One third of the government has decided Direct Primary Care is good for poor people too (the other two thirds are the Senate and the Executive Branch). It’s likely the other 2/3 will approve Crenshaw/Schrier Medicaid Primary Care Improvement Act.
According to most doctors Medicaid payments won’t allow the kind of lifestyle commercial payments do. Fewer take Medicaid patients because of low reimbursement rates. What will be the government approved capitated rate charged for Direct Primary Care? Will it be $25, $50, $75, $100 or more? Our best guess it will be around $40-$50.
Direct Primary Care is a fast growing market phenomenon but with a limited ability to scale over time unless America imports a heck of a lot more physicians to fill the need. Training nurse practitioners could be a new growth industry colleges and universities should invest in. The end product will reach the end of the conveyor belt in half the time of physician factories.
As time goes by and as our national deficits grow through reckless spending and borrowing causing turbocharged inflation it is likely more Americans will qualify for Medicaid creating a Direct Primary Care capacity problem. Physician importation and added reliance on the virtual component of Direct Primary Care will help alleviate the problem.
Virtual primary care as an important component of Direct Primary Care and should not be overlooked. More than half of all Direct Primary Care visits are virtual. It’s not uncommon for 80-90% of all Direct Primary Care encounters are in a virtual setting.
Stand-alone virtual care is growing in acceptance by consumers seeking faster and more cost effective access. Employers see the value and are incorporating virtual primary care in their core medical plan. A small employer with 100 employees recently put in a 24/7 capitated virtual primary care benefit with good success. In the month of December 2023 alone there were 40 virtual primary care visits. Plan members didn’t have to wait days and weeks to see a doctor, taking a day off from work to sit in a room with sick and contagious fellow patients waiting hours to see the same doctor for 5 minutes.
Hybrid Direct Primary Care programs combining fee-for-service primary care and virtual care will do well competing with subscription direct primary care for a variety of economic and political reasons. Direct Primary Care’s ultimate inability to scale further will be offset by hybrid program’s capacity to grow alongside.
Reps. Crenshaw and Schrier Lead Bipartisan Medicaid Primary Care Improvement Act
May 1, 2023
Reps. Dan Crenshaw and Kim Schrier introduced bipartisan legislation to expand access to personalized health care.
The Medicaid Primary Care Improvement Act clarifies that state Medicaid programs have the authority to broaden health care access for Medicaid beneficiaries, including through direct primary care, a successful model of health care delivery that allows patients to access primary care services at a flat, monthly fee.
“I’m proud to lead this bipartisan legislation that will assist states in expanding access to personalized health care,” said Rep. Dan Crenshaw. “This bill addresses health care costs and workforce challenges, allowing state Medicaid programs to innovate and enabling patients to access direct primary physicians. We need every available health care provider to improve preventative care and confront the provider shortage that is impacting too many communities across America.”
“As a mom and a pediatrician, I know how important primary care is for the health and wellbeing of families and children,” said Rep. Kim Schrier. “A strong provider-patient relationship can mean catching issues earlier, and fewer costly trips to the emergency room. I’m happy to work on bipartisan legislation that clarifies Medicaid can participate in direct primary care arrangements, and help more families access care.”
Health care organizations around the country applauded the bill introduction.
“Direct primary care (DPC) provides a pathway to continuous, comprehensive, coordinated primary care for patients. However, too many physicians face legal and financial obstacles to fully embrace this model. The AAFP is proud to endorse the Medicaid Primary Care Improvement Act, which will ensure state Medicaid programs can pay for DPC arrangements for beneficiaries. Addressing this barrier will help improve access to primary care for some of the nation’s most vulnerable and underserved populations.” – Tochi Iroku-Malize, MD, MPH, FAAFP, President, American Academy of Family Physicians
“The Direct Primary Care Coalition applauds Reps. Crenshaw and Schrier for coming together on this bipartisan bill to bring the best possible primary care to Americans with lower incomes. This bill clears old federal regulatory roadblocks and encourages states to give Medicaid beneficiaries the option to chose a DPC practice for their primary care needs rather than seeking routine medical care in the ER. Studies have long shown individuals in need that have a lasting relationship with a primary care doctor have far better health outcomes. This common sense bill potentially saves states millions of dollars by cutting unneeded care delivered in a more expensive acute care settings.” – Jay Keese Executive Director, Direct Primary Care Coalition.
“Giving states the flexibility to incorporate Direct Primary Care into their Medicaid programs would alleviate many of the problems those programs currently experience. Allowing beneficiaries to direct funds for an arrangement with their personal doctor would not only improve access, it also has great promise for increasing the quality of care as well.” Dave Balat, Texas Public Policy Foundation
Reps. Smucker and Blumenauer are original cosponsors of the bill.
“I want to thank my colleagues for coming together to advance bipartisan legislation to make it easier for Medicaid patients to access direct primary care,” said Rep. Lloyd Smucker. “Direct primary care keeps patients out of the emergency room, improves health outcomes, and will yield savings to the Medicaid program. When state Medicaid programs innovate on behalf of their patients, especially by leveraging value-based care delivery models like direct primary care, patients and taxpayers are the winners. I look forward to working together to advance this legislation.”
Read the full bill here.
