|By PYRILLIS, RITA|
A newer development, and one that is likely to get more attention in the next two years, is direct primary care. Starting in 2014 direct primary-care providers will start competing for employers on the insurance exchanges established by the health care reform law.
It's a twist on "concierge medicine" where wealthy patients pay a doctor a steep annual fee or retainer for unlimited access to medical attention. Direct primary care is the populist version with a more affordable monthly membership fee, usually less than
Direct primary-care providers receive a salary, unlike most physicians who are paid per service, which allows for more time with patients. Appointments typically last up to an hour. There are no insurance claim forms to fill out or deductibles to meet. Everything is covered by the monthly fee.
While direct primary care is not an insurance product, when paired with a "wrap around" insurance policy to cover specialized and emergency care, direct primary-care clinics will be allowed to compete on the exchanges. Such a product has yet to be developed, according to providers who envision a policy customized for direct primary-care practices that would cover services not offered by the practice.
"Do you pull out your auto insurance card when you go to Jiffy Lube? Of course not," he says. "So why do you do it for health care? You shouldn't use insurance for the predictable day-to-day stuff, like changing your tire or getting a flu shot. Insurance is for the unexpected, catastrophic events."
The concept is new enough that many in the insurance industry haven't heard of direct primary care. A spokesman for
"We've said from the beginning that we're not anti-insurance, but primary care is a routine and predictable event," she says. "So, why not divide it up and let us handle the routine care and let insurance cover what they need to? We reduce risk for insurance companies, and that's appealing."
She says that Qliance has been meeting with insurance companies to develop a wrap-around policy and that interest is growing among insurers and employers.
Starting this fall, Qliance, which has five clinics in
MedLion is pushing hard to sign up employers in
Anderson points out that a doctor typically has a patient base of about 2,500, but at MedLion each doctor handles about 1,000 to 1,500 patients allowing for greater access. "Everyone is taken aback at first because we're taking the medical-care model and setting it on its ear," Anderson says. "It's a hard concept for everybody. Things are changing dramatically, and it's going to take time for everyone to figure it out."
The coming changes to health care delivery will likely be challenging for all stakeholders. What the system will look like in the future is anyone's guess, but
"We will learn a great deal from data derived from electronic medical records and that will drive much of the changes to come," he says. "With data and the applications of some very smart people will come innovations that we can't even imagine today. Look at Apple. People weren't looking for an iPhone or a tablet but [
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