 2022? According to a report by Definitive Healthcare, these departures were attributed to various factors such as concerns of COVID-19 infection, "untenable" hours, emotional toll, and stress.

To address the challenges prevalent in the traditional healthcare system, many physicians have been embracing the patient-centric Direct Care model. If you're considering transitioning to this model, you're in the right place.

First of all: What is Direct Care?

Direct care focuses on the direct interaction between the patient and the physician, without the interference of insurance companies. Patients usually pay a flat or subscription-based fee directly to you for a personalized care, covering various services based on the practice's specifics and their needs.

Direct Care is a vital topic discussed across various fields, each making significant contributions to expand this movement. Physicians, organizations, and researchers collaborate, while patients and employers increasingly learn about its benefits.

Main Advantages of Direct Primary Care Model Compared to the Traditional Model

Personalized Care‍

Direct Primary Care fosters closer relationships between patients and physicians, enabling care that's tailored to the individual. With more time for each appointment, you can thoroughly understand a patient's health concerns and lifestyle, leading to personalized and effective treatment plans.

Accessibility‍

One of the hallmarks of Direct Primary Care is the ease of access to healthcare services. Patients can often schedule same-day or next-day appointments and have direct communication channels with you, making healthcare more responsive and convenient.

Transparency‍

The DPC model offers a clear, straightforward approach to healthcare costs. The monthly fee covers most primary healthcare services, removing the unpredictability and hidden costs associated with traditional healthcare billing.

Focus on Prevention

With an emphasis on regular check-ups and a strong patient-physician relationship, DPC naturally leans towards preventive medical care. This proactive approach aims to keep patients healthy and reduce the need for costly specialist and hospital care.

Reduced Administrative Burden‍

DPC eliminates much of the bureaucracy associated with insurance billing, allowing physicians to spend more time with patients.‍

Better Health Outcomes‍

The emphasis on preventive care and the ability to spend more time with patients can lead to earlier detection of health issues and more effective management of chronic conditions.

Cost-Effectiveness

For many patients, the flat monthly fee for unlimited primary care services can result in significant savings, especially for those with chronic health issues that require regular medical attention.

What's Typically Included in a Direct Care Membership Plan?

Here is an example of services offered under what is a Direct Care membership plan

• Office visits without co-pays.
• Telemedicine consultations as needed.
• Same or next-day appointments for urgent care.
• Comprehensive annual physical exams.
• Basic in-office procedures and tests at no extra cost.
• Mental health and Wellness recommendations.
• Simple wound care.
• Chronic diseases management, adjusting treatments as needed, and providing continuous support.
• Direct communication with you via phone, text, or email.

Understanding the Direct Care Mindset

In this post, we'll feature an interview with Gayle Brekke, who has navigated the complex world of health benefits as an actuary, explored academia with a Ph.D., and emerged as a fervent advocate for transformative change in primary care. Her journey is a dedicated quest to unravel healthcare complexities, challenging conventional wisdom to unearth effective solutions that resonate with all involved.

One of her initiatives, the Primary Care Mindset, aims to redefine the essence of primary care. Through her engaging podcast, "Nurturing the Heart of Family Practice," she also invites family doctors to embrace the Direct Primary Care model, offering a more intimate and impactful approach to health delivery.

Gayle is on a mission to shift perspectives, advocating for a healthcare system that is not just sustainable but also equitable, ensuring that every individual, regardless of their background, has access to the care they deserve.

Join us as we explore Gayle's insights and experiences, shedding light on how we can collectively contribute to a healthier, more inclusive future with Direct Care.

How has your interest in Direct Care started? Could you explain the core principles of the Direct Care Model and how it differs from the traditional healthcare model? 

With my background as an actuary, I was interested in the role health insurance plays in the various issues and challenges within the healthcare system. I quickly noticed that we use insurance differently in healthcare compared to other areas. In healthcare, insurance is used for almost everything, while in other areas, it's typically reserved for highly unpredictable events.

My actuarial training suggests that insurance should not be used for primary care, as it tends to make it more expensive, complicated, and inconvenient. This realization was the main reason I became interested in the Direct Care Model, which avoids insurance for affordable, routine, and predictable services.

When I began meeting Direct Care Physicians and attended a DPC Summit a few years ago, I was struck by their enthusiasm for the model. They were excited about how much better the experience was for them and their ability to care for patients as they wished. This highlighted for me how DPC significantly differs from insured primary care.

The ability to immediately see your doctor when an incident occurs, a new symptom arises, or your child sustains an injury, knowing you can contact and see your doctor that same day if it's urgent, changes everything. This familiarity and trust make a world of difference, as this model truly allows for patient care as it's meant to be. This is what sparked my deep interest in Direct Primary Care.

How does Direct Care address issues of healthcare affordability and transparency in medical billing for patients?

Regarding billing and the overall experience of receiving care, I believe it's significantly different. Direct Primary Care typically operates on a membership model. In this model, a patient might pay, for example, $80 a month for an adult for unlimited access to primary care.

This fee often includes a variety of additional services such as very low-cost labs, imaging, and prescription medications, among others. This straightforward arrangement is similar to a gym membership, where a consistent monthly payment provides access. 

It eliminates the need for extra billing and reduces hassle, as there is no requirement for pre-approval to try a new medication or undergo a treatment the doctor deems appropriate for the patient's condition. The membership model simplifies interactions, offering direct access and, in most cases, eliminating additional billing for many services, as they are included in the monthly membership fee.

