Direct primary care and population health

A growing number of direct primary care (DPC) physicians are working with employer groups to provide healthcare for the company’s employees. The DPC model has come to be recognized as a quality alternative to traditional workplace medical insurance. When an employer contracts with a DPC to provide healthcare services to its employees, by its very nature the DPC practice becomes focused on the population health of the employer group.

Population health is a relatively new term, having been coined in 2003 by David Kindig and Greg Stoddart. They defined it then as “the health outcome of a group of individuals, including the distribution of such outcomes within the group.”

The Centers for Disease Control and Prevention (CDC) sees population health as “an interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally.” The CDC adds that the population health approach “utilizes non-traditional partnerships among different sectors of the community – public health, industry, academia, health care, local government entities, etc. – to achieve positive health outcomes.”

HIMSS emphasizes that population health “brings significant health concerns into focus and addresses ways in which communities, healthcare providers, and public health organizations can allocate resources to overcome the problems that drive poor health conditions in the population, e.g. diabetes, obesity, autism, heart disease, etc.” In addition, HIMSS states that “Information technology is a part of the core infrastructure on which population health can be assessed and addressed.”

Those partnerships referred to by the CDC and HIMSS include DPC practice and the independent physicians that run them. DPC physicians generally either began their practice or converted their practice out of a desire to focus more on each patient and, in particular, the quality health outcomes of those patients. When a DPC contracts with an employer, the physician and the practice staff naturally desire to “address the health status and health issues of the aggregate population,” as the non-profit organization HIMSS describes population health.

Gabby Marquez
July 24, 2018


Physician perspective: DPC does not mean patient abandonment

When an independent physician decides to convert the practice to a direct primary care (DPC) model, part of the process will involve reducing the size of the patient panel. In a DPC practice, the physician sees fewer patients in order to be able to spend more time with each patient during the visit. Downsizing the practice in such a manner may leave some patients feeling as though they have been abandoned.

A recent post in Medical Economics, written by Stephen C Schimpff, MD, MACP, a quasi-retired internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and author of Fixing the Primary Care Crisis and Longevity Decoded – The 7 Keys to Healthy Aging, explains the situation from a physician’s perspective. In essence, Dr. Schimpff states that physicians who operate DPC practices are able to devote more time to their patients, less expensively, than in a traditional practice and that is “certainly not patient abandonment.”

All of a DPC physician’s patients are not expected to follow the practice through its conversion. That would actually defeat the purpose. However, Dr. Schimpff points out that there are still plenty of traditional primary care practices operating that will take in those patients who choose not to go the DPC route with their physician.

In addition, Dr. Schimpff states that, far from decrying the physician’s move to a DPC model, “once it becomes clear that people can get better care at a reasonable cost, the general public will be the ones who will pressure their PCPs to make the conversion.”

He adds that large patient panels can contribute to physician burnout as well. “The need today is to get back to a reasonable number of visits per day. Using better technology and team functions, that number can be somewhat greater today than it was years ago but it still needs to be a reasonable number that the PCP can interact with appropriately.”

Gabby Marquez
July 9, 2018


How could direct primary care save on healthcare costs?

Health insurance can be complicated and costly. There are usually multiple levels of plans from which to choose, varying in cost depending on the services covered, the percentages of costs covered for each service, and the co-pays and deductibles. All of these costs add up for the typical consumer. A patient may pay a monthly premium, a co-pay for each visit, and a deductible for the year, for each individual in the family. Direct primary care (DPCs) practices operated by independent physicians are drastically changing that structure.

DPCs can help patients save on their healthcare costs, primarily because of their simplicity. A DPC operates on a set monthly membership fee, usually between $50 and $100 per individual, that covers all basic services for the patient. There are no office visit co-pays for preventive services, such as well-checks. In addition, the DPC independent physician usually negotiates significantly lower costs for medications and lab tests, which also saves the patient a considerable amount.

