Michigan Association of Health Plans

Direct Primary Care: Does it Really Save You Money?

To paraphrase Mark Twain, in today’s Internet-connected world, a really bad public policy idea can travel half way around the world while the truth is putting on its shoes.

An example is the notion that something called “direct primary care” can replace health insurance to provide access to quality health care for state workers and retirees and Medicaid recipients and save 20 percent on the state’s overall health care bill, as claimed in a recent Detroit News guest column by Sen. Patrick Colbeck (Re: Health care saving could fund Michigan’s roads, Nov. 18). Direct primary care — which may have its place — was described as a “Swiss army knife” for public policy, freeing up billions for other purposes. Readers of The Detroit News need to hear the full story.

The concept of direct primary care sounds appealing. By law, it is not an insurance program. Patients go to their primary care medical home for all routine and preventive services like checkups, urgent care and chronic care management. Patients, employers or insurers pay a monthly fee directly to the physician’s office.

Sounds appealing but upon reflection, it quickly becomes apparent that this idea more resembles “Swiss cheese” than a “Swiss knife.

Hole No. 1:Direct primary care still requires the individual to have health insurance to cover specialty services, hospitalization, and all other care that doesn’t happen in the physician’s office. In a car crash in another town? Sorry. Child breaks an arm on a ski slope? Sorry, not covered. Need a very expensive prescription? Better check the fine print, because most of those are unlikely to be covered for one low flat monthly fee. Kidney stone require hospitalization? You’ll be digging into your savings for that bill.

Hole No. 2: Currently, in Medicaid alone there are over 9,000 physicians contracted to provide primary care services. How many of these doctors are willing to forgo health insurance for direct payments? About 150 so far, according to the recent op-ed — and we don’t know if any of them would accept Medicaid patients.

Hole No. 3: Does this really save money, as the writer suggested? Years ago, before Gov. John Engler launched the Medicaid managed care program, physicians were directly responsible for managing care in Medicaid. After implementation of managed care via private health insurance companies, Michigan saw major cost reductions, an increase in the number of providers willing to participate in Medicaid, and higher quality of service — because the managed care health insurers are held accountable by state contracts.

Hole No. 4: If a patient goes to three or four physicians, none would have any way to know what the other was diagnosing or prescribing. Today, the company assigned to manage the individual’s health care tracks what is going on in all phases of the patient’s health care to assure patient safety and protect against fraud.

Direct primary care is an experiment that is still being studied and will be dependent on its ability to reduce the use of emergency services, specialists, and high-cost prescription medications. Direct primary care may help some people in some cases, but it does not eliminate the need for health insurance and it is a cruel hoax to suggest that this program provides a way out of the state’s fiscal problems.

We never know when a serious illness, an accident, or a tragic condition will strike. Replacing your health insurance with your bank account is not a move many financial analysts are likely to support for you — or for the state.