Case Studies: Direct Primary Care Pioneers

By Thomas Crocker
Monday, July 20, 2020

Direct primary care (DPC) offers physicians and patients an alternative to fee-for-service care involving third-party payers. Two physicians who have been immersed in DPC for years say it has allowed them to get back to the basics of medicine — and that patients’ response proves it is a force to be reckoned with.

Most DPC practices charge patients a monthly or annual membership fee that covers extensive access to a physician and a range of services, such as lab work, medication dispensing, urgent care, diagnostic services, minor procedures and health coaching. DPC practices do not accept insurance, but they may advise patients to purchase a policy covering services that fall outside their scope of care.

The American Academy of Family Physicians supports DPC, and DPC proponents argue that it enhances the physician/patient relationship, produces significant cost savings for patients and reduces overhead costs and administrative burdens for physicians. DPC does, however, have detractors. In a 2018 op-ed for STAT, Timothy Hoff, PhD, Professor of Management, Health Care Systems and Health Policy at Northeastern University, argued that DPC presents a number of problems, including inherent limitations on scalability.

Nevertheless, DPC seems to be growing more popular. From 2010 to 2020, the number of DPC practices in the U.S. surged from a handful to more than 1,000 and counting, according to Josh Umbehr, MD, family medicine physician and cofounder of Atlas MD in Wichita, Kansas, one of the first DPC practices. He believes the COVID-19 pandemic may contribute to further growth.

“Post-COVID-19, when many outpatient clinics have realized that insurance contracts are not the financial security blanket they thought they once were, I think we may see the direct care model become the standard for outpatient care in the U.S. and abroad,” he says.

The Trailblazer

Dr. Umbehr cofounded Atlas MD in 2010 two months after completing his residency. He discovered DPC — then largely known as concierge family medicine — after working in medical billing and coding for a plastic surgeon as an undergraduate. Disenchanted by that firsthand look at the complexities of insurance billing, Dr. Umbehr resolved to practice affordable, concierge-style medicine.

“The problem with fee-for-service care is that patients don’t know when they are going to need care, but when they need it, they want it now from someone they know and trust, and they are worried about the price,” Dr. Umbehr says. “All of those things are opposed to the fee-for-service model, which is why I think a lot of membership services, including Netflix and Amazon Prime, are so successful. People want maximum choice, but also maximum predictability in cost.”

With practically no other DPC practices to serve as guides, Atlas MD built a business model from the ground up. Ten years later, the practice is thriving, with two offices and five physicians, each of whom treats hundreds of patients. Monthly membership fees for adults range from $50 to $100, with patients receiving unlimited provider access, extended appointments, diagnostic and procedural benefits, and more. Members value the convenience, intimacy and cost-effectiveness of DPC, according to Dr. Umbehr, who says being a DPC physician benefits his physical and mental health by reducing or eliminating many of the factors that contribute to physician burnout.

Dr. Umbehr believes it is incumbent upon physicians to use innovative methods, such as DPC, to rein in healthcare costs.

“Physicians can take responsibility for the problems of high-cost health care, but we can also be responsible for the solution,” Dr. Umbehr says. “Insurance and government can’t fix it unless we show them a better way.”

The Second-Generation Innovator

M. Chad Williamson, MD, CEO of Alabama-based DeKalb MD, is one of 800 physicians that Dr. Umbehr and Atlas MD have helped transition to DPC. Like Dr. Umbehr, Dr. Williamson realized early that he wanted to practice medicine free of the administrative, cost and scheduling limitations of the fee-for-service model. Extensive research and a visit to Atlas MD convinced Dr. Williamson to get into DPC. He started his practice — the first of its kind in Alabama — right after residency, in 2016.

“What most drew me to DPC is that it brings back transparency in medicine,” Dr. Williamson says. “We lost the true cost of medicine, to the point that people wouldn’t take care of basic things because of the unknown cost. At DeKalb MD, we love telling patients, ‘This is what a service costs, these are your options and I’m an advocate for you.’”

DeKalb MD features six clinics in Alabama, and two each in Tennessee and Georgia. Its approximately 3,200 members pay a $60 monthly fee for primary care, urgent care, medication dispensing, lab tests, access to a fitness center and more.

“Patients can call or text us, wait less than five minutes for a scheduled appointment and then spend more than an hour with their provider,” Dr. Williamson says. “It’s better customer service, which has been lacking in health care for so long. I think DPC makes me a better physician.”