Direct primary care amendment may offer affordable health care options for Americans

The U.S. Senate today made an important step that could expand health care coverage to more Americans while simultaneously reducing costs. The Manager's Amendment, introduced by Senator Harry Reid (D-Nev.) this morning, includes a provision that would allow flat-fee direct primary care practices, in which patients pay a flat fee for primary and preventive care, to compete in the proposed insurance exchange. This will provide Americans more affordable health care options beyond traditional insurance.

Under both the House and Senate versions of health care reform legislation, the insurance exchange is where Americans will be able to shop for health coverage after the bill is implemented. Without these supplemental amendments in each respective version of health care reform, the insurance exchange would not allow alternatives to traditional insurance to compete, which would dramatically limit consumer choice. Under the amendment, flat-fee direct primary care medical membership would be bundled with a new, lower-cost "wrap-around" insurance plan that covers rare and unpredictable services outside of primary, preventive and chronic care, such as specialist care, hospital stays or emergency room visits.

Direct primary care practices already exist in more than one-third of U.S. states, offering affordable health care alternatives to more than 50,000 Americans, according to the Direct Primary Care Coalition (www.dpcare.org).

"We're very pleased the Senate followed the House's lead in recognizing the innovation and value behind direct primary care medical homes in increasing competition in the exchange and providing Americans with more options at lower cost," said Garrison Bliss, MD, Chief Medical Officer, Qliance Medical Management Inc., which operates two clinics in Washington State, and co-founder of the Direct Primary Care Coalition. "I thank Senators Harry Reid, Maria Cantwell and Patty Murray in particular for their personal support. We encourage all members to reform the status quo and provide our proven direct primary care model a place in our country's health care future."

Dr. Bliss pioneered the direct primary care medical home model in Washington state more than a decade ago. Today, flat-fee practices like Qliance offer affordable, high-quality health care at up to 50 percent less than the cost of traditional insurance, even when combined with a lower-cost "wrap-around" insurance plan that covers everything direct practices do not. Benefits of direct primary care membership can vary by provider, but typically include many of the following:

-- Unhurried 30- to 60-minute office visits -- No limits for pre-existing conditions -- Same- or next-day appointments for urgent care needs -- Open 7 days per week, with 24 hour cell phone and email access to a physician -- Low, predictable monthly fees as low as $39 per month plus savings on wrap-around insurance plans -- On-site x-ray, laboratory and "first-fill" prescription drug dispensary -- All routine care including vaccinations, routine blood tests, women's health services, pediatric care, broken bones and ongoing management of chronic diseases like diabetes, hypertension and obesity. -- Coordination of any needed specialist and hospital care as a "medical home" model

"Health care costs are going through the roof, and I have many patients here in New York who have seen their insurance rates increase to the point where they can no longer afford it. This amendment allowing direct primary care practices to compete in the exchange is the only amendment in the Senate health care bill that is going to cure the high cost of health care," said Dr. John Muney, founder of AMG Medical Group, which operates five direct primary care clinics serving all five boroughs of New York. "I am very appreciative to the Senate for recognizing the value of direct primary care practices, and making sure they can continue to grow and patients can continue to have access and choice."

"Until now, health care reform has been entirely focused on insurance issues, rather than patient care," said Dr. Samir Qamar, CEO of Access Primary Care, which is the first medical practice in the state of California to provide primary care for one low monthly fee. "I applaud the Senate for including direct primary care in its legislation. With this amendment, direct primary care practices like ours can continue to prioritize high-quality patient care, rather than focusing on insurance billing."

Direct primary care medical homes can typically service approximately 90 percent of the reasons most people see a doctor in a lifetime. By removing time-consuming and costly insurance reimbursement processes from routine and inherently low-cost services and procedures, direct primary care practices eliminate approximately 40 cents of every dollar currently wasted in traditional insurance models.