January 12, 2023 4 min read

Homebound patients often struggle with complex medical conditions among the most costly in healthcare. Further, they typically face health equity issues related to social determinants of health, including the ability to visit a clinic, hospital or doctor's office.

Many in healthcare believe patients tend to be happiest and healthiest when they're in the home. This increasing awareness could potentially fuel a trend toward shifting direct primary care into the home.

McKinsey estimates up to $265 billion worth of care services (representing up to 25% of the total cost of care) for Medicare fee-for-service and Medicare Advantage beneficiaries could shift from traditional facilities to the home by 2025.

Delivering needed healthcare services and providing help with daily activities requires a team-based approach to direct primary care that includes nontraditional providers, said Lynn Carroll, chief operating officer at HSBlox, a vendor of health IT for the administration of value-based care programs.

Carroll talks about what direct primary care is; how direct primary care has the potential to produce better outcomes, an improved patient experience and lower costs; and how coordinating care, services and reimbursements through a digital infrastructure can potentially improve health equity for vulnerable populations.

  1. For those unfamiliar, what exactly is direct primary care and what does it entail?
  2. Direct primary care is an alternative care and payment model that eliminates fee-for-service payments and third-party billing. Instead, patients pay their primary care providers a flat annual or monthly fee for routine services, such as quarterly exams and routine lab testing, as well as enhanced services such as telehealth and home-based visits.

DPC is becoming increasingly popular among patients and self-insured employers concerned about rising healthcare costs and among providers eager to reduce administrative burdens, according to the "Trends in Direct Primary Care Report" from Hint Health.

The success of DPCs depends heavily on a strong patient/PCP relationship. Patients in a DPC model generally have greater access to their physicians/healthcare teams in a more convenient and affordable manner than they would under traditional billing systems.

The DPC model can help smaller practices stabilize their revenue streams while eliminating administrative burdens related to coding, billing and filing claims with insurers. This gives them more time to spend with patients and enables them to reduce costs.

  1. Why do you feel direct primary care is a must for the future of healthcare?
  2. The pandemic exposed a lot of inherent flaws in the U.S. healthcare system, which has accelerated the adoption of new care delivery models such as telehealth and home-based care. DPC is a viable alternative payment model for providers with smaller practices who want to avoid administrative and reimbursement headaches.

Another reason DPC will be a must going forward is that it's a consumer-centric care model, and healthcare consumers are more demanding than ever. They want personalized and convenient service from their PCPs, and they don't want any billing surprises.

Finally, the inherently preventive nature of care under the DPC model aligns perfectly with the goals of value-based care to improve patient experience and health outcomes, address physician fatigue and well-being, and incorporate health equity, all while lowering healthcare costs.

  1. How can direct primary care produce better outcomes, an improved patient experience and lower costs?
  2. DPC produces better outcomes because primary care providers can spend more time with patients. This allows them to ask more questions, engage in discussions about conditions and possible treatments, and conduct basic testing in the office and even in a patient's home.

The more familiar a physician is with a patient – including understanding the social determinants that may impact that patient's life and health – the greater the chances of a better outcome.

DPC improves the patient experience through better outcomes and greater convenience. Research shows that DPC members can schedule appointments with their providers within one day, wait less than five minutes in the DPC office, and spend nearly 40 minutes on average with their providers, versus 15 or 16 minutes with a traditional PCP.

In a recent study analyzing the impact of DPC on health outcomes and costs, DPC members had 25.5% lower hospital admissions, while the cost of ER claims was reduced by 53.6%. The improved outcomes, better patient experience, reduced paperwork and lower costs generated through DPC payment models can help smaller practices remain independent.

  1. How can coordinating care, services and reimbursements through a digital infrastructure improve health equity for vulnerable populations?
  2. A key element of a healthy DPC practice is strong working relationships with community-based organizations that provide nutrition counseling, transportation and other services addressing the social determinants of health that can impact patients' lives and outcomes. Establishing this type of community support network for vulnerable populations is essential if we want to improve health equity and attain the goals of value-based care.

A digital infrastructure is needed to power this network of service providers. Successfully integrating community-based organizations into a care network requires providers to deploy technologies that offer complex hierarchy support for onboarding, data capture, digitization and exchange. These technologies must support SDOH, quality reporting and other use cases.

The right cloud-based digital infrastructure can support the many-to-many relationships necessary for coordinated care of patients. By sharing information and analytics and realigning downstream reimbursement to include both medical and nonmedical services, providers can activate a powerful community-based network of care for their patients.