“Direct primary care is too expensive!, It’s two, three, four times more expensive than fee-for-service primary care!” cries the insurance consultant waiving his calculator. “The true cost should be something south of a $20 membership, not $70, $80 or more!”
He’s right. Sort of. Calculators don’t lie do they? Numbers in, number out. Just numbers, nothing else.
So why is Direct Primary Care taking off across the country? Why are consumers buying it? Why are plan sponsors endorsing it?
It can’t be lower cost could it? Well, yes it can. And more.
Are you confused now? If direct primary care is more expensive, and provably so by our friend, how can it save money at the same time? Calculators don’t lie. Numbers in, numbers out.
On the face of it our consultant friend is absolutely correct and can prove his argument in pure mathematical terms producing indisputable, provable facts we can all agree on. There’s no guess work involved. And that’s a problem.
But he’s missing a few things that make his argument less compelling, the biggest being the difference between traditional managed care controlled by distant corporations and independent direct primary care.
Corporate care is a fast moving conveyor belt. Patients are stacked in the waiting room like inventory in a manufacturing plant. Inventory must necessarily be carefully calculated to assure continuous feed to the factory floor where assembly workers wait their turn in the echo chamber. The intake clerk is first. “What brings you in today?” Then comes the nurse. “What brings you in today?” And finally in comes the doctor. “What brings you in today?”
The average finished product wholesales for about $85 and retails about double that. The more products produced the greater the profit. Anything more than 5 minutes with the chief body mechanic is a drag on profits. A patient panel of 3,000 to 4,000 or more is needed for profitability.
Direct primary care is more efficient. It takes no more than a 600 patient panel to produce profits. There is no conveyor belt requiring constant maintenance. There is no echo chamber either. Parking is never a problem and a wait of more than the time to say “Hi, I’m here for my appointment” is a promise religiously kept.
Convenience is hard to price yet there’s value in it. The convenience store business model is built on that.
The Why Behind Convenience Stores explains their industry and mirrors the magic of direct primary care:
“Our industry has established and reimagined convenience with one likeminded purpose: To own it. 1). A place that provides necessities and satisfies material wants, and 2). offers a complete experience conducive to personal ease and comfort.“
“By the time 2000 rolled around, it was commonplace for households to have two working parents, two vehicles and busier lifestyles and daily commutes. Fuller schedules meant longer days where everything from work, meals, school, shopping, driving kids to extracurricular activities and seeing family and friends was more planned. Basically, more people were on the go and time starved.“
The article stated something that rings true for today’s traditional fee-for-service primary care physician, “It’s time to adapt or die.”
People are time starved. There’s the fountain of the secret sauce of direct primary care.
Ok, so direct primary care is more efficient, offers better patient experience, convenient. But is it really more expensive than what our consultant friend believes? Can it be proven, without a doubt, to be true?
Nope it can’t. It’s impossible to prove a return on investment when it comes to health care outcomes. Of course others will argue that’s wrong and offer numbers “proving” their argument. But numbers do lie and they lie all the time. That’s proven (another topic for another article).
So let’s go to statistics in an attempt to quantify return on investment. Everyone agrees direct primary care reduces ER visits, surgical procedures, hospital admissions, and prescription drug costs. How do you price that? You can’t, you can only guess. A guess doesn’t win arguments as well as numerical figures spewed forth from a cold, unemotional calculator. However guessing does trigger doubt and releases emotional calculations that can sway an argument in one’s favor.
“Bill, a traditional fee-for-service primary care physician is no different than a direct primary care physician! They have a professional mandate to take care of their patients in the best possible way, ordering only necessary procedures and upstream care! You haven’t proven to me direct primary care is more cost effective!” says our friend.
So, knowing the argument will forever remain unsettled with Bonehead, we end with “If people are buying it, and buying it a lot of it, why aren’t we selling it rather than someone else? If someone wants to buy something what place is it of ours to tell them no? If they are gonna buy it, they might as well buy it from us.”
FROM BONEHEAD
Bill, you’re doing a disservice to your blog readers. You’re not telling the truth, the whole truth, and nothing but the truth!
I can rebut your entire article. Here’s the best part: Ask any DPC provider what percentage of their visits are virtual. The answer will vary from 50 to 90%! You can access a dedicated virtual primary care provider for less than $15 per month! Couple that with brick and mortar fee-for-service primary care and you win both ways at a hell of a lot less in cost. And, it provides consumers a choice, not a one size fits for all model attached to one doctor you’ve never had a relationship with before.
