The Flavors of Direct Primary Care

What do various flavors of DirectPrimaryCare save employers? OneMedical (‘Exceptional Primary Care”) saved Google 🔳8% according to its S1. Meh. NexteraHealth measured 🔳29% in its most recent study. Exceptional. PaladinaHealth 18% on outpatient comparables.


Qliance offered it had 27% fewer ER visits, 60% fewer hospital days and cost their employers 🔳20% less on average than similar non-Qliance patients in the area.

IoraHealth says 83% of the patients in its practices with high blood pressure have it under control; the national average is 63%.

RHealth, a Philadelphia-based group, says it can save self-funded employers 🔳15% on their total costs, and has high rates of cancer and cholesterol screenings, medication adherence and blood-sugar control. R-Health has teamed up with Aetna and Humana to offer unlimited primary care at four of its practices to New Jersey state employees. It hopes to enroll as many as 60,000 of the 800,000 eligible workers . “We need to hire a lot of doctors,” says Mason Reiner, R-Health’s CEO.

And therein lies a big challenge: Scaling up the model significantly could exacerbate the shortage of primary-care doctors.

Daddy Was Wrong

We grew up from “A Because Daddy Said So” mentality. Daddy was wrong. The day our healthcare outcomes placed us between Croatia and Cuba. Two combined GDPs equal to ?

SanAntonio the poorest of top 20 metros with 25% in poverty , my hometown.

We spend almost double per capita hashtagSwitzerland the second biggest spender and half as much @ 7% of our peer countries on hashtagprimarycare
Dimon says this outcome to spend ratio is embarrassing
Buffet calls healthcare a tapeworm on our economy.
Bezos says this is the era of disappearing middles
Military leaders say the state of our healthcare is a national security threat. Up there with Iran. North Korea. Terrorism. American Healthcare.

The day the music died is when this all came together for us.

I live in a future for two years now where everyone wins.

  • Employers
  • Employees
  • Docs
  • Population Health
  • Costs


No Audits Ever Required?

Oh my. I just realized if Direct Primary Care or Direct Contracting with wholesale price transparent pharmacies, surgery, imaging no audits are ever required. Those consultants, lawyers, and accountants who thrive on audit misery are now under the bus. These edible headlines for those folks won’t carry water anymore.

“HHS OIG Flags $2.2 Billion in Potential
Medicare Advantage Overpayments for CMS Audits”
National Law Review

“How firms are delivering
value with audit data analytics”
Journal of Accountancy

Value-Based Care is 3.0

Valuebasedcare is 3.0 and DirectPrimaryCare is 2.0 an expert in primary care models told me Tuesday over fish tacos.

Here’s why he’s wrong:

  • VBC relies on the kindness of BUCAH.
  • Yet they are directly competing for PCPs.
  • So can set the amount they pay below realistic economics to drive VBC ACOs to their knees.
  • Like they did with dozens of services like independent imaging or orthopids or DME.
  • They will do the same to independentACOs married to VBC in primarycare then “rescue” them. Buy em cheap. They can later pay themselves a fair rate. A fat profit, in fact, because it’s not their money. It’s ours.

DPC is more resilient to this game largely opting off the tilted game board.

Why would they do this if VBCs offer great value? Because they can.

Call me a jerk, but VBC appears a race to the bottom until BUCAH owns it all. It’s so clear.


“We can get typecast as anti-insurance or anti-government,” Umbehr said but likes the idea of insurance used appropriately.

“Insurance is perfect for expensive things, hospitalizations, major car wrecks, your house catches on fire, but … you don’t submit an insurance claim to wash your car, to paint a new room in your house, [or get] an oil change. … Insurance is a great tool, but not for affordable things,”

Paying for Direct Primary Care

My 2-year experience as an employer paying for #DirectPrimaryCare

  • #Turnover was zero 2019. Three days of less turnover per employee paid for my annual cost. I’m ahead.
  • In January we needed four MAs. Takes 60-80 candidates to find four A players. We stopped all interviews at #5 because now we attract an excellent pool of advertising-free healthcare.
  • #Absenteeism is half because 6-hour time suck Medicaid exams to get a 7-minute visit and script is replaced by a call or text at their desk.
  • #Presenteeism I don’t measure, but intuitively way down since my team, with 24/7 bilingual #PCP access is healthier.

I live in a future where everyone wins: employer, employee, and doctors. Cannot imagine going back to #highdeductibles, copays, clipboards, long waits #factorymedicine and shocking lab bills.

I feel in full integrity with promised safety.

This emphasis on the doctor-patient relationship has contributed to the growth of an innovation commonly referred to as Direct Primary Care (DPC).

For the patients, the benefits are clear. They now make their own health care decisions, with the advice of their providers and full knowledge of what the costs will be.

Another Grand Fix for American Healthcare

This #Forbes article is actually pretty funny. Supposed to announce yet Another Grand Fix for the hot mess called #AmericanHealthcare.

You decide :

Plan A)Retrofit ”complex administrative operation of multiple networks and payers as well as the lack of standardization in information technology.”

Plan B) invent a model eliminating #administrativebloat and artificial #EHRmandates  and join the #DirectPrimaryCare -a #movement where everyone wins  #Doctors #Employees #Employers


According to JAMA, there is an estimated $1T of waste in the US healthcare system, making it the world’s most expensive health system per capita. One of the main sources of waste is the complex administrative operation of multiple #networks and #payers as well as the lack of standardization in #informationtechnology. Another major bucket is the unwarranted variation in #healthcare delivery, driven mostly by low-value care and over-treatment.

What does DPC Cover for free?

What does DPC Cover for free to little additional cost over membership fees of $50-95?

Think of most clinics like ice cream flavors. They’re all different dependent on their maturity. This will look more like a statewide offering in Colorado with #Nextera and others like them

But something like this

  • Acne,
  • Allergy Test,
  • Asthma test,
  • Blood Sugar Test (A1C)
  • Eczema, Psoriasis,
  • Ear Wax
  • Flu Shot
  • Incisions, Drainage
  • Laser – Acne, Veins, Scars
  • Lesion Removal
  • Sprains, Lacerations, Bone fracture
  • School & Sports Physicals
  • Biopsy
  • Sleep Hygiene + Apnea Tests
  • Stress Management
  • Testosterone
  • Toenail Removal
  • Ultrasound
  • Women’s Health
  • Weight Management
  • Well Checks

Acute Care Plans

Chronic Care Plans:

  • Cardiology
  • Mental Health
  • Diabetes, Prediabetes
  • Hypertension,
  • Pre-Hypertension
  • Asthma
  • COPD
  • Falls
  • Low Back

Direct Primary Care Act as an Ultimate Stimulus Plan?

How does #DirectPrimaryCare act as an ultimate stimulus package?

If you’re an employee picking up $8000 found money, formerly going to premiums that look like

  • $138,000 mortgage or
  • Eliminate Debt ( $8500 is ave cc debt ) or
  • $920,000 in a 401k (30 years)or
  • A great family vacation yearly

If you’re an employer saving $4.5m per 1000 employees

If Margins Are

10% = $45m in equivalent sales

5% =.  $90m “.     “

#Walmart has 1.6% margin so the $1b saved on #healthcare last year is like $96b in-newfound sales.

Ultimate Eco 101

DPC is the frictionless stimulus package with no

  • Coopted Pols
  • Regulators
  • Lobbyists
  • Pitchforks nor torches
  • Marches nor banners

In fact any flavor or combo of #directcontracting with #surgeons #imaging #meds #medicaltourism #VirtualPrimaryCare #onsiteclinics are all #buriedtreasure.