Today, the Detroit Free Press wrote an article about our Direct Primary Care service, Plum Health DPC. To read the full article, head here. In this post, I’m going to be breaking down what we read and what we thought. Let me start by saying that the article is great as is, but if you want to take a deeper dive into some of the stats and some of the experiences behind the article, read on to my breakdown.
Direct Primary Care practices Serving Underinsured and uninsured patients
The article starts out by discussing how one of our patients is underinsured:
Katelyn Burkart, 29, has health insurance, but because of her plan's nearly $7,000 annual deductible, she can't really afford to use it.
"It is like pretty worthless insurance, frankly," said Burkart, who lives in Hamtramck. “It’s one of those things where if I'm in a horrible accident I can come up with $7,000, but I know I can’t do that every year.”
I’m glad that they focused on the human aspect of being uninsured or underinsured, but I had hoped that the Free Press would have discussed how prevalent this problem is. From a survey performed by the Commonwealth fund in 2019, “45 percent of U.S. adults ages 19 to 64 are inadequately insured.” The Survey goes on to reveal that “People who are underinsured or spend any time uninsured report cost-related problems getting care and difficulty paying medical bills at at higher rates than those with continuous, adequate coverage.”
This is why Plum Health and Direct Primary Care really matters - it meets people where they’re at and provides them with a low-cost, high-value solution to a pervasive problem.
How many direct primary care practices are in Michigan?
The article goes on to discuss the number of Direct Primary Care practices in Michigan:
Plum Health, which doesn't bill or accept health insurance, is one of roughly 15 direct primary care clinics in Michigan where doctors see fewer patients than in a typical primary care office, and can spend more time with each one.
Plum Health DPC was one of the early adopters of this Direct Primary Care model. We saw clearly that through a DPC practice, we could spend more time with our patients, deliver a higher value service, all while lowering the cost of medications, lab tests, and imaging services.
Can Direct Primary Care Scale?
One of the critiques of the Direct Primary Care model comes from Marianne Udow-Phillips:
"Direct primary care is still a pretty small, and not by any means widespread strategy for delivering services," said Marianne Udow-Phillips, executive director of the Center for Health and Research Transformation in Ann Arbor. "Whether or not it’s going to grow over time is a real question."
Frankly, I disagree with this assessment. When we started Plum Health in 2017, there were roughly 400 Direct Primary Care practices across the United States. As of today, there are roughly 1,119 Direct Primary Care practices across the United States:
That being said, it’s time to address the concept of scaling Direct Primary Care. From the article:
“Still, it's an open question whether direct primary care can scale up and become more than a niche in care health.”
I have often said that you can’t scale relationships, meaning that we’ve built our business by taking care of one person at a time, by building a relationship with one person at a time. This relationship building is often done during hour-long appointments where we really get to know one another. I’m grateful to have this opportunity to really get to know my patients and their health goals - it makes the practice of medicine more meaningful.
And to address this concept of scale, there are now over one thousand doctors practicing this way every day in every type of community across the country, slowly building relationships with their patients and with their community, and meeting people where they’re at.
For people that choose a Direct Primary Care doctor over a traditional fee-for-service doctor or practice, this stronger relationship with their doctor can be refreshing. In the more corporate structures of health care delivery, people can often feel like just another number, as their doctor rushes in and out of the room. In our DPC practice, we really want to make sure that people feel valued and understood, listened to and well cared for.
In a way, the Direct Primary Care model has already “scaled” as the number of doctors practicing in the DPC model has more than doubled over the last 2.5 years. If this trend continues, in another 2.5 years, there would be 2,400 DPC practices in the US, which is very exciting.
Direct primary Care is not Health Insurance
In the article, they mention that Direct Primary Care does not replace Health Insurance, and yes, we unequivocally recommend that folks have some sort of health insurance or catastrophic health insurance policy. From the Free Press:
It also is unlikely to replace the need for health insurance. That is because direct primary care doctors still refer patients to outside specialists for more complex medical situations, anything from joint replacements to cancer. Also, primary care doctors are no substitute for an emergency room.
This is an important point, we can care for roughly 80 - 90% of what someone may need, like blood pressure management, diabetes management, acute care or sick visits, laceration repair like sewing up cuts, Pap testing, biopsies, wart removal, skin tag removal, etc… And we can do all of this at a low cost and without billing insurance. This is health care - time with the doctor and trust that your doctor can take care of what you need.
The biggest problem that I have with insurance is when it becomes comprehensive, covering everything from Flu Shots to time in an Intensive Care Unit. When insurance is mandated to cover everything, the costs of these services become inflated. This is unfortunate because primary care services are relatively low cost.
So for the folks who are uninsured or underinsured, they are paying a very high cost for relatively inexpensive primary care services, because they are often forced to pay the insurance-based prices. Because we remove the insurance company middle men in our practice, we’re able to dramatically lower the cost of health care.
Thank you for reading and learning more about our practice! If you’d like to have this sort of service for yourself, your family, or your business you can sign up here or reach us at 313.444.5630.
-Paul Thomas, MD with Plum Health DPC