What would be your advice about how to approach Direct Care benefits for employers?

From everything I have learned and from people I've talked to, it seems this is an important area where DPC can really shine. Many employers are diligently working to save on costs throughout their business, from the cost of materials for production, if they're a manufacturer, to all business operation costs, especially in today's challenging economy. And of course, every business faces competition and strives to grow, improve, and succeed. 

Something like the cost of benefits is an enormous expense for businesses, typically the second highest after payroll, sometimes the third, depending on the business type. Therefore, they must always monitor these costs. Certainly, they want to lower benefit costs, but they cannot do so without ensuring a solution that still takes good care of their people. Direct Primary Care addresses this by eliminating much unnecessary cost, not only for primary care itself but also for downstream care.

Again, mindset plays a significant role here, as we're accustomed to thinking about benefits in a certain way. Employers seek comfortable solutions; they don't want to upset people with changes but must balance the health of their workforce. If the workforce is satisfied with their benefits and can be productive without worrying about access to healthcare for their families, while also potentially saving on benefit costs, it's a win-win. 

DPC presents a huge opportunity but requires a different approach. It's crucial to understand the difference between working with employers or setting up a practice for individual patients and their families. You may need a different perspective, possibly different tools, or technology tailored to whether your DPC practice focuses on employers and their employees and families or on individual people and their families. We discussed many valuable and important topics today, and it's exciting to see more companies finding ways to benefit from DPC and help it grow.

How do you see technology and digital health tools playing a role in the expansion and effectiveness of the Direct Care model?

From my perspective, I think that's one area where a DPC Physician is very different from a primary care doctor being paid by insurance, part of a hospital system, working in the system. They have a very different need for technology.

One of the wonderful things about Direct Care is that it's much lower cost because they can avoid a lot of the hassles and paperwork that doctors who take insurance have to deal with. So technology has a role to play in keeping all of that very streamlined, very low cost for the practice, very efficient. 

I think many doctors with DPC practices use EMR and billing systems designed specifically for DPC because their needs are so different. So they can really focus on what they need to run their business, what they need for patient record keeping so that they can keep track of, for example, which patients are on which medications and which lab tests were done last year, just for patient care. 

It's not for someone else. They're not doing a bunch of record keeping for someone else who is going to look at their records and is not involved with the care, I mean Insurance. So, I think for DPC, it can be very streamlined, very specifically designed for their particular needs.

What are the challenges to the wider adoption of the Direct Care models in the healthcare systems, and how can this be overcome?

Yes, that's really the question, isn't it? How can we get people to understand how much different and how much better this is? I think that's a lot of people's first reaction. It was my first reaction when I first started hearing about this. "Oh yeah, it sounds great. But there's got to be something negative about it. There's got to be something they're not telling us." And I haven't found anything yet.

So, I think a lot of it is education, just really going through all of the reasons why the experience is so different for the patient and for the doctor. And then, one of the things I'm focusing on moving forward with my own work is mindset. It's how we as a society think about healthcare, how we think about how it should be paid for, how we should have access to it, how things should function. And I think we have a very established way of thinking about it because healthcare has been done basically the same way for probably close to 100 years.

Another aspect of mindset is that it has become so complicated and so expensive that the regular person who is just living their life, taking care of their family, going to work, and doing all the things they do in their day-to-day life, just finds it way too complicated to figure out how to do it differently, so they just go along with the way that it's done. And if we're using insurance for everything, it's way more complicated and way more expensive, and people don't realize that they have a lot of power to do it differently, to think about it differently, to approach it differently. 

With so many people getting their healthcare in connection with their job—so they have benefits through work or through their spouse's work—they feel like they don't really have control of, or say or any ability to change anything. So, we do need to educate and engage with employers, and with individual people as well as, of course, doctors and other people that work in healthcare. 

But also, I find with my background working as an actuary as well as now being a little bit more in academia and doing research, I feel like everybody, in all different kinds of roles and all different kinds of jobs, needs to become more engaged and just talk together with each other to understand what is really wrong with how we're doing healthcare and how DPC is something we should really talk together about and understand better, so that we can all kind of move in a better direction together.

Which kind of advice would you give to a physician who is starting a Direct Care practice?

First of all, I would say talk to other people who are doing it. There are so many wonderful people that spend a lot of time just giving advice and helping their fellow doctors and others make the transition to their own practice, to answer questions, and to help them realize what the benefits are, what the challenges are at this point. I believe that some of the challenges are definitely scary, but someone else has already figured it out. Someone else has been through it.

So a lot of it is just networking. Talking to other doctors, reading blogs, and absorbing information that people have published, joining different kinds of conversations to learn how others have done it. How have they found space to rent? How did they find all of the equipment they needed? Or how did they find nurses to hire? Other people have been through those challenges and want to help. So, I think the best advice I could give is to start talking to people who have already done it.

Looking towards the future, what developments and innovations in Direct Care are you most excited about?

That's a really good question. I think, given my background and the types of people I interact with, my goal is to bring together individuals from a variety of experiences, roles, and jobs to think more about Direct Primary Care. That’s just my own personal objective. 

Additionally, I am excited to see its growth. I've encountered more doctors all the time who are switching, people who are discussing it differently, and really understanding it better. So, I think it’s poised to continue growing, and it’s exciting to have a small part in it.