Mission Statements and Manifestos
Someone recently emailed me, very cordially, asking about Momentum Direct Primary Care, our model, and what my company’s “mission” is. It was probably somewhere around the 500-word mark into my well intended “short response” that I realized that neither this poor individual nor their email server deserved to be subjected to such a lengthy diatribe. However, as I hope you realize in reading this, effectively describing the “why” or the “mission” of my DPC practice is surprisingly difficult to do without a lot of necessary but complicated background context, which helps illustrate what sets Momentum and the growing number of independent DPC clinics like ours apart from the medical status quo.
In my experienced and well-traveled professional opinion, direct primary care is simply a dramatically better and more satisfying model for providing healthcare than anything most people are used to experiencing. Heck, I now do this and even I am not used to the stark difference. On its face, the mission is actually pretty simple. By cutting out insurance-mediated reimbursement from the physician-patient relationship, we create profound and mutual benefits. Let me run through the highlights.
What’s in it for the doctor?
The DPC physician gets the benefit of seeing far fewer patients per day, which - in addition to being less “work” - enables them to spend substantially superior quality and quantity of time with each of their members on the individual level; helping them to reach their goals and to be generally healthier and better taken care of. Because DPC docs are paid directly, there's less pressure that they MUST see a certain consistent number of people every day or every month to maintain their salary. They are paid regardless of the number of patients they see, which may sound selfish, but here’s the best part. Within this model, they are actually incentivized to keep their patients as healthy and satisfied as possible, so that they tend to require less time and attention despite allowing for more of each when the need arises. This lower volume of "work" fosters a much better work-life balance for the clinician, increases the time they get to spend with their families and friends, and greatly reduces the accelerating phenomenon of burnout. Physicians also get to practice medicine as they see fit since they have so much more autonomy outside the system.
What’s in it for the patient?
The patient benefits in many ways as well. Most importantly, despite paying a monthly subscription fee, DPC can usually save members hundreds or even thousands of dollars per year when properly coordinated with their existing (properly structured) insurance plans. (I'll explain how below.) DPC members get a much greater say in the style of care they receive. No gatekeepers telling them that the medication, treatment, therapy, test, or procedure their doctor just ordered yesterday is "not allowed" because it didn't meet certain arbitrary coding criteria in order to compel the insurance to approve (i.e. pay for) it. These patients receive unprecedented access to their doctor in a multitude of ways. By virtue of merely being part of a much smaller patient panel (usually 1/4 to 1/5 the size of what a standard physician panel in the fee-for-service world must maintain) members gain highly expedient, personalized care and attention. Most appointments are 30 or 60 minutes, and almost always with same day or next day availability. Generally all the usual primary care services are included in the same monthly membership fee, affording patients peace of mind that their doctor is always available for them when needed. And no middlemen can get in the way and deny services or inflate costs. DPC pricing is simple and transparent (a complete novelty in modern healthcare) and there are no limits to the number of visits, no co-pays, and no restrictions on the type of patient-physician interaction. They can meet with the doctor face to face in office, during house calls, via video visits, phone calls, emails, and even texts.
*Side note: while you CAN do some of things, such as telemedicine, EMR portal messaging, emailing providers, etc. in the fee-for-service model, because ALL encounters require extensive documentation and coding justification for [eventual] insurance reimbursement, and - since most of those modalities aren’t even ELIGIBLE for an insurance charge - most doctors are naturally disincentivized to provide non-in-person interactions with patients because they will never be reimbursed for them. So, what tends to follow from that? Large corporate health organizations continuously over-promise (Access! Access! Access! Look at our fancy new EMR!) and perpetually underdeliver. At the provider level, patient messages, phone calls, emails, etc. - ALL OF WHICH ARE VERY SENSIBLE MECHANISMS FOR COORDINATING CARE - become a massive administrative burden, eating up vast amounts of time and bandwidth. Remember that there are 4 or 5 times as many patients who need the physician’s attention in this scenario. Therefore, there is no real incentive for them to allocate such an immense chunk of time, outside of managerial pressures to perform and meet the afore-mentioned over-promises.*
Other benefits (varying by the individual DPC practices) include things like on-site rapid testing for things like Strep and Flu, wholesale pricing on prescription medications (dispensed in-house,) deeply discounted pricing for laboratory and imaging tests, (negotiated on their behalf by their DPC.) Most only pay what it costs the practice. There's typically no mark up for these services because those benefits are intended to enhance the value of the membership.
Cost Savings:
In addition to some of the perks described above, the biggest savings come from properly allocating one’s healthcare budget. Optimally, patients should tailor their "backup coverage" to function more like ACTUAL insurance, (think catastrophic events such as accidents, or unexpected serious illnesses requiring high dollar hospital stays, surgeries, multi-specialty care appointments, etc.) which is what insurance is meant to be used for. Expensive "insurance" should not be the default setting for 90% or more of what most patients really use it for, which is mostly just access to basic primary care and prevention and/or management of various chronic issues. My favorite analogy for this is to imagine we lived in a system where all insurance products operated like modern health insurance. Under such a system, you would have to have a big, expensive auto insurance plan just to afford (and in many cases just to gain ACCESS to) gas stations, oil change shops, and tire centers. It makes ZERO sense for relatively low-cost acute and preventative care and maintenance to be paid for by a third party. Once you understand this it quickly becomes very apparent why healthcare costs in the US have grown completely out of control.
If you’re still reading this, I salute you. And while I don’t believe that Direct Primary Care will become the new normal way of obtaining health care anytime soon, for now I remain content and excited that I get to play a small part in the creation of a sorely needed alternative, joining the ranks of hundreds if not thousands of family physicians blazing this trail and building a truly competitive and patient-centered parallel institution. Lord knows we need it.
Coincidentally, 2 days after this mock exam, I diagnosed her with strep throat