An independent physician in a DPC typically does not accept insurance, so has reduced overhead costs. There is no need to process paperwork or wait for reimbursements. However, most DPC physicians do recommend that patients carry high-deductible insurance for major medical issues that require specialized treatment or hospitalizations. For healthy individuals who typically visit their physician for routine exams, however, the DPC membership fee covers all their basic services.

DPC patients enjoy the added bonus of the independent physician’s extended attention. The physician can spend more time with the patient during office visits because the DPC’s patient panel is smaller. The DPC physician has more time to spend with each patient so a relationship can be developed that enables the independent physician to get to know the patient’s medical history and concerns more fully. In addition, most DPC physicians are available before and after the visit to respond to communication via text, email, or phone.

The DPC practice is growing in popularity. Particularly as healthcare costs increase, the simple monthly fee can help patients and independent physicians save on healthcare costs.

Gabby Marquez
June 12, 2018


Why concierge medicine isn’t just for patients with chronic conditions

Concierge medicine is often thought of as a service available only for the rich or appropriate only for the chronically ill. Concierge physicians provide personal service, sometimes to the extent of traveling to a patient’s vacation site for a medical emergency. Patients who have chronic conditions are attracted to the concept of concierge medicine primarily for the comfort of knowing their primary care physician will manage their specialty visits, possibly even accompanying them to those physicians’ offices, and will help them navigate an often complex healthcare system.

However, concierge medicine can also benefit those patients who are generally healthy. The concierge physician is able to get to know patients well and can be more focused on proactive measures designed to keep those patients healthy.  Daniel Carlin, M.D., CEO of WorldClinic and author of The World of Concierge Medicine, makes the point that “Proactively taking steps to live a long life without illness is referred to as longevity planning. Unfortunately, longevity planning is not characteristic of the traditional healthcare system but is embraced by many concierge medical practices.”

Concierge medicine is a relatively new concept, having begun in the late 1990s. The birth of the concierge concept is attributed to a Seattle doctor who “decided to ask his patients to pay a flat fee—or retainer—in exchange for what he called ‘highly attentive medicine.’ This allowed him to not have to rely on fees-for-service that were regulated by insurance companies.”

Today, as the practice of concierge medicine grows, it is a concept appropriate for most patients. Whether chronically ill or basically healthy, the concierge patient receives personal attention from the primary care physician who is available for that patient virtually 24/7. Patients enjoy reduced wait times at the doctor’s office and access to the physician before and after the visit, either through communications channels or additional in-person visits. Beckoning to the days of the physician who made house calls, concierge patients enjoy personalized services for a high level of quality healthcare.

Gabby Marquez
June 4, 2018


How fast is direct primary care growing?

It has long been known that the number of direct primary care (DPC) practices is increasing throughout the US. A concept that began in its current form only around the turn of the 21st century, the DPC practice is growing in popularity among independent physicians who no longer want to deal with insurance companies and with patients who appreciate the more personalized service they receive from their physicians.

The exact number of DPCs has only recently been mapped, however, and those numbers are showing significant increases in numbers of practices, numbers of patients, and average numbers of patients per practice. The DPC Trends Report uses the data from the mapping project to cull specific numbers and trends among DPC practices.

Data from the mapper shows that the number of DPC practices has increased to 620 in 2017, from 125 in 2014 when the data was first tracked. The total number of DPC patients in 2017 was 173,042, an increase from 5,988 in 2014. Average number of patients per practice increased to 279.1 in 2017, from 47.9 in 2014. Data for each year shows a steady and significant increase:

Number of DPC practices Estimated number of DPC patients Average number of patients per practice
2014 125 5,988 47.9
2015 290 37,758 130.2
2016 445 85,129 191.3
2017 620 173,042 279.1


There are still no reported DPC practices in North Dakota or South Dakota, but the mapper has tracked practices in all other 48 states as well as Washington, DC.

The numbers as tracked over the past four years are probably conservative, as no precise census exists yet to determine the exact number of DPC practices across the country. However, the mapper definitely shows a fast-growing movement toward the DPC practice for both patients and independent physicians across the US.

