In recent years, Direct Primary Care (DPC) has been the most talked-about and innovative healthcare delivery model in the United States. At the Hint Summit in Denver this week, DPC clinicians, business leaders and technology experts came together to share ideas. The excitement and energy were palpable.
I had the opportunity to deliver the opening keynote address and my remarks centered on two main points:
- DPC is leading the way
- Keep striving for more
As a major proponent of primary care—and as a leader in a healthcare system plagued by dysfunction—I believe in the immense power of the doctor-patient relationship and the potential for the DPC model to transform healthcare in this country.
In fact, in 2017, I wrote a bestselling book called “Mistreated: Why We Think We’re Getting Good Healthcare—and Why We’re Usually Wrong,” which laid out the Four Pillars of Healthcare Transformation. As I spoke in Denver about this still-developing field, I assured the audience that DPC is already capitalizing on all four pillars. But I noted there is much left to accomplish in all four areas, as well.
Getting there will require both a meaningful shift in physician culture and a willingness to abandon the parts of the healthcare system that no longer serve doctors or patients well.
DPC & The Four Pillars Of Healthcare Transformation
1. Integration
DPC makes a broad range of clinical services available to patients. Some practices offer 24/7 telemedicine, onsite pharmacies, X-rays and laboratories. Others bring in experts from a wide-range of specialties, including dermatology, mental health and nutrition.
But I called on attendees at the conference to think bigger in terms of integration. If care were integrated both horizontally within specialties and vertically across primary, specialty, and diagnostic care, the quality of medical services would improve, costs would come down (thanks to greater efficiencies) and primary care physicians would be situated to oversee the totality of patient treatment.
2. Prepayment
Hint Health, the summit’s host and creator of EHR-integrated membership management & billing software, sells products and services designed to help doctors “escape fee-for-service hell.” That is, after all, an essential component of DPC. In this model, practices charge a flat, recurring fee instead of billing insurance for each new test and treatment.
Unlike with fee-for-service (FFS), DPC doctors do better, financially, when their patients do better, medically. However, escaping the old payment model entirely is no easy task in a country where more than 95% of physician visits are paid fee-for-service. The more you do, the more you get paid. In U.S. healthcare, whether it adds any value is irrelevant.
3. Technology
Doctors in a prepaid model don’t need to surround themselves with fancy gadgets and multimillion-dollar machinery that—studies confirm—hardly (if at all) move the needle on patient outcomes. Although many forms of med-tech today boost the status and ego of the doctors using them (see: surgical robots), there is one kind of technology that greatly benefits patients and physicians, particularly those providing Direct Primary Care. It’s the kind that improves health, lowers costs and increases access to care.
Telehealth, as I recently wrote for Harvard Business Review, has tremendous potential to eliminate the current barriers of time and distance in medicine. It can bring doctors and patients together any time of day and from anywhere, and with an ability to solve 30-40% of all patient problems while significantly reducing unnecessary ER and hospital visits. This, along with a well-functioning EHR system, allows doctors to connect both with each other and with patients in ways that live up to the higher purpose of medicine.
4. Leadership
Disruption in healthcare is inevitable, but whether transformation is led by primary care clinicians or business executives remains to be seen. This is why it is essential for DPC doctors to bolster their leadership capabilities. Although many successful health systems are managed by business- and finance-trained administrators, only physicians understand what it means to take care of patients. This gives clinicians a distinct advantage over business leaders in our industry.
When I led The Permanente Medical Group, I made it a mission to provide our doctors with extensive training and development opportunities in everything from healthcare finance and data analytics to information technology and core leadership skills.
At the Hint Summit, it was inspiring to see so many physicians, nurses, physician assistants and nurse practitioners in the audience committed to learning these skills and applying them to Direct Primary Care.
But we need a lot more of them if we are going to transform the U.S. system from where it is now to where it can be: a healthcare system that is once again the best in the world.
Many thanks to Hint Health CEO and Co-founder Zak Holdsworth, a product of the Stanford Graduate School of Business where I teach, for inviting me to speak. Thanks also to expert event coordinators Dani Henderson and LynAnn Henderson with whom I’ve worked before, and to the entire team behind this week’s summit. It was a fabulous and flawless event.
Photo credit: Colin Hung (via Twitter @Colin_Hung)
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Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s a Forbes contributor, bestselling author, Stanford University professor, and host of two healthcare podcasts. Pearl’s newest book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients,” is available now. All profits from the book go to Doctors Without Borders.
