Amazon-One Medical Deal Gives Spotlight to Direct Primary Care, Other Subscription Models

Direct Primary Care

Mega online shopping platform, Amazon, is buying the buzz worthy, concierge-like primary care platform, One Medical, ushering in a new era for healthcare companies providing subscription-based medical care. 

While concierge medicine and direct primary care are distinct models, most notably in price, direct primary care, specifically, has gained a lot of momentum recently with membership rates increasing +240% in the last five years. Nevertheless, many are still unaware of this type of membership-based health care that offers unlimited access to primary care providers, either virtually or in person. 

With Amazon’s purchase of One Medical, we predict this is about to change. 

What is direct primary care?

Think about the last time you saw a doctor. You booked an appointment likely many days or weeks in advance. Showed up and waited. When you finally got into the exam room, the visit felt like it was over almost as soon as it started. 

The majority of traditional primary care visits last less than 16 minutes. If you’re lucky, the doctor was able to look at you and not just at the computer as they typed notes.

But it’s not just time (or not enough of it) that has made the traditional primary care model a lot less about patients. The primary care that most of us know is based on a “pay for service” model. The name is what it does — every time you see the provider, the provider gets paid often through whatever payment arrangement exists regarding the patient’s health insurance. It means two things: 

1) each visit requires a lot of documentation to ensure reimbursement and 

2) doctors are incentivized to do paperwork versus fixing the underlying health issue.

Direct primary care is different. It’s based on a subscription model. The doctor gets paid a monthly fee to take care of that patient. No claims. No necessary EHR paperwork. And they offer to take care of patients in a broad range of ways to better meet the patient where they are at, and not vice versa. Text message, video chat, longer visits or same or next day appointments — are all typical services of a DPC.

And there’s more. In a fee-for-service setting, a provider’s patient panel (how many patients they have for a year) ranges from 2,000 to 2,500 patients. Part of the reason is that they need to see more patients to pay for the high overhead (billing department, claims departments, etc.) For a direct primary care provider, it’s about ⅓ of that, between 600 and 800 patients in a year. Remember, they don’t deal with claims or health insurance (except for Decent, that is).

A notable misperception regarding direct primary care is that it’s unaffordable. Yet, patients pay a monthly fee, typically in the $60-$120 range, that covers all of their basic primary care services. (There are some monthly Starbucks budgets larger than that.) And there is often some other perks — free or reduced labs as well as lower-cost x-rays and prescription drugs. The “con” is that patients still need health insurance to cover other important medical care like specialist visits and potential hospital care.

Why is DPC gaining so much interest?

Under the currently ubiquitous pay-per-service, revolving-door-of-patients model, healthcare providers are rewarded for seeing more patients and ordering more tests, lab work, and other services in order to make their money. This often leads to frustrated patients and doctors, because under this model it's difficult to build a relationship where doctors know their patients and their medical history thoroughly. It also makes it harder for a patient to fully trust their medical providers when they only get to spend a few minutes together--and usually only when they are sick or have a medical emergency. Yet, we know access to primary care can make a big difference. According to the Journal of the American Medical Association (JAMA), “Greater health system orientation toward primary care is associated with higher quality, better outcomes, and lower costs.” 

So is it any wonder, that direct primary care is gaining momentum? 

What isAmazon’s doing with One Medical?

Direct primary care is a promising model that eliminates the gobs of administrative paperwork and multiple codes doctors have to do with traditional health insurance programs. Will Amazon’s entry into healthcare improve access to quality healthcare? That remains to be seen. This isn’t their first attempt (nor the first of other big tech giants to shake up healthcare). 

But, what it does is lift the lid off of this promising model that aims to improve access to primary care for all by investing more in patient care rather than the six cents on every healthcare dollar spent now.

Why is Decent so excited?

Decent’s health insurance plans give small business members free primary care available by doing something that no other health plan does — partnering with direct primary care providers. DPCs don’t typically work with insurance providers, but Decent is different — we pay our DPCs exactly the way they want to be paid, a monthly fee per patient.

And what’s not to love about direct primary care? Employees can see their primary care doctors when they want to and begin building a medical history and trust with their doctor because they don’t have to worry about co-pays and other fees that add up quickly. Healthcare providers under this model are paid monthly for being available to their patients, and thus are able to spend time getting to know their patients and providing care for them. 

That the secret sauce to improved health is better access to primary care isn’t new. Somehow our healthcare system lost sight of this. Decent did not and we're excited it's getting the attention it deserves.

Learn more about Decent PEOs small group health plans and how Texas small businesses can save up to 35% on their employee benefits.

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