Gabby Marquez
May 22, 2018


Why direct primary care is a model for getting the most out of an EHR

A streamlined, efficient operation is essential for the success of a direct primary care (DPC) practice. DPCs operate on patient membership fees and cannot rely on the income generated through insurance reimbursement. Likewise, the DPC practice must have the proper technology that ensures optimal results for minimal effort. This technology should also, and more importantly, enable the DPC independent physician to focus on the patients’ health while managing the practice efficiently.

DPC physicians tend to be heavy users of technology in their practices, due to the demands of retaining memberships. Practices need access to a wide-range of technology and services, from patient marketing platforms to labs and imaging services. Electronic health record (EHR) technology is optimized for and best suited to meet the needs of direct care practices.

A recent article published by the Mayo Clinic’s Center for Innovation stated that:

The problem-oriented EHR is ideal for Direct Primary Care because most encounters are characterized by multiple problems, which is different from a specialist, who typically sees a patient for a single problem during any given visit. Additionally, DPC medicine has a more holistic approach to patient health that neatly aligns with the problem-oriented medical record, which provides a longitudinal view of the patient’s health care over time.

The DPC community of independent physicians can benefit greatly from the features of an EHR solution that enables them to run their practice more efficiently while spending more time with their patients. Communication tools, easy access to patient medical data, and collaboration with specialty providers are key to a successful DPC practice.

Elation’s Clinical First EHR offers DPCs the tools they need to minimize practice overhead for more efficient practice management. With the right EHR solution, physicians in a DPC practice spend less time on paperwork and more time with the patients themselves.

Gabby Marquez
May 14, 2018


A recap of how DPC practices can partner with employers

The direct primary care (DPC) physician typically chooses the DPC model out of a desire to spend more time with patients and less time with third-party paperwork, especially that dealing with insurance companies. So, many DPC physicians may be hesitant to reach out to employers to explore the idea of partnering their practice. However, the DPC practice must also find ways to become financially stable and partnering with employers to provide healthcare to their employees can be an effective way to do just that.

The DPC practice that wants to partner with employers should emphasize the advantages for those employers and their employees. By most estimates, employers that contract with DPC practices to provide healthcare to their employees can save up to 40% on their healthcare costs. In fact, some employers are willing to pay the entire cost of the DPC membership for their employees because they are saving so much overall.

In addition, the employees benefit by being able to see an independent physician who is able to spend more time with each one, developing that critical patient-physician relationship that can lead to better health outcomes. Employees are healthier and employers benefit from reduced absenteeism as well as an increased opportunity to recruit with the enhanced benefit.

DPC physicians who cater their practices to employer groups benefit from the opportunity for a captured patient panel. The practice becomes easier to grow with virtually guaranteed patient membership. The independent physician who works with employers can maintain the sanctity of the DPC model, while enjoying a solid, predictable income.

Independent physicians who partner with employer groups also have the opportunity to become an advocate for healthcare within the employee population group. Offering more personalized care, tracking each patient’s medical progress and/or challenges, and spending more time with each patient on preventive care can benefit the physician, the employee, the employer, and the community as a whole.

Gabby Marquez
May 8, 2018


How direct primary care is changing the way we think about healthcare

Back in the day, primary medical care involved only the independent physician and the patient. In the early 20th century, however, the concept of health insurance was formed as part of Theodore Roosevelt’s presidential platform. Today, primary care physicians are tasked with securing prior approval, billing, and awaiting reimbursements from insurance companies as a part of their daily practice management.

Direct primary care (DPC) is a relatively new concept that actually takes independent physicians back to those days of dealing directly with patients for payment as well as treatment. Based on patient membership fees that cover most basic services, the DPC model bypasses insurance companies almost completely.

One DPC “trailblazer,” Dr. Paula J. Frantz had participated in the fee-for-service traditional primary care practice for several years before deciding she needed to be able to spend more time with her patients and less time dealing with insurance companies. She launched her DPC practice in 2016, “on a mission to change the way people view health care by taking a trip back in time to re-visit a concept grounded in our collective medical history.”

The growth of the innovative DPC model is changing the way independent physicians and their patients think about healthcare, by eliminating the middle man of the insurance companies and returning to the original concept of the doctor-patient relationship. Complicated payments and reimbursements do not exist in a DPC practice. Instead, the patient pays a regular monthly fee directly to the physician’s office.

In return, the physician is able to spend more time with the patient during each visit and is generally more available for communications before and after the visit. Dr. Frantz’s patient visits can last anywhere from 30 minutes to an hour. Most visits in a traditional practice are limited to a maximum of 15 minutes. In the DPC practice, there is less emphasis on the volume of patients and more emphasis on the quality of patient care, which benefits physician and patient.

Gabby Marquez
May 1, 2018


Important features for a direct primary care EHR

Direct primary care (DPC) operates on a unique financial model. Rather than submitting claims and relying on insurance reimbursements, the DPC physician bills patients for a monthly membership fee. These transactions require a different type of practice management system than that used by the traditional primary care practice.

The DPC practice “offer patients the full range of comprehensive primary services, including routine care, regular checkups, preventive care, and care coordination in exchange for a flat, recurring retainer fee that is typically billed to patients on a monthly basis.” This arrangement enables the DPC physician to spend more time with each patient, particularly when the practice incorporates the technology of electronic health records (EHRs).

DPC practices that rely on patient membership fees must be able to manage the practice efficiently to remain financially solvent. DPC EHRs must offer the independent physician the tools necessary to bill patients for their monthly fee as well as to communicate with patients regarding questions and clarifications for follow-up treatments.

Minimizing practice overhead is critical for DPCs. Important features of EHRs for these practices include integrated practice management tools to efficiently manage office appointments, send patient reminders, and collaborate on care with electronic faxing and referrals.

A primary focus of the DPC practice is to become more engaged with patients, spending more time with them at each visit and developing a positive, long-term relationship with each. DPC physicians also encourage patients to become more engaged in their own healthcare. An appropriate EHR solution can also help with that goal.

DPC EHRs, such as Elation’s Clinical First EHR, provide the ability to send and receive messages with patients to engage them beyond the encounter. Communication histories are automatically linked to the patient’s chart and are easy to find. The physician can securely share vitals, lab results, and encounter summaries through the HIPAA-compliant patient portal.

An effective EHR solution provides easy access to patient data and to practice management tools that are essential for the DPC’s success. Elation Health is focused on helping DPC physicians reach their goals, for their practice and for their patients.


Krystle Thornton
April 25, 2018


DPC Coalition Fly-In is a resource for those interested in direct primary care policy

The direct primary care (DPC) model is a relatively new and often misunderstood concept of healthcare delivery. Patients, policymakers, and even some physicians still need to be educated as to how DPC practices function, particularly how they can be financially self-sustaining and still offer high quality, personalized care.

Policymakers are the focus of an upcoming event hosted by the Direct Primary Care Coalition (DPCC). The DPCC Washington Fly-in is scheduled for May 21-22 at the Hall of States, 400 North Capitol St NW, in Washington, DC. The agenda is yet to be announced for this year’s Fly-in. In past years, however, DPC leaders from around the country have come to Washington “to focus attention on important federal policy changes to help DPC practices grow and improve health care for more Americans.”

The coalition is urging lawmakers to pass legislation regarding DPCs and their relationship to insurance, especially health savings accounts (HSAs) and the Affordable Care Act (ACA). Whether DPCs are considered insurers and must adhere to insurance regulations is of particular concern to many primary care physicians.

The DPCC May 2018 Washington Fly In is now open for registration. DPC physicians concerned about current and future legislation that may impact their practices are encouraged to register and participate.

DPC practices are growing in popularity. In 2005, there were fewer than 150 physicians practicing in direct primary care, concierge, and other direct care models. This number grew five times in the next five years, to 756 in 2010, and then even more rapidly to an estimated 6,500 direct care physicians across the country by the end of 2015.

Elation Health is dedicated to helping independent physicians succeed in their DPC practices. Our Direct Care Playbook is designed to provide physicians with specific guidance on setting up a practice, marketing to and educating patients, and optimizing a practice for success.

Gabby Marquez
April 23, 2018