Electronic Health Reporter

By Zak Holdsworth, co-founder and CEO, Hint Health.

As physicians work to escape the fee-for-service hamster wheel in which they’re forced to practice medicine today, many are increasingly seeking out new and innovative business models that allow them to prioritize value over volume. This has led primary care practices across the country to rapidly transition to the most promising option available: Direct Primary Care (DPC).

Under this rapidly-growing business model, providers collect a monthly fee directly from their patients, or their employer sponsors, in exchange for a predetermined list of services. There are no guessing games, no copayments, no insurance claims submitted, and no third-party billing of any kind.

The vast majority of physicians adopting DPC are small- and medium-sized practices who are new to the experience of navigating direct-to-consumer models and customized employer plans, having in the past greatly relied on insurance plans for payments and new patients.

While there’s no magic wand to entirely eliminate the hurdles that appear through this transition, there are three benefits of emerging technology that can largely reduce the concerns that may have previously prevented physicians from considering DPC.

1. Creates an all-in-one command center

Physicians now have the ability to build a foundation specifically designed to support practices as they transition to a DPC business model, while simultaneously reducing the complexity of direct-to-consumer membership management and employer direct contracting. By automating and streamlining all of these new processes — allowing providers to more easily manage their billing, payments, and networking infrastructure — practices reduce manual work and reap even more benefits of the DPC model.

As physicians are freed up from the administrative side of membership management, they are able to focus their time and efforts on what’s most important to the success of their practice: their patients’ health. By implementing a well-rounded system that allows physicians to spend more time with patients instead of being tied up with tedious paperwork, we also eliminate one of the biggest challenges today to practicing good medicine.

2. Builds the infrastructure needed to help eliminate risk

One of the biggest barriers for physicians who are considering transitioning to a DPC model is the risk associated with no longer accepting insurance, or only accepting insurance for some services, which has typically been the biggest foundation of a practice’s revenue. Many physicians are burned out and change can be daunting. They want to know that DPC will work, and rightly so. This is where custom technology comes in – tech built specifically for each individual practice can address their exact needs, such as managing billing, adding new patients, and connecting them with new resources.

With DPC, there’s also an entire ecosystem of partners who can increase the potential population that physicians will have waiting once they make the switch, along with the tools that already exist to ensure a seamless way to securely handle member enrollment, employer plan administration, eligibility management, billing, invoicing, payments, collections, and much more.

With nearly every state across the country having at least one DPC practice, physicians who are interested in hearing from others who have transitioned to this business model need only to look to their neighbors.

3. Scales as practices evolve

Since most of the practices transitioning to DPC are small- or medium-sized, technology can help physicians succeed at all stages—whether they’re designing a business model, launching a practice or seeking to expand. The right technology infrastructure will grow alongside each practice without forcing the need to “rip and replace” the core system as they scale.

For Wild Health, which provides physicians easier access to building their own DPC practice by establishing a franchise model for the Wild Health brand, partnering with the right technology alleviated much of the complexity of multi-employer direct contracting (such as variations in contract terms, pricing arrangements, employment eligibility rules, and more). By choosing a solution with end-to-end automation that simplified employer relationships, Wild Health was able to scale faster and cheaper than before and triple their number of employer contracts within eight months. Additionally, one employer also shared that they were able to save 58 percent on monthly healthcare costs.

The Future of Care is Value-Based

As physicians increasingly move towards DPC to escape a system that lacks price transparency, uses perverse incentives, and presents a tremendous administrative burden, industry leaders must provide the tools and support to streamline the process. Doing so won’t just remove the monotonous administrative work that burdens physicians, but will further accelerate the industry’s shift to value-based care with the promise of a better experience for patients and providers alike, with reduced costs and improved health outcomes.