Direct primary care and the ACA make strange bedfellows

Direct primary care is one solution to keeping Americans healthy, but dramatic growth of these types of practices is held back by the Affordable Care Act (ACA), writes Anish Koka, M.D., a Philadelphia-based cardiologist, in a commentary in Medical Economics.

The ACA diminishes the physician’s role to a “population health master” who leads a team of coaches, clinical staff and massage therapists in the care of patients, insists Koka. He is also critical of the role of digital health devices, saying they provide data no one has the time or interest in looking at.

In a direct primary care practice, a patient typically pays a physician a direct payment in the form of a subscription service that may range from $50 to $100 per month, Koka says. The challenge to the further growth of direct primary care practices is they must be linked up with a “catastrophic” health plan, a costly proposition for patients and one that requires minimal essential benefits such as prescription plans and laboratory benefits, he writes.

For a healthy 40-year-old patient, that means the least expensive plan available under the ACA marketplace costs around $3,600 annually, on top of a $6,000 deductible, according to Koka, who is equally critical of the inability to use health savings accounts to pay for care provided by a direct primary care physician.

He points to the success passing laws that allow the health insurance marketplace to accept direct primary care--16 states now recognize direct primary care, he writes. Still, it’s an “uphill battle.”

“Even without having to deal with the political machinations that seem to drive policy, the simple fact is that the ACA in its current form has great difficulty co-existing with Direct Primary Care,” he writes. “Those interested in a real fix to the travails facing physicians and patients can only hope that the too-big-to-fail ACA actually fails.”

- read the commentary