Direct care making its way to new markets

Concierge-like direct care isn't necessarily just for the wealthy anymore, but its place in the Medicare and Medicaid markets remains uncertain, according to an article from Kaiser Health News.

For starters, the Affordable Care Act identifies direct primary care, which typically involves a monthly fee of about $100, as an acceptable option when combined with a high-deductible health plan for specialty and emergency care. For patients from all walks of life, these total expenses may still be lower than traditional insurance.

The health law's language was "sort of [an] 'open-for-business' sign," Jay Keese, a lobbyist who heads the Direct Primary Care Coalition, told KHN. As a result, the number of direct practices continues to rise, with the American Academy of Family Medicine estimating that 2 percent of its 68,000 members now offer direct care.

Meanwhile, there's a great deal of interest in young programs currently underway that provide direct primary care to lower-income groups. Seattle-based Qliance is a leader in such experiments, KHN reports. The company has enrolled about 15,000 Medicaid patients since it began accepting them in 2014. In this arrangement, Qliance's monthly fee that covers unhurried, easily accessible primary and preventive care is paid at a contracted rate by an insurance company in Washington's Medicaid program. Specialty and emergency services are covered by the insurer as well, but patients are only referred to specialists who accept Medicaid.

While Qliance estimates that the model will cost Washington state up to 20 percent less than traditional Medicaid through better upfront primary care, several other states are watching and waiting before following suit. Many eyes are also on New Jersey, according to the article, as it launches access to direct primary care for state employees such as teachers and firefighters.

Despite the benefits of direct primary care, the model has its critics. Even with affordability becoming less of an issue, some detractors believe that doctors who reduce their patient panels drastically contribute to physician shortages and access problems.

To learn more:
- read the article