'Direct Primary Care' A New Option For The Uninsured

More primary care doctors are turning to a new model they say is cheaper and more effective than traditional health insurance. In fact, it skips the insurance system entirely. Robert Siegel talks with Arnold Milstein, director of the Stanford Clinical Excellence Research Center, about how direct primary care works.

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ROBERT SIEGEL, HOST:

Now, another novel model for health care, it's called Direct Primary Care. Workers, through their employers or their union, pay a monthly fee and they get all the primary care they need. For specialists, they would still need insurance. But for that fee, and it could be 50 to a $150 a month, they get routine care coverage.

For more, we turn now to Dr. Arnold Milstein. He directs the Stanford Clinical Excellence Research Center at Stanford University. Welcome to the program.

DR. ARNOLD MILSTEIN: Thank you, Robert.

SIEGEL: And give us a direct primary care model works.

MILSTEIN: There are two features. Number one: it's a fixed price so that the primary care doctor have no time constraints, as it pertains to payments that typically occurs on a cost per visit basis. And most importantly, the more enlightened versions of these models are offering care seven days a week, including after-hours care.

SIEGEL: What are the advantages to the doctors? Would doctors with a reasonable caseload that they can be available to at all hours, can they make a good living?

MILSTEIN: Absolutely. Certainly not if they try to do it alone but these are - the best of these models are typically implemented in groups so physicians can work reasonable hours. From the perspective of most primary care physicians, this offers a pathway from the what's been referred to as life as a primary care hamster.

And for any primary care doctor that doesn't want to cut down their time spent with a patient below 15 minutes per visit, most struggle to take home $90,000 a year - which is certainly above average relative to average American incomes. But it certainly is not remotely competitive with other medical specialties.

SIEGEL: And if, in fact, a practice of the sort is supported by monthly fees there aren't the calls to, and arguments with, people at insurance companies about what's covered and what isn't covered.

MILSTEIN: That's exactly right. Also, what it tends to do is free up physicians - since they're being paid a monthly fee, whether they see the patients are not - to be able take the time that those patients prefer. Primary care doctors spend, you know, with them - typically patients with chronic illness - who've got a list of more than one, you know, minor problem to problem to handle.

And it turns out to be much more satisfying for the patient. They're able to kind of get through their whole problem list. And also much more satisfying for conscientious primary care doctors.

SIEGEL: This Direct Primary Care idea would obviously require people to have some provision for what they would deal with if they're referred to a specialist or if they need hospitalization. So at some point, for it to work, it would have to square with the existing or some modified insurance system. Does it square easily or is it a minefield?

MILSTEIN: Well, I think today it work certainly no worse than traditional primary care works. These practices, just like the ordinary primary care practices do run into problems of being able to get, you know, rapid access and adequate communication back and forth to the specialist physicians.

But what's interesting about this phenomenon is it tends to be led by primary care physicians with more progressive ideas as to how to better serve patients and their front-line medical needs. And so, what several of them have begun to do - which I think is a promising direction irrespective of whether the primary care model is traditional or this new style - and that's to begin to concentrate their specialist referrals on a subset of specialists that are willing to be much more rapidly available and responsive, with respect to both receiving, listening to, and then feeding necessary information back to the primary care doctor.

SIEGEL: Doctor Milstein, thank you very much for talking with us.

MILSTEIN: My pleasure, Robert.

SIEGEL: That's Dr. Arnold Milstein of Stanford's Clinical Excellence Research Center.